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  1. 1. Infertility • Inability to conceive a child or sustain a pregnancy to childbirth – Pregnancy has not occurred after at least 1 year of engaging in unprotected sexual intercourse – Affects 14% of couples desiring childrenTypes of infertility: • Primary infertility - refers to a couple who has never established a pregnancy • Secondary infertility - refers to couple who has conceived previously but are currently unable to establish a subsequent pregnancyMale Infertility Factors • Inadequate sperm count – less than 20million/mm of seminal fluid Less than 60% are motile Less than 60% has normal shape and form Causes: chronic infection Cryptorchidism Testicular trauma Endocrine imbalances Drug/excessive alcohol use Exposure to radiation • Obstruction or impaired sperm motility from: Mumps orchitis Epididymitis Gonorrhea Ascending urethral infection Prostate gland hypertrophy Extreme obesity Anomamalies of the penis (hypospadias/epispadias) • Ejaculation problems Erectile dysfunction (debilitating diseases, pdychological problems,drug side effect) Premature ejaculationFemale Infertility Factors • Cervical problems – Thick cervical mucus – Stenotic cervical os • Vaginal problems – pH becomes excessively acidic (bec. of Infection) – Sperm agglutinating antibodies in blood plasma (destroys sperm cells) • Unexplained infertility • Anovulation (most common cause of infertility in women may be caused by – Turner’s syndrome (no ovaries -genetic abnormality)
  2. 2. – Hormonal imbalance (hypothyroidism which interferes with hypothalamus- pituitary-ovarian interaction) – Polycystic ovarian syndrome (no response to FSH) – Exposure to radiation – Predisposing factors: stress, decreased body weight, poor diet, general ill healthFertility Assessment • Semen Analysis – Assessment of the number, appearance, motility, and penetration of sperms • count: 20 million / ml or 50 million /ejaculation • volume: 2.5ml - 6 ml • Motility: >75% • Quality of motion: graded 1-4 (poor to excellent) • Morphology: more than 70% normal • Ovulation Monitoring – Record basal body temperature – Ovulation by test strip  Assesses upsurge of LH that occurs before ovulation Tubal Patency – Sonohysterography  Ultrasound to inspect uterus – Hysterosalpingography  Radiologic exam of fallopian tubes Advanced Surgical Procedures – Uterine endometrial biopsy (obtaining a sample of the endometrium- must be corkscrew) – Hysteroscopy (introduction of hysteroscope through the cervix to visualize internal reproductive structures) – Laparoscopy (introduction of laparoscope through a small incision made on the abdomen to visualize internal reproductive structures) – Infertility evaluation:Infertility Management Increasing sperm count o Advise to abstain from coitus for 7-10 days to allow maturation of sperm cells o Lifestyle changes to reduce scrotal heat Reducing the presence of infection through antibiotics Managing erectile problems (most common is through the use of prescribed medication such as Sildenafil (Viagra) Hormone therapy research for the actions!!!! o Clomiphene citrate (Clomid) o Menotropins o Low-dose estrogen
  3. 3. o Progesterone vaginal suppositories Surgery o Myomectomy o Canalization (to eliminate obstruction Fallopian tube) • Assisted Reproductive Techniques o Artificial insemination – instillation of sperm into the female reproductive tract to aid conception - technique of micromanipulation that thins the zona pellucida and inject sperm into the ovum in an effort to enhance fertilization o In vitro fertilization (IVF)– removing 1 or more mature oocytes from a woman’s ovary by laparoscopy and then fertilizing them by exposing them to sperm under laboratory conditions outside the woman’s body (placed on a dish together with the sperm) o Embryo Transfer (ET)– ova transfer; insertion of laboratory grown fertilized ovum into the wopman’s uterus approx. 40 hours after fertilization where 1 or more of them will implant and grow o Gamete intrafallopian transfer (GIFT) –ova and sperm are instilled in the patent fallopian tube within a matter of hours without waiting for the fertilization t o occur in the laboratory o Zygote intrafallopian transfer (ZIFT) – retrieval of oocytes, culture and insemination of oocytes in the laboratory; fertilized eggs are transferred in the patent fallopian tube within 24 hours o Surrogate embryo transfer –oocyte from a donor is fertilized by the recipient woman’s male partner’s sperm and placed in the recipient’s uterus by ET or GIFT• Childbirth Alternatives o Surrogate mothers o Adoption o Child-free living