This document discusses infertility, including the myths and realities surrounding it. It explains what is needed for pregnancy from both the male and female perspectives. Some of the key causes of infertility are problems with egg production, ovulation, the fallopian tubes, and sperm production or transport. Testing may include semen analysis, ultrasounds, hormone levels, and HSG/HyCoSy. Treatment options range from lifestyle changes to ovulation induction, IUI, IVF, and ICSI. The success rates, costs, and emotional aspects of infertility treatment are addressed.

1. INFERTILITY- Myths and Reality

2. What is needed for pregnancy?

3. MALE

4. Testis

5. Epididymis

6. Vas deferens (Ductus)

7. Vas

8. Vas

9. Vas

10. Prostate

11. Urethra

12. Penis

13. Ejaculated out

14. FEMALE

15. Vagina

16. Cervix

17. Uterus

18. Uterus

19. Tube

20. Ovary

21. Ovulation

22. Tube

23. Sperm and Egg

24. Embryo

25. Embryo

26. Tube

27. Uterus

28. Implantation !!!

29. Factors required to start pregnancy
• Normal sperm production
• Transport of sperm in the semen
• Deposition of semen in the vagina
• Transport of sperm from vagina through cervix, uterus into the
tubes
• Production and maturation of eggs in the ovaries
• Ovulation
• Meeting of sperms and eggs in the tube to form the embryo
• Transport of the embryo from the tubes into the uterus

30. The Four
1
2
3
4

31. INTIMACY

32. Myth
• Timing
• Sperms “coming out”
• “Excessive” Masturbation
• “Thin” semen
• Only females should consult doctors

33. Reasons for Infertility

34. Problems in Female
Problem in egg production
• Increased age
• Pituitary gland disease
• Ovarian surgery
• Infection (Mumps)
• Medicines, chemotherapy, radiation
• Genetic factors
• Smoking, alcohol
• Automimmune factors
Problem in Ovulation
• Thyroid diseases
• High prolactin, high androgen
• PCOS
• Endometriosis
• Pain killers
• Genetic factors
• Smoking, alcohol
• Obesity
Problem in tubes
• Infections (STD, TB)
• Pelvic surgery
• Congenital (From birth)
• Fibroid
• Endometriosis
• Smoking
• Past ectopic pregnancy
Problem in uterus
• Fibroid
• Utrine surgery
• Infection (STD, TB)
• Radiation
• Hormonal diseases
• PCOS, Obesity
• Endometriosis, Adenomyosis

35. Problems in Male
Problem in sperm production
• Pituitary gland disease
• Thyroid diseases
• Diabetes
• Testicular injury
• Testicular tumour
• Infection (Mumps)
• Medicines, chemotherapy, radiation
• Genetic factors
• Undescended testes
• Varicocele
• High temperature of the scrotum
• Smoking, Alcohol
• Obesity
Problem in Sperm transport
• Surgery (Hernia)
• Infection (STD, TB)
• Genetic diseases
• Block from the birth (Congenital)
• Ejaculatory problems- Prostate disease
Surgery
Diabetes
Nerve problems
Congenital
Psychological
• Erectile dysfunction- Diabetes
Hormonal diseases
Smoking, alcohol
Obesity
Psychological
Problems in blood, heart, nerves

36. CAUSES OF INFERTILITY

37. When to visit doctors
• Myths
• Chance of pregnancy
1. 15% in one cycle
2. 60% in 6 cycles
3. 80% in 12 cycles
4. 90% in 24 cycles

38. When to visit doctors
• After 1 year- of regular frequent unprotected vaginal
intercourse
• Do not wait for more than 6 months if
1. Age of woman >35 years
2. Known diseases- PCOS, Fibroid, endometriosis, painful
periods, irregular periods, diabetes, reproductive tract
infection, varicocele, testicular tumour/ trauma
3. Treatment- surgery, radiation, chemotherapy
• Immediately if
Severe Sexual Dysfunction

39. What we see
• Discussion
• Take history
• Clinical examination, if needed
• Preconceptional care
Fertility tests
• Sperm condition-
Semen analysis
• Ovarian function-
TVS- D1-4
Blood- for hormones
• Tubal function-
HSG/ HyCoSy
• Uterus-
TVS

40. Preconceptional care
• Myths- Visit only if you have difficulty in getting pregnant

41. Preconceptional care includes
• Blood group
• Thalassaemia screening
• Rubella testing
• Others- depending on the individuals
• Folic acid
• Life Style Changes
• Medicine Review

42. Thalassaemia

43. Dasgupta S et al. Int J Reprod Contracept Obstet Gynecol. 2015 Jun;4(3):790-794

44. If wife is carrier
Next generation
50% normal
50% carriers
Husband also carrier
Next generation
•25% normal
•50% carrier
•25% Major
Spontaneous
pregnancy
Chorionic villous
sampling
IVF with PGD
(Pre-Implantation Genetic
Diagnosis)
Husband’s testing
No further action
Husband normal

45. Tests for Rubella
• Rubella IgG and IgM
• TORCH Test- Obsolete

46. Vaccination for Rubella
• If Rubella IgG is negative- then vaccination- avoid
pregnancy one month afterwards

47. Any other tests before pregnancy
Depends on individual cases
• Blood sugar
• TSH
• HIV, Hepatitis B, Hepatitis C
• Hb%

48. Folic acid
• At least 1 month before
pregnancy

49. FERTILITY TESTS

50. Semen analysis
• Single Abnormal test has Little value
• Nothing related to “Manliness”
• If abnormal- find out the cause
• Repeat the test
• Blood- FSH, LH, Testosterone, Chromosomal Analysis
• Ultrasound- Scrotum, Trans-rectal

51. Ovaries
TVS- D1-4
Blood- AMH- any day
Blood- FSH, LH- D1-4
Blood- Progesterone- D21

52. Fallopian Tubes
• HSG
• SSG/ HyCoSy
• Laparoscopy

53. Uterus
• TVS
• HSG/ SSG
• Hysteroscopy

54. Myths regarding the tests
• TVS- Painful
• HSG- Painful
• Tube block- only laparoscopy or IVF
• Single tube block
• “Cysts” in PCOS
• Low AMH- No hope
• Semen test- Embarrassing

55. Sperm Collection Method
• Masturbation
• Relaxation
• Medicines
• Non-Toxic Condom
• Vibro-ejaculator
• From Urine- Retrograde Ejaculation
• With Needle/ Biopsy- TESA/ TESE/ PESA/ MESE

56. Sperm Collection in Azoospermia

57. Treatment for Infertility
• Treat the cause-
Medicines
Laparoscopy/ Hysteroscopy (Surgery)
• Trying “Naturally”
• Trying with Medicines (Ovulation Induction)
• Assisted Reproductive Techniques (ART)- IUI, IVF, ICSI

58. Ovulation Induction (OI)
• Tablets/ Injection from Day 2/3- for 5-7 days
• TVS from day 9- for 4-5 days
• Frequent Intercourse around the time of Ovulation

59. OI- Myths and Reality
• Only tablets at home
• Success rates
• How many months
• When it will not help

60. INTRA-UTERINE INSEMINATION (IUI)

61. IUI- Myths and Reality
• Success rates
• How many months
• When to do it
• When it will not help

62. IN VITRO FERTILIZATION (IVF)

63. INTRA-CYTOPLASMIC SPERM INJECTION
(ICSI)

64. IVF/ ICSI- Myths and Reality
• Success Rate
• Painful
• Safety for the woman
• Rest and time
• Test-Tube
• When to do it

65. Uncertainty

66. Treatment- Myths and Reality
• Only treatment for Infertility is IVF !!!
• Whose Sperms/ Eggs/ Embryos
• Confidentiality
• Will the babies be normal
• If it fails

67. What decides the mode of treatment
• Investigation reports
• Age
• Duration of Infertility
• Wish, Decision and affordability

68. Third Party Reproduction
• Donor Sperm
• Donor Egg
• Surrogacy

69. Advancement
• Pre-implantation genetic diagnosis (PGD)
• Fertility Preservation in Cancer Patients
• Blastocyst
• Freezing

70. COST
• Luxury
• Govt-funded
• Insurance
• Hope???

71. Infertility- Different from other “diseases”
• Stress
• Conjugal Life
• Family Pressure
• Social Interaction
• SUCCESS !!!
• Percentage game

73. http://m.facebook.com/GynaeInfertility
dr.sujoydasgupta@gmail.com