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  1. 1. Infertility
  2. 2. Definition <ul><li>defined as not being able to get pregnant despite trying for one year. </li></ul><ul><li>10 percent of couples are affected </li></ul><ul><li>Primary infertility: never conceived </li></ul><ul><li>Secondary infertility: at least one previous pregnancy </li></ul>
  3. 3. <ul><li>Pregnancy is the result of a chain of events. </li></ul><ul><li>A woman must release an egg from one of her ovaries (ovulation). </li></ul><ul><li>The egg must travel through a fallopian tube toward her uterus (womb). </li></ul><ul><li>A man's sperm must join with (fertilize) the egg along the way. </li></ul><ul><li>The fertilized egg must then become attached to the inside of the uterus. </li></ul>
  4. 4. Causes <ul><li>The incidence of male factors and female factor infertility are similar </li></ul><ul><li>Ovary factor 25% (anovulation) </li></ul><ul><li>Tubal and pelvic factor 25 % </li></ul><ul><li>Uterine factor<5% </li></ul><ul><li>Cervical factor <5% </li></ul><ul><li>Male factor 30% </li></ul><ul><li>Unexplained infertility 15% </li></ul>
  5. 5. <ul><li>Ovulatory factor </li></ul><ul><li>Ovulatory disfunction </li></ul><ul><li>Anovulatory </li></ul><ul><li>Amenorrhea </li></ul><ul><li>Investigated as follow by means of </li></ul><ul><li>Mid-luteal (day 21-23)progesterone in serum </li></ul><ul><li>Endometrium biopsy at the end of a cycle </li></ul><ul><li>BBT(basal body temperature) </li></ul><ul><li>Mid-cycle LH surge in urinary </li></ul><ul><li>Blood test: LH, FSH, prolactin, thyroid function, </li></ul><ul><li>androgen </li></ul><ul><li>*ultrasound </li></ul>
  6. 6. <ul><li>Anatomical factor: </li></ul><ul><li>Tubal disease following pelvic inflammatory disease(PID) </li></ul><ul><li>Intraperitoneal scarring(PID,endometriosis) </li></ul>
  7. 7. <ul><li>Uterine factor: </li></ul><ul><li>Polyps </li></ul><ul><li>Submucosal fibroids </li></ul><ul><li>Endometrial scarring </li></ul>
  8. 8. <ul><li>Cervical factors: </li></ul><ul><li>By mid-cycle(day 13-15) </li></ul><ul><li>ample clear watery mucus with good </li></ul><ul><li>stretchability is produced </li></ul><ul><li>Be favorable to sperm survival </li></ul><ul><li>Abnormal cervical factor may relate to </li></ul><ul><li>poor cycle timing, </li></ul><ul><li>poor mucus production (surgery,inflammation) </li></ul><ul><li>an abnormal male factor </li></ul>
  9. 9. <ul><li>Male factor: </li></ul><ul><li>semen analysis </li></ul><ul><ul><li>Volume 1.5-5.0ml </li></ul></ul><ul><li>Count>20 million/ml. 40X10 6 /total </li></ul><ul><li>Initial motility(<1 hour)50% </li></ul><ul><li>Normal Morphogy>30% </li></ul><ul><li>No clumping or significant WBC(<1 million/ml) </li></ul><ul><li>Information on coital frequency and ejaculatory difficulty should be sought </li></ul>
  10. 10. The step of test <ul><li>The assessment of both partners should begin simultaneously </li></ul><ul><li>History </li></ul><ul><li>Physical examination </li></ul><ul><li>Ovulation detection (menstrual history,BBT,serium progesterine,urinary LH,serial ultrasound) </li></ul><ul><li>Evaluation of tubal patency (Hysterosalpingogram, HSG, Laparoscopy) </li></ul><ul><li>Evaluation of uterine cavity (HSG, Hysteroscopy) </li></ul><ul><li>Cervical factor (postcoital testing, PCT) </li></ul>
  11. 11. <ul><li>Male infertility factor </li></ul><ul><li>unexplained infertility </li></ul>
  12. 12. treatment <ul><li>Depending on the test results, different treatments can be suggested </li></ul><ul><li>Various fertility drugs may be used for women with ovulation problems. </li></ul><ul><li>should understand the drug's benefits and side effects. </li></ul><ul><li>Ovulation induction: </li></ul><ul><li>Clomiphene </li></ul><ul><li>HMG(human manopausal gonadotropin) </li></ul><ul><li>FSH(follical stimulating hormone) </li></ul><ul><li>HCG(human chorionic gonadotropin) </li></ul>05/15/10
  13. 13. <ul><li>surgery can be done to repair damage to a woman's ovaries, fallopian tubes, or uterus. </li></ul>
  14. 14. <ul><li>Assisted reproductive technology (ART) </li></ul><ul><li>uses special methods to help infertile couples. </li></ul><ul><li>ART involves handling both the woman's eggs and the man's sperm. </li></ul><ul><li>Success rates vary and depend on many factors. </li></ul><ul><li>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. </li></ul>
  15. 15. <ul><li>Intrauterine insemination </li></ul><ul><li>Artificial insemination with husband’s sperm (AIH) </li></ul><ul><li>Artificial insemination by donor (AID) </li></ul>
  16. 16. <ul><li>IVF(in vitro fertilization) </li></ul><ul><li>1978 birth of Louise Brown, the world's first &quot;test tube baby”. </li></ul><ul><li>used when a woman's fallopian tubes are blocked or when a man has low sperm counts. </li></ul><ul><li>A drug is used to stimulate the ovaries to produce multiple eggs. </li></ul><ul><li>Once mature, the eggs are removed and placed in a culture dish with the man's sperm for fertilization. </li></ul><ul><li>After about 40 hours, the eggs are examined to see if they have become fertilized by the sperm and are dividing into cells. </li></ul><ul><li>these fertilized eggs (embryos) are then placed in the woman's uterus </li></ul>
  17. 17. <ul><li>Gamete intrafallopian transfer (GIFT): </li></ul><ul><li>is similar to IVF, but used when the woman has at least one normal fallopian tube. </li></ul><ul><li>Three to five eggs are placed in the fallopian tube, along with the man's sperm, for fertilization inside the woman's body. </li></ul>
  18. 18. <ul><li>Zygote intrafallopian transfer (ZIFT), </li></ul><ul><li>ICSI (intracytoplasmic sperm injection) </li></ul>
  19. 19. <ul><li>ART procedures sometimes involve the use of donor eggs (eggs from another woman) or previously frozen embryos. </li></ul><ul><li>Donor eggs may be used if a woman has impaired ovaries or has a genetic disease that could be passed on to her baby. </li></ul>
  20. 20. Key Word <ul><li>Infertility </li></ul><ul><li>Ovulation induction </li></ul><ul><li>ART </li></ul><ul><li>IVF </li></ul><ul><li>What are the causes of infertility? </li></ul><ul><li>Explaining the steps of infertility test. </li></ul>