ppt on infertility by ROBEL


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  • Female Factors: 35% Unexplained: 28% Male Factors: 24% Other: 13% Some sources list female factors as high as 50% Female Factors Breakdown: Ovarian Dysfunction: 21% Tubal Factors: 14%
  • Many of the risk factors for both male and female infertility are the same. They include: Age. After about age 32, a woman's fertility potential gradually declines. Infertility in older women may be due to a higher rate of chromosomal abnormalities that occur in the eggs as they age. Older women are also more likely to have health problems that may interfere with fertility. The risk of miscarriage also increases with a woman's age. A gradual decline in fertility is possible in men older than 35. Tobacco smoking. Men and women who smoke tobacco may reduce their chances of becoming pregnant and reduce the possible benefit of fertility treatment. Miscarriages are more frequent in women who smoke. Alcohol use. For women, there's no safe level of alcohol use during conception or pregnancy. Moderate alcohol use does not appear to decrease male fertility. Being overweight. Among American women, infertility often is due to a sedentary lifestyle and being overweight. Being underweight. Women at risk include those with eating disorders, such as anorexia nervosa or bulimia, and women following a very low-calorie or restrictive diet. Strict vegetarians also may experience infertility problems due to a lack of important nutrients such as vitamin B-12, zinc, iron and folic acid. Too much exercise. In some studies, exercising more than seven hours a week has been associated with ovulation problems. Strenuous exercise may also affect success of in vitro fertilization. On the other hand, not enough exercise can contribute to obesity, which also increases infertility. Caffeine intake. Studies are mixed on whether drinking too much caffeine may be associated with decreased fertility. Some studies have shown a decrease in fertility with increased caffeine use while others have not shown adverse effects. If there are effects, it's likely that caffeine has a greater impact on a woman's fertility than on a man's. High caffeine intake does appear to increase the risk of miscarriage.
  • After about age 32, a woman's fertility potential gradually declines. Infertility in older women may be due to a higher rate of chromosomal abnormalities that occur in the eggs as they age. Older women are also more likely to have health problems that may interfere with fertility. The risk of miscarriage also increases with a woman's age. A gradual decline in fertility is possible in men older than 35. The reason is straightforward. A woman is born with all the eggs she'll have. And with time, the supply diminishes. The remaining eggs also age along with the rest of the body.
  • The normal tissue lining the uterine cavity is called the endometrium. Endometriosis is a condition in which the presence of this endometrial tissue moves outside the uterus. The most common places for implantation are the ovaries, fallopian tubes, bladder and intestines, uterine wall, and the lining of the pelvis. In very rare cases it may be found in the lungs, surgical wounds (cesarean section scars), brain tissue and the vaginal wall. Can Endometriosis cause infertility? Adhesions (scar tissue) can block the fallopian tubes and prevent the egg from entering the uterus. There is a 25-35% rate of infertility in moderate to severe cases of Endometriosis, resulting primarly from damage incurred to the ovaries and fallopian tubes. http://www.alternativesurgery.com/education/endometriosis.php
  • Endometritis (Inflammation of the endometrium). , salpingitis ( Inflammation of the uterine tube). , tuboovarian abscess (A large abscess involving a uterine tube and an adherent ovary, resulting from extension of purulent inflammation of the tube.) , and peritonitis( Inflammation of the peritoneum .) infection of the uterus (womb), fallopian tubes (tubes that carry eggs from the ovaries to the uterus) and other reproductive organs. It is a common and serious complication of some sexually transmitted diseases (STDs), especially chlamydia and gonorrhea . PID can damage the fallopian tubes and tissues in and near the uterus and ovaries. Untreated PID can lead to serious consequences including infertility, ectopic pregnancy (a pregnancy in the fallopian tube or elsewhere outside of the womb), abscess formation, and chronic pelvic pain.
  • A delicate balance of sex hormones (oestrogen, progesterone, luteinizing hormone, follicle stimulating hormone) is needed for the timely growth and release of the egg from the ovary (ovulation). Hormone imbalances can cause ovulation disorders in women and are the most common cause of infertility in women.
  • Hyperprolactinemia (excessive prolactin) can cause irregular or no ovulation, resulting in infertility. Women who have this disorder often have irregular periods, and may also experience galactorrhea (ga-LAK-to-RE-ah) - milk production when not pregnant
  • Polycystic Ovarian Syndrome (PCOS) is a health problem that can affect a woman’s menstrual cycle, fertility, hormones, insulin production, heart, blood vessels, and appearance. Women with PCOS have these characteristics: high levels of male hormones, also called androgens an irregular or no menstrual cycle may or may not have many small cysts in their ovaries. Cysts are fluid-filled sacs. PCOS is the most common hormonal reproductive problem in women of childbearing age. An estimated five to ten percent of them have PCOS. In women with PCOS, the ovary doesn't make all of the hormones it needs for any of the eggs to fully mature. They may start to grow and accumulate fluid. But no one egg becomes large enough. Instead, some may remain as cysts. Since no egg matures or is released, ovulation does not occur and the hormone progesterone is not made. Without progesterone, a woman’s menstrual cycle is irregular or absent. Also, the cysts produce male hormones, which continue to prevent ovulation.
  • Medications. Temporary infertility may occur with the use of certain medications. In most cases, fertility is restored when the medication is stopped. Thyroid problems. Disorders of the thyroid gland, either too much thyroid hormone (hyperthyroidism) or too little (hypothyroidism), can interrupt the menstrual cycle and cause infertility. Cancer and its treatment. Certain cancers — particularly female reproductive cancers — often severely impair female fertility. Both radiation and chemotherapy may affect a woman's ability to reproduce. Chemotherapy may impair reproductive function and fertility in men and women. Other medical conditions. Medical conditions associated with delayed puberty or amenorrhea, such as Cushing's disease, sickle cell disease, HIV/AIDS, kidney disease and diabetes, can affect a woman's fertility. Caffeine intake. Excessive caffeine consumption reduces fertility in the female.
  • In women with anti-sperm antibodies ASA, the antibodies gather sperm together and poke holes in their membranes, rendering them useless for conception. It makes it impossible for the sperm to penetrate correctly into the egg.
  • A sperm–egg interaction begins after sperm capacitation. A sperm first penetrates the cumulus oophorus ( a ), consisting of cumulus cells (somatic cells from the ovarian follicle) embedded in an extracellular matrix (ECM). The sperm then contacts the zona pellucida ( b ), where the acrosome reaction is triggered by ZP3. Acrosome-reacted sperm penetrate the zona pellucida, enter the perivitelline space, then adhere to ( c ) and fuse with ( d ) the plasma membrane of the egg. The egg has extruded the first polar body (PB1) and progressed to metaphase II. In most mammals, sperm–egg fusion triggers the completion of meiosis. This model is based on in vitro studies of gamete interactions and is consistent with in vivo fertilization, which occurs in the oviduct.
  • damage from external sources ( teratogens ) including viral infections such as rubella, x-rays and other radiation, and poor nutrition. In Week 3 we see the formation of the heart, the beginning development of the brain and spinal cord, and the beginning of the gastrointestinal tract. Teratogens introduced during this period may cause severe problems such as the absence of one or more limbs or a heart that is outside of the chest cavity at birth.
  • American Society for Reproductive Medicine American Fertility Association
  • ppt on infertility by ROBEL

    1. 1. Addis Ababa University Faculty of Medicine Department of medical Physiology Presentation on Infertility ROBEL ABAY infertility Oct 2, 2011
    2. 2. Presentation objectives <ul><li>Define infertility </li></ul><ul><li>List risk factors for female infertility </li></ul><ul><li>List and explain common cause of female infertility </li></ul><ul><li>List causes of male infertility </li></ul><ul><li>Explain pathophysiology of male infertility </li></ul>infertility Oct 2, 2011
    3. 3. What is infertility ? <ul><li>Couples that have been unable to conceive a child after 12 months of regular sexual intercourse without birth control are infertile. </li></ul><ul><li>Women who have repeated miscarriages are also said to be infertile. </li></ul>infertility Oct 2, 2011
    4. 4. Infertility Etiology
    5. 5. Female Infertility <ul><li>In order for a woman to become pregnant: </li></ul><ul><ul><li>Egg must be released from one of her ovaries (ovulation) </li></ul></ul><ul><ul><li>Egg must go through the fallopian tube toward the uterus </li></ul></ul><ul><ul><li>Sperm must join with the egg in the fallopian tube (fertilization) </li></ul></ul><ul><ul><li>Fertilized egg must attach to the uterine wall (implantation) </li></ul></ul><ul><li>Infertility can result from problems that interfere with any of these steps. </li></ul>infertility Oct 2, 2011
    6. 6. What Increases the Risks ? <ul><li>Age </li></ul><ul><li>Stress </li></ul><ul><li>Poor diet </li></ul><ul><li>Smoking </li></ul><ul><li>Alcohol </li></ul><ul><li>STDs </li></ul><ul><li>Overweight </li></ul><ul><li>Underweight </li></ul><ul><li>Caffeine intake </li></ul><ul><li>Too much exercise </li></ul>infertility Oct 2, 2011
    7. 7. The Age Factor <ul><li>A woman's fertility naturally starts to decline in her late 20's. </li></ul><ul><li>After age 35 a woman's fertility decreases rapidly. </li></ul><ul><li>A woman is born with all the eggs she'll have, and with time, the supply diminishes. </li></ul><ul><li>The remaining eggs also age along with the rest of the body. </li></ul>infertility Oct 2, 2011
    8. 8. Common Causes of female Infertility <ul><li>Severe endometriosis </li></ul><ul><li>Pelvic Inflammatory Disease (PID) </li></ul><ul><li>Ovulation disorders </li></ul><ul><li>Elevated prolactin </li></ul><ul><li>Polycystic ovary syndrome (PCOS) </li></ul><ul><li>Early menopause </li></ul><ul><li>Benign uterine fibroids </li></ul><ul><li>Pelvic adhesion </li></ul>infertility Oct 2, 2011
    9. 9. Physical Obstructions <ul><li>Endometriosis </li></ul><ul><li>Pelvic Inflammatory Disease </li></ul><ul><li>Uterine Fibroids </li></ul><ul><li>Pelvic Adhesions </li></ul><ul><li>Ovarian Failure </li></ul>infertility Oct 2, 2011
    10. 10. Endometriosis <ul><li>Occurs when the uterine tissue implants and grows outside of the uterus, affecting the function of the ovaries, uterus and fallopian tubes. </li></ul><ul><li>Scar tissue can block the fallopian tubes and prevent the egg from entering the uterus. </li></ul><ul><li>There is a 25-35% rate of infertility in moderate to severe cases of Endometriosis </li></ul>infertility Oct 2, 2011
    11. 11. PID <ul><li>Pelvic inflammatory disease (PID) is a spectrum of infections of the female genital tract that includes endometritis , salpingitis, tuboovarian abscess, and peritonitis . </li></ul>infertility Oct 2, 2011
    12. 12. Uterine Fibroids and Pelvic Adhesions <ul><li>Fibroids are benign tumors in the wall of the uterus </li></ul><ul><li>May cause infertility by blocking the fallopian tubes </li></ul><ul><li>Pelvic adhesions are bands of scar tissue that bind organs after pelvic infection, appendicitis, or abdominal or pelvic surgery </li></ul><ul><li>This scar tissue formation may impair fertility . </li></ul>infertility Oct 2, 2011
    13. 13. Ovarian failure <ul><li>Ovarian failure can be a consequence of medical treatments, or the complete failure of the ovaries to develop or contain eggs in the first place (Turner's Syndrome). </li></ul><ul><li>Ovarian failure can also occur as a result of treatments such as chemotherapy and pelvic radiotherapy for cancers in other body areas. These therapies destroy eggs in the ovary. </li></ul>infertility Oct 2, 2011
    14. 14. Hormonal Obstructions <ul><li>Ovulation disorders </li></ul><ul><li>Elevated prolactin </li></ul><ul><li>Polycystic ovary syndrome </li></ul><ul><li>Early menopause </li></ul>infertility Oct 2, 2011
    15. 15. Ovulation disorders <ul><li>Disruption in the part of the brain that regulates ovulation can cause low levels of luteinizing hormone (LH) and follicle-stimulating hormone (FSH). </li></ul><ul><li>Even slight irregularities in the hormone system can affect ovulation. </li></ul>infertility Oct 2, 2011
    16. 16. Elevated prolactin <ul><li>Also called Hyperprolactinemia </li></ul><ul><li>Can cause irregular or no ovulation </li></ul><ul><li>Irregular periods </li></ul><ul><li>May cause galactorrehea, milk production when not pregnant </li></ul>infertility Oct 2, 2011
    17. 17. PCOS <ul><li>Polycystic ovary syndrome (PCOS) </li></ul><ul><li>Produces too much androgen hormone (male hormones) </li></ul><ul><li>Causes an irregular or no menstrual cycle </li></ul>infertility Oct 2, 2011
    18. 18. Early menopause <ul><li>Absence of menstruation </li></ul><ul><li>Early depletion of ovarian follicles before age 35 </li></ul><ul><li>Although the cause is unknown, certain conditions are associated with early menopause, including immune system diseases, radiation or chemotherapy treatment, and smoking </li></ul>infertility Oct 2, 2011
    19. 19. Other Causes <ul><li>Medications </li></ul><ul><li>Thyroid problems </li></ul><ul><li>Cancer and treatment </li></ul><ul><li>Other medical conditions </li></ul><ul><ul><li>conditions associated with delayed puberty or amenorrhea, sickle cell disease, HIV/AIDS, kidney disease and diabetes </li></ul></ul>infertility Oct 2, 2011
    20. 20. Fertilization Problems <ul><li>Anti-sperm antibodies (ASA) </li></ul><ul><li>Oocyte membrane proteins </li></ul>infertility Oct 2, 2011
    21. 21. Immune Infertility <ul><li>The developing embryo may be miscarried due to the mother’s immune system recognizing it as a “foreign body” and attacking it. </li></ul><ul><li>Also, the woman may produce anti-sperm antibodies (ASA) to her partner’s sperm. </li></ul><ul><li>ASA neutralize sperm by clumping them together and destroying their membranes. </li></ul><ul><li>They also coat over receptors involved in sperm-egg binding and fertilization. </li></ul><ul><li>An estimated 12 to 15 percent of unexplained infertility in women is linked to ASA. </li></ul>infertility Oct 2, 2011
    22. 22. Membrane Proteins <ul><li>Receptin, an Oocyte membrane protein, is responsible for binding sperm with the egg. </li></ul><ul><li>If this protein is not receptive or present, fertilization cannot occur . </li></ul>infertility Oct 2, 2011
    23. 23. Development Problems <ul><li>Hard Eggs </li></ul><ul><li>Teratogens </li></ul>infertility Oct 2, 2011
    24. 24. Hard Eggs <ul><li>If the egg is too 'hard', then the embryo cannot hatch out of the zona pellucida and it dies. </li></ul><ul><li>To fix this problem, scientists can make a tiny hole in the egg to give it a head start . </li></ul>infertility Oct 2, 2011
    25. 25. Hard Eggs infertility Oct 2, 2011
    26. 26. Teratogens <ul><li>Damage from external sources, including viral infections, x-rays and other radation, and poor nutrition </li></ul><ul><li>Depending on the stage of development at which the exposure to the teratogen takes place, a variation of developmental malformations may occur. </li></ul>infertility Oct 2, 2011
    27. 27. Male infertility <ul><li>PRETESTICULAR </li></ul><ul><li>TESTICULAR </li></ul><ul><li>POST TESTICULAR </li></ul>infertility Oct 2, 2011
    28. 28. PRETESTICULAR <ul><li>ENDOCRINE </li></ul><ul><li>Hypogonadotrophic hypogonadism </li></ul><ul><li>Hyperprolactinemia </li></ul><ul><li>DM </li></ul><ul><li>Hypothyroidism </li></ul><ul><li>Androgenic steroid abuse </li></ul>infertility Oct 2, 2011
    29. 29. Coital disorders <ul><li>Erectile dysfunction </li></ul><ul><li>Ejaculatory failure </li></ul>infertility Oct 2, 2011
    30. 30. Causes of erectile dysfunction <ul><li>Anything that interferes with the nerve pathway can cause erectile dysfunction </li></ul><ul><li>Trauma such as head and spinal cord injuries, stroke, Parkinson's disease, and diseases with systemic effects such as multiple sclerosis and diabetes can diminish nerve function and lead to impotence. </li></ul><ul><li>Aging </li></ul><ul><li>medications and alcoholism can also cause impotence </li></ul>infertility Oct 2, 2011
    31. 31. Ejaculatory failure <ul><li>Ejaculatory failure can be grouped under 4 categories – </li></ul><ul><li>unejaculation – no ejaculation of sperms. </li></ul><ul><li>b. Retrograde ejaculation – semen is ejaculated in bladder. </li></ul><ul><li>c. Premature ejaculation – inability to control ejaculation for sufficient length of time during intravaginal containment to satisfy female partner </li></ul><ul><li>d. Ejaculatory obstruction – failure to achieve erection. </li></ul>infertility Oct 2, 2011
    32. 32. TESTICULAR <ul><li>GENETIC </li></ul><ul><li>Klienfelter syndrome, </li></ul><ul><li>Y chromosome deletion, </li></ul><ul><li>Immotile cilia syndrome </li></ul><ul><li>CONGENITAL </li></ul><ul><li>Cryptorchidism </li></ul>infertility Oct 2, 2011
    33. 33. Testicular contn’d <ul><li>ORCHITIS </li></ul><ul><li>Infective </li></ul><ul><li>Traumatic </li></ul><ul><li>VASCULAR </li></ul><ul><li>Torsion </li></ul><ul><li>Varicocele </li></ul><ul><li>IDIOPATHIC </li></ul>infertility Oct 2, 2011
    34. 34. POST TESTICULAR <ul><li>OBSTRUCTIVE </li></ul><ul><li>Epididymal </li></ul><ul><li>Vasal </li></ul><ul><li>ACCESSORY GLAND INFECTION </li></ul><ul><li>Prostitis </li></ul><ul><li>Seminal vesiculitis </li></ul><ul><li>IMMUNOLOGIC </li></ul><ul><li>Post vasectomy </li></ul><ul><li>idiopathic </li></ul>infertility Oct 2, 2011
    35. 35. References infertility Oct 2, 2011
    36. 36. THANK YOU infertility Oct 2, 2011