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Infertility Infertility Presentation Transcript

  • Infertility
  • 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
    • 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.
  • 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%
    • 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
    • Anatomical factor:
    • Tubal disease following pelvic inflammatory disease(PID)
    • Intraperitoneal scarring(PID,endometriosis)
    • Uterine factor:
    • Polyps
    • Submucosal fibroids
    • Endometrial scarring
    • 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
    • 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
  • 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)
    • Male infertility factor
    • unexplained infertility
  • 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)
    • surgery can be done to repair damage to a woman's ovaries, fallopian tubes, or uterus.
    • 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.
    • Intrauterine insemination
    • Artificial insemination with husband’s sperm (AIH)
    • Artificial insemination by donor (AID)
    • IVF(in vitro fertilization)
    • 1978 birth of Louise Brown, the world's first &quot;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
    • 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.
    • Zygote intrafallopian transfer (ZIFT),
    • ICSI (intracytoplasmic sperm injection)
    • 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.
  • Key Word
    • Infertility
    • Ovulation induction
    • ART
    • IVF
    • What are the causes of infertility?
    • Explaining the steps of infertility test.