Scribd
Upload
11 views

Infertility

Infertility.

Uploaded by

Bright Kumwenda
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPT, PDF, TXT or read online on Scribd
11 views

Infertility

Infertility.

Uploaded by

Bright Kumwenda
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPT, PDF, TXT or read online on Scribd
You are on page 1/ 51

The McCoughey Septuplets

Infertility 101
Definitions
Under 35 yo No conception after one
year of unprotected
intercourse
Over 35 yo No conception after 6
months of unprotected
intercourse
Your Infertility Patient. . .
34 yo woman presents to your
clinic to discuss her concerns
about infertility
Psychosocial Issues
 Expectations
 Stress on Relationships
 Stress on Finances
 Alternatives- Adoption or Childless
 Counseling, Support Groups
Etiologies
 Male Factor 40%
 Tubal Factor 40%
 Ovulation Problem 10%
 Unexplained 10%
Start with History. . .
What Clues Can You Find on History?

 Male Factor

 Tubal Factor

 Ovulation
Semen Analysis
Normal values:
Volume 2-5cc
Count >20 million
Motility >50%
Morphology >50% normal
(strict criteria >15%)
Male Factor Infertility

Evaluation:
Repeat semen analysis
Physical exam- varicocele, testicular size
Lab testing- testosterone, FSH, LH
Genetics for special cases

IUI (intrauterine insemination)


ICSI (intracytoplasmic sperm injection)
Donor sperm
Etiologies

 Male Factor 40%


 Tubal Factor 40%
 Ovulation Problem 10%
 Unexplained 10%
Hysterosalpingogram
HSG: Unilateral Blocked Tube
HSG: Tubal Infertility
HSG: Hydrosalpinx
HSG of DES daughter
Etiologies
 Male Factor 40%
 Tubal Factor 40%
 Ovulation Problem 10%
 Unexplained 10%
Ovulation Physiology
 The LH (lutenizing hormone) surge occurs
34-36 hours prior to follicle rupture
 Progesterone is increasingly produced after
the LH surge
 Secretory changes to the endometrium
occur secondary to the increased
progesterone levels
Ovulation Predictor Kits
Salivary Estrogen: TCI
Ovulation Tester- 92% accurate
Add Saliva Sample
Non-Ovulatory Saliva
Pattern
High Estrogen/ Ovulatory
Saliva Pattern
Approach to Ovulation Disorders
 Evaluate- Hypothyroidism
Prolactin Disorder
Hyperandrogenism-
PCOS Weight loss/
weight gain
 Induce Ovulation
Clomid (clomiphene
citrate)
Traditional Infertility Evaluation
1) Semen Analysis
2) Hysterosalpingogram (HSG)
3) Documentation of Ovulation

4) Post-coital Exam
5) Diagnostic Laparoscopy
Current Infertility Evalution
1) Semen Analysis
2) Hysterosalpingogram (HSG)
3) Documentation of Ovulation
4) Ovarian Reserve Testing
Ovarian Reserve Testing
Day #3 FSH (<10 mIU/ml) and estradiol (<80 pg/ml)
-Correlates with the functional status of the
ovaries and the quality of the oocytes
- FSH >15 only 5% success with IVF
- High estradiol level increases risk of
cancelling IVF cycle
Unexplained Infertility
 12-15% of couples
 3% chance of achieving a pregnancy
 Treatment:
Superovulate with IUI
(intrauterine insemination)-
Clomid 12% success
Pergonal 16%
IVF
Infertility?
Infertility

Lin jianhua

24/11/23 32
Definition
 defined as not being able to get
pregnant despite trying for one year.
 10 percent of couples are affected

 Primary infertility: never conceived


 Secondary infertility: at least one
previous pregnancy

24/11/23 33
Pregnancy is the result of a chain of events.

 A woman must release an egg from one of her


ovaries (ovulation).
 The egg must travel through a fallopian tube
toward her uterus (womb).
 A man's sperm must join with (fertilize) the
egg along the way.
 The fertilized egg must then become attached
to the inside of the uterus.
24/11/23 34
Causes
The incidence of male factors and female
factor infertility are similar

 Ovary factor 25% (anovulation)


 Tubal and pelvic factor 25 ％
 Uterine factor<5%
 Cervical factor <5%
 Male factor 30%
 Unexplained infertility 15%

24/11/23 35
Ovulatory factor
 Ovulatory disfunction
 Anovulatory
 Amenorrhea

Investigated as follow by means of


 Mid-luteal (day 21-23)progesterone in serum
 Endometrium biopsy at the end of a cycle
 BBT(basal body temperature)
 Mid-cycle LH surge in urinary
 Blood test: LH, FSH, prolactin, thyroid function,
androgen
 *ultrasound
24/11/23 36
Anatomical factor:
 Tubal disease following pelvic
inflammatory disease(PID)

 Intraperitoneal
scarring(PID,endometriosis)

24/11/23 37
Uterine factor:

 Polyps
 Submucosal fibroids
 Endometrial scarring

24/11/23 38
Cervical factors:
 By mid-cycle(day 13-15)
 ample clear watery mucus with good
stretchability is produced
 Be favorable to sperm survival

 Abnormal cervical factor may relate to


 poor cycle timing,
 poor mucus production (surgery,inflammation)
 an abnormal male factor

24/11/23 39
Male factor:
 semen analysis
 Volume 1.5-5.0ml
 Count>20 million/ml. 40X10 6/total
 Initial motility(<1 hour)50%
 Normal Morphogy>30%
 No clumping or significant WBC(<1 million/ml)

 Information on coital frequency and ejaculatory


difficulty should be sought
24/11/23 40
The step of test
The assessment of both partners should begin
simultaneously
 History
 Physical examination
 Ovulation detection(menstrual history,BBT,serium
progesterine,urinary LH,serial ultrasound)
 Evaluation of tubal patency (Hysterosalpingogram, HSG,
Laparoscopy)
 Evaluation of uterine cavity (HSG, Hysteroscopy)
 Cervical factor (postcoital testing, PCT)
24/11/23 41
 Male infertility factor
 unexplained infertility

24/11/23 42
treatment
 Depending on the test results, different treatments can be
suggested
 Various fertility drugs may be used for women with
ovulation problems.
 should understand the drug's benefits and side effects.

Ovulation induction:
 Clomiphene
 HMG(human manopausal gonadotropin)
 FSH(follical stimulating hormone)
 HCG(human chorionic gonadotropin)
24/11/23 43
 surgery can be done to repair
damage to a woman's ovaries,
fallopian tubes, or uterus.

24/11/23 44
Assisted reproductive technology (ART)

 uses special methods to help infertile couples.


 ART involves handling both the woman's eggs and
the man's sperm.

 Success rates vary and depend on many factors.

 ART can be expensive and time-consuming. But


ART has made it possible for many couples to have
children that otherwise would not have been
conceived.
24/11/23 45
 Intrauterine insemination

 Artificial insemination with husband’s


sperm (AIH)

 Artificial insemination by donor (AID)

24/11/23 46
 IVF(in vitro fertilization)
 1978 birth of Louise Brown, the world's first "test tube
baby”.
 used when a woman's fallopian tubes are blocked or when
a man has low sperm counts.
 A drug is used to stimulate the ovaries to produce multiple
eggs.
 Once mature, the eggs are removed and placed in a culture
dish with the man's sperm for fertilization.
 After about 40 hours, the eggs are examined to see if they
have become fertilized by the sperm and are dividing into
cells.
 these fertilized eggs (embryos) are then placed in the
woman's uterus

24/11/23 47
 Gamete intrafallopian transfer
(GIFT):
 is similar to IVF, but used when the
woman has at least one normal
fallopian tube.
 Three to five eggs are placed in the
fallopian tube, along with the man's
sperm, for fertilization inside the
woman's body.
24/11/23 48
 Zygote intrafallopian transfer
(ZIFT),
 ICSI (intracytoplasmic sperm
injection)

24/11/23 49
 ART procedures sometimes involve
the use of donor eggs (eggs from
another woman) or previously frozen
embryos.

 Donor eggs may be used if a woman


has impaired ovaries or has a genetic
disease that could be passed on to her
baby.

24/11/23 50
Key Word
 Infertility
 Ovulation induction
 ART
 IVF
 What are the causes of infertility?
 Explaining the steps of infertility
test.

24/11/23 51

You might also like

pFad - Phonifier reborn

Pfad - The Proxy pFad of © 2024 Garber Painting. All rights reserved.

Note: This service is not intended for secure transactions such as banking, social media, email, or purchasing. Use at your own risk. We assume no liability whatsoever for broken pages.


Alternative Proxies:

Alternative Proxy

pFad Proxy

pFad v3 Proxy

pFad v4 Proxy