SEYED MORTEZA MAHMOODI
 Definition
 Fertility
 Fecundity
 Fecundability
 Incidence
 Prevalance
FEMALE
MALE
COMBINED
UNKNOWN
 Cervical factor infertility
 Uterine factor infertility
 Ovarian factor infertility
 Tubal factors
 Peritoneal facto...
 5%-10%
 Stenosis , chronic cervicitis
 Abnormalities of the mucus-sperm
interaction
 Surgical procedures, infections,...
 PCT, Sims-Huhner
 Speculum examination, 1-2 mm probe
 IUI
 2%-5%
 Congenital
 Acquired
 Environmental and occupational
 Toxins
 Exercise
 Inadequate diet
 previous pregnancies and their outcomes
 frequency of intercourse, use of lubricants (eg, K-Y gel) that could be
spermi...
 Vitals
 height and weight to calculate the body mass
index,
 Perform an eye examination
 The presence of epicanthus, ...
 A thorough gynecologic examination should include an
evaluation of hair distribution, clitoris size, Bartholin
glands, l...
 Postcoital test (PCT), Sims-Huhner test
 speculum examination
 HSG
 US
 Saline infusion sonography
 MRI
 Hysterosc...
 Laparoscopy
 Ovulation
 Progesterone greater than 4 ng/mL
 Sonographic confirmation of follicle rupture with
serial u...
Single line
Late menstrual endometrium
Thick proliferative
endometrium
Thick secretory
endometrium
Posterior enhancement
T...
 Semen analysis
 Volume - 2-5 mL
 pH level - 7.2-7.8
 Sperm concentration - 20 million or greater
 Motility - 50%, fo...
 Ovulation predictors
 Conception cap
 Semen collectors
 Collection condoms are sterile and made
from silicone or poly...
In vitro fertilisation (IVF)
&
Embryo transfer(ET)
Involves:-
1. Retrieval of pre-ovulatory oocytes from the woman.
2. In ...
1. Ovarian follicles stimulated
2. Mature oocytes aspirated at laproscopy
3. Oocytes placed in a petri dish to culture wit...
•In vivo fertilization occur within 12 hours
after ovulation
•In vitro fertilization is not possible after
24 hours.
•Most...
Complications
•Increased risk of multiple gestations,
•Spontaneous abortions
•High incidence of chromosomal and cellular
a...
Procedure
Prior to any GIFT, IVF, or ICSI procedure, the woman
receives hormones to stimulate development of the
ovarian f...
Approximately three hours before the procedure, a semen sample from the
husband is obtained.
The sperm is washed and prepa...
Sperm and ova are sequentially loaded into the catheter, which is then introduced
into the patient's fallopian tube throug...
2 cell stage 4 cell stage
6-8 cell stage
Morula
Just prior to beginning the hatching process on an 8-cell embryo
Assisted Hatching
Hatching a high quality 8-cell embryo
A small opening is being made in the embryo's shell (zona pellucida)
The needle has been further advanced through the embryo's shell
A gap in the shell is developing
A gap in the zona has been created
The oolemma (egg membrane) is bulging and about to "pop"
A blastocyst starting to hatch from its shell - lower right of photo
After hatching, the embryo can implant in the uterine...
Intracytoplasmic sperm injection (ICSI)
The injection of the sperm into the oocyte
Process of supplementation of sperm fer...
Procedure:
The sperm will be injected into the oocyte cytoplasm using
apparatus called micromanipulator
Under microscope c...
About to inject the egg with a sperm
Holding pipette on left
ICSI needle on right
Sperm head visible in needle at far righ...
Needle is advanced to the left
Shell of embryo has already been penetrated by needle
Membrane of egg (oolemma) is stretchi...
ICSI needle has penetrated the egg membrane
A single sperm is being injected into the cytoplasm of the egg
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Infertility

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Transcript of "Infertility"

  1. 1. SEYED MORTEZA MAHMOODI
  2. 2.  Definition  Fertility  Fecundity  Fecundability  Incidence  Prevalance
  3. 3. FEMALE MALE COMBINED UNKNOWN
  4. 4.  Cervical factor infertility  Uterine factor infertility  Ovarian factor infertility  Tubal factors  Peritoneal factors  Advanced Age
  5. 5.  5%-10%  Stenosis , chronic cervicitis  Abnormalities of the mucus-sperm interaction  Surgical procedures, infections, hypoestrogenism, and radiation therapy
  6. 6.  PCT, Sims-Huhner  Speculum examination, 1-2 mm probe  IUI
  7. 7.  2%-5%  Congenital  Acquired
  8. 8.  Environmental and occupational  Toxins  Exercise  Inadequate diet
  9. 9.  previous pregnancies and their outcomes  frequency of intercourse, use of lubricants (eg, K-Y gel) that could be spermicidal, use of vaginal douches after intercourse, and the presence of any sexual dysfunction such as anorgasmia or dyspareunia.  menstrual history, frequency, and patterns since menarche. A history of weight changes, hirsutism, frontal balding, and acne should also be addressed.  Ask male patients about previous semen analysis results, history of impotence, premature ejaculation, change in libido, history of testicular trauma, previous relationships, history of any previous pregnancy, and the existence of offspring from previous partners.  history of sexually transmitted diseases (STDs); surgical contraception lifestyle; consumption of alcohol, tobacco, and recreational occupation; and physical activities.  Ask the couple whether they are currently under medical treatment, the reason, and whether they have a history of allergies.  A complete review of systems may be helpful to identify any endocrinological or immunological problem that may be associated with infertility.
  10. 10.  Vitals  height and weight to calculate the body mass index,  Perform an eye examination  The presence of epicanthus, lower implantation of the ears and hairline, and webbed neck  gland enlargement or thyroid nodules  Perform a breast examination galactorrhea. menstrual cycles.  Abnormal masses
  11. 11.  A thorough gynecologic examination should include an evaluation of hair distribution, clitoris size, Bartholin glands, labia majora and minora, and any condylomata acuminatum or other lesions that could indicate the existence of venereal disease.  Bimanual examination should be performed to establish the direction of the cervix and the size and position of the uterus to exclude the presence of uterine fibroids, adnexal masses, tenderness, or pelvic nodules indicative of infection or endometriosis.  The examination of the extremities is important to rule out malformation, such as shortness of the fourth finger or cubitus valgus, which can be associated with chromosomal abnormalities and other congenital defects. Examine the skin to establish the presence of acne, hypertrichosis, and hirsutism.
  12. 12.  Postcoital test (PCT), Sims-Huhner test  speculum examination  HSG  US  Saline infusion sonography  MRI  Hysteroscopy  Endometrial biopsy
  13. 13.  Laparoscopy  Ovulation  Progesterone greater than 4 ng/mL  Sonographic confirmation of follicle rupture with serial ultrasonography can also be performed.  Basal body temperature charts prefer to use urinary ovulation predictor kits as they are more accurate and easier to administer  Ovarian reserve
  14. 14. Single line Late menstrual endometrium Thick proliferative endometrium Thick secretory endometrium Posterior enhancement The uterine lining changes throughout the normal menstrual cycle
  15. 15.  Semen analysis  Volume - 2-5 mL  pH level - 7.2-7.8  Sperm concentration - 20 million or greater  Motility - 50%, forward progression  Morphology - Normal sperm (>4%)  White blood cells - Fewer than 1 million cells/µL  Sperm function test  the acrosome reaction test  computer assessment of the sperm head,  computer motility assessment  hamster penetration test  human sperm-zona penetration assay
  16. 16.  Ovulation predictors  Conception cap  Semen collectors  Collection condoms are sterile and made from silicone or polyurethane, as latex is somewhat harmful to sperm. Semen can also be collected by masturbation into a sterile container, such as a specimen cup.
  17. 17. In vitro fertilisation (IVF) & Embryo transfer(ET) Involves:- 1. Retrieval of pre-ovulatory oocytes from the woman. 2. In vitro fertilization by sperm. 3. Culture to 8 or 16 cell stage. 4. Transfer to the uterus.
  18. 18. 1. Ovarian follicles stimulated 2. Mature oocytes aspirated at laproscopy 3. Oocytes placed in a petri dish to culture with capacitated sperms. 4. Cleavage monitored in fertilized egg till 6-8 cell stage 5. Embryo transferred into vagina and cervical canal
  19. 19. •In vivo fertilization occur within 12 hours after ovulation •In vitro fertilization is not possible after 24 hours. •Most human sperms do not survive for more than 48 hours in the female genital tract
  20. 20. Complications •Increased risk of multiple gestations, •Spontaneous abortions •High incidence of chromosomal and cellular abnormalities Advantages Long periods of preservation of blastocysts and embryos
  21. 21. Procedure Prior to any GIFT, IVF, or ICSI procedure, the woman receives hormones to stimulate development of the ovarian follicles. The fluid containing the ova is placed in a laboratory dish and observed under a microscope. The ovum is located and its stage of maturity noted. It is then carefully cultured in a special nutrient.
  22. 22. Approximately three hours before the procedure, a semen sample from the husband is obtained. The sperm is washed and prepared for loading into the same catheter into which several of the wife's ova will be placed. The ova are obtained by transvaginal needle aspiration (no surgical incision) via an ultrasound guide.
  23. 23. Sperm and ova are sequentially loaded into the catheter, which is then introduced into the patient's fallopian tube through a tiny incision in her abdomen. GAMETE INTRAFALLOPIANTRANSFER
  24. 24. 2 cell stage 4 cell stage 6-8 cell stage Morula
  25. 25. Just prior to beginning the hatching process on an 8-cell embryo Assisted Hatching
  26. 26. Hatching a high quality 8-cell embryo A small opening is being made in the embryo's shell (zona pellucida)
  27. 27. The needle has been further advanced through the embryo's shell A gap in the shell is developing
  28. 28. A gap in the zona has been created The oolemma (egg membrane) is bulging and about to "pop"
  29. 29. A blastocyst starting to hatch from its shell - lower right of photo After hatching, the embryo can implant in the uterine lining Photo taken a few minutes prior to EmbryoTransfer
  30. 30. Intracytoplasmic sperm injection (ICSI) The injection of the sperm into the oocyte Process of supplementation of sperm fertilization potential by the direct transport of the sperm into the oocyte is termed ICSI Indications: Non satisfactory sperm motility Loss of acrosome Sperm immaturity Presence of antisperm antibodies in the woman.
  31. 31. Procedure: The sperm will be injected into the oocyte cytoplasm using apparatus called micromanipulator Under microscope control the oocyte will be moderately vacuum held and using an injection pipette of the diameter of 5 micrometers, the direct transport of the sperm into the oocyte is performed. 1. Oocyte holder 2. Spermatozoon expulsed from the capillary 3. Mature oocyte with the polar body 4. Injection capilary
  32. 32. About to inject the egg with a sperm Holding pipette on left ICSI needle on right Sperm head visible in needle at far right, just below X Polar body of egg at 7 o'clock
  33. 33. Needle is advanced to the left Shell of embryo has already been penetrated by needle Membrane of egg (oolemma) is stretching and is about to break Sperm head is visible at tip of needle
  34. 34. ICSI needle has penetrated the egg membrane A single sperm is being injected into the cytoplasm of the egg
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