Although it has more than one year without using contraception mating, as much as approximately 7% of couples do not get a descent. Various means have been taken, ranging from simple to the in vitro fertilization (IVF) and intra-sitoplama sperm injection (SSIS / ICCI), but still have not got pregnant. Apparently many molecular biological processes is still unknown and still takes a long time to learn it. Nidasi and trophoblast invasion in the early embryo growth, influenced by various factors such as paracrine hormone fluctuations, local tissue reactions occurring within the trophoblast and desidu, as well as the role of metalloproteinases and adhesive proteins. All of these factors are only found in the tissue and the levels in the serum can not be checked. Therefore, to look for causes of infertility are forced to use conventional methods, which can also help some women.
History is still a good way to look for causes of infertility in women. Many important factors associated with infertility can be asked to the patient.
Age of patients is very important to know, because with increasing age, the more difficult to get the child. Difficulty in getting a child not because the woman has become old, but more due to the reduced quality of the woman's egg cell. When done egg donation, for example in a menopausal woman, the woman would get pregnant and her pregnancy is progressing well. This suggests that instead of the uterus that causes women to not be pregnant but the ability of the woman's egg to be fertilized has been reduced
Theoretically, as long as the ovaries are normal, then it is likely to become pregnant is always there. Therefore do not occasionally say About a woman aged 40 years might not be pregnant. Pregnancy is possible, but likely not so great. By act of IVF did not give satisfactory results.
History of disease, or previous surgery can provide information about the causes of infertility. History of previous diseases such as appendicitis, peritonitis, salpingitis can cause abnormalities in the tube. In the anamnesis should also ask whether the patient is suffering from diseases such as hypothyroidism, hyperthyroidism, pituitary disease, and suprarenal, yagn DAPT cause infertility. Diabetes is also one of the causes of infertility.
Weight loss and changes in body weight (too fat, too skinny) will affect the treatment of infertility. Subcutaneous fat contain the aromatase enzyme, so that androgen is converted to estrogen. High estrogen to suppress FSH and LH expenditure. Moreover, high estrogen increases LH secretion. High LH suppresses the activity of the enzyme aromatase that androgens can not be converted into estrogen. In obese women often found insulin resistant. Insulin triggers the consistency of DHEA in the suprarenal, resulting in hyperandrogenaemia. Androgen levels in follicular fluid and serum in high and this causes the follicle atresia. Keep in mind also that DHEA is a precursor that is used to mensistensis other types of steroid hormones (estrogen, progesterone, and androgens).
Leptin cells suppress the production of neuropeptide Y in the hypothalamus. Usually, this neuropeptide reduces hunger. Because leptin in obese women suppress the production of neuropeptide Y, then the patient will always feel hungry, so the porch body will continue to grow. Leptin also triggers the FSH and LH. High LH levels of androgens to estrogens inhibit change and naturally rapid increase in androgen levels. Emaciation due to chronic malnutrition does not cause the formation of fat and leptin, so there is no expenditure of FSH and LH stimulation. The result is anovulation until amenorrhoea. Therefore, the regulation of body weight is extremely important in the treatment of female infertility.
With a history can also be known endokrinologik abnormalities. Presence of hirsutism, acne, or seborrheic indicates hyperandrogenaemia, or abnormalities in the thyroid gland function. The discovery of galactorrhea is a sign of hyperprolactinemia.
There should also note the pattern of life of patients with infertility. Alcohol, for example, can inhibit the action of the enzyme sulfatase and aromatase enzyme, resulting in interference with the hormonal system. Nicotine reduces blood flow and accelerate the destruction of genitalia tool hormones. Stress is also a causative factor for difficulty having children. Stress triggers the corticotropin releasing factor (CRF). CRF expenditure suppress LH and GH and triggers the pro-opiomelanocortin (POMC) in pituitary cells kortikotrop front. Intermedia in the pituitary, POMC this will be resolved into two parts, namely lipoprotein and endorphin. Endorphin has antigonadotrop effect and is a dopamine antagonist. In people who use marijuana frequently found morphine or menstrual disorders.
Disorders of sexual relations can cause infertility, such as incomplete penetration into the vagina, very rarely have sex, or vaginismus. Nowadays women often washes her intimate organs and the surrounding area with antiseptic fluids. This habit can cause changes in cervical mucus which becomes inhospitable to sperm. In the vagina there are various types of microorganisms. These microorganisms keep the vagina is acidic, so it serves to protect the vagina from infection. Microorganisms are also known as "good" bacteria. Cleaning the sex organs with antiseptic fluids it will cause the bacteria are "good" is dead, will cause the bacteria are "bad" breed. Using deodorant perfumes in sex organs also made a "good" bacteria die. It should be encouraged to use underwear made of cotton, and do not use the pants are too tight, so as not to cause a feeling wet all the time.