[Female sterility].

Abstract

Recent progress in female sterility of Japanese women is reported in this study. The causes of sterility in the female side, the most popular sterile factor is a tubal factor due to the increase of the endometriosis and pelvic inflammatory disease. The main treatment of the tubal factor is an IVF-ET technique. The ovulatory disturbances occupy the second position of the female sterile factor. The precise endocrinological examinations must be done for the diagnosis of the ovulatory disturbances. In case of the hypergonadotropic hypogonadism, the ovulation induction is almost impossible. Generally, clomiphene citrate is used for moderate hypothalamic anovulations, and bromocriptine or terguride is for prolactin related diseases (hyperprolactinemia, occult hyperprolactinemia, galactorrhea) and endocrinological PCO (LH/FSH > 1) in the beginning. If these treatments are not effective, hMG-hCG therapy will be performed. During hMG-hCG therapy, we must take care for the occurrence of the ovarian hyperstimulation syndrome. For the treatment toward the cervical factor, the artificial insemination with husband semen will be done, however, if it is not effective, IVF-ET must be performed. For the uterine factor (such as after hysterectomy state, adhesion of uterine cavity, etc.) surrogate mothers are hired in some foreign countries, however, it is prohibited in Japan. If patients have anti-phospholipid antibodies, low dose aspirin and/or heparin administration will be done for the treatment of infertility. Recently, the assisted reproductive technology (ART) have made much progress. IVF-ET is performed widely in Japan. Cryopreservation of the fertilized ovum and intracytoplasmic sperm injection (ICSI) are also performed. However, the legal and ethical problems are occurring, and much discussion must be done for the acceptance of such new technologies.