الفهرس 
Introduction
Chapter 1: Aetiology of InfertilityOnly 14 pages are availabe for public view
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Abstract
Infertility is defined as one year of unprotected coitus without conception. It affects approximately 10-15% of couples in the reproductive age group which makes it an important component of the practices of many physicians.
There has been a recent increase in the number of infertility cases reported throughout the world. A review of literature reveals that 60 to 80 million couples experience infertility worldwide and about 2 million couples (15%) in the United States, wherein infection is the major cause. Regions with high infection rates with human immunodeficiency virus (HIV) also show a high incidence of post infectious infertility. Around the world, infertility represents a major health and social problem. For women in many developing countries, the inability to have children can result in stigmatization and abandonment by their husbands. The highest rates of infertility in the world occur in sub-Saharan Africa--ranging from 10-21%. These high rates of infertility can partly be attributed to high rates of sexually transmitted infections (STIs) and complications of delivery or unsafe abortions.
Aims of the study:
1-to detect the laparoscopic findings in patients diagnosed as unexplained infertility.
2- To compare the prevalence of organisms like Chlamydia, Mycoplasma and Ureaplasma urealyticum obtained by endocervical swabs in both patients with unexplained infertility and fertile patients.
Materials and Methods:
This study will include patients at the childbearing age with unexplained infertility attending the Infertility outpatient clinic of the Woman’s Health Hospital, Asyut University. However it is primary or secondary infertility.
These cases will be evaluated according to The Practice Committee of the American Society for Reproductive Medicine (ASRM), semen analysis of the husband, ultrasonic assessment of ovulation and a hysterosalpingogram. When the results of the standard infertility evaluation are normal, it is diagnosed as unexplained infertility.
The patient will be put in lithotomy position where an unlubricated vaginal Casco speculum will be inserted under good light, and then an endocervical swab will be taken and sent to bacteriology department. The study group had a diagnostic laparoscopy as well.
Sample size
100 cases divided into two groups
A- Patients with unexplained infertility 50 cases
B- Control group (known fertile group) 50 cases
Exclusion criteria:
1) Other causes of infertility.
2) The use of vaginal douches prior to the procedure
Data collection and analysis
The data will be collected and entered on Microsoft access data base to be analyzed using the Statistical Package for Social Science (SPSS Inc., Chicago, version 16). Comparisons between the groups will be done using Chi square test as a test of significance. For analysis P<0.05 will be considered significant.
Results:
The study was carried out on 100 patients including 50 cases and 50 patients with known fertility. the mean age of the study group was 28.9 years and the mean age of the control group was 32.9 years .Mycoplasma was detected in 24% in the the study and 8% of control group. The difference was statistically significant (p value =0.029).Chlamydia was detected in 18% in the the study group and 6% in the control group. The difference was statistically insignificant (p value >0.05).Ureaplasma Urealyticum was detected in 4% of the study group and in 2% of the control group .the difference was statistically insignificant (p value >0.05).Proteus Mirabilis was detected in 10% of the study group. the difference between the study and control group was statistically significant ( p value =0.022).
Regarding the laparoscopic finding in the study group, 60% of the cases showed normal laparoscopic finding. Peritubal adhesions were found in 16% of cases followed by tubal block which was found in 10% of cases. Endometriosis was found in 10% of cases. Tubal stricture was found in 2% of cases while fimbrial agglutinations found in 2% of cases.
Conclusion:
We found no significant statistical difference between patients with unexplained infertility and the fertile group regarding Chlamidya and Ureaplasma, but there was a statistically significant difference regarding Proteus mirabilis and Mycoplasma Hominis.