Infertility and medical aspects

1. EVALUATION OF
INFERTILITY AND
MEDICAL ASPECTS
BHAVYA RAVAL
MASTER OF SCIENCE IN CLINICAL EMBRYOLOGY AND ASSISSTED REPRODUCTIVE TECHNOLOGY
DEPARTMENT OF BIOCHEMISTRY AND FORENSIC SCIENCE
GUJARAT UNIVERSITY

2. WHAT IS INFERTILITY ?
• Infertility is when a male or female cannot conceive due to a problem
with the reproductive system of either partner.
• Infertility can be primary or secondary.
• Primary infertility is when someone is not able to conceive at all.
• Secondary infertility is when someone has previously conceived but is
no longer able to.
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3. INFERTILITY
CAUSES
Infertility is defined as the inability to get pregnant
after 12 months of trying. Any person of either sex
who fits this definition is experiencing infertility.

4. INFERTILITY IN MALES
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Problems with semen
and sperm:
Semen is the milky fluid that the penis
releases during ejaculation and consists of
fluid and sperm. The fluid comes from the
prostate gland, the seminal vesicle, and
other sex glands. The sperm is produced
in the testicles. When the ejaculate comes
out of the penis, semen helps transport
the sperm toward the egg.
About 2% of males may
have these types of issues
with their sperm. They can
result from:
•A medical condition: This could
be a testicular infection, cancer,
or a surgery.
•Overheated testicles: Causes
include an undescended testicle,
a varicocele, a varicose vein in
the scrotum, the use of saunas or
hot tubs, wearing tight clothes,
and working in hot environments.
Things that
can make it more
difficult for sperm
to fertilize the egg
include having a
sperm count
below 15
million, low sperm
motility, or sperm
that have an
unusual shape and
a harder time
fertilizing the egg.
Ejaculation disorders: If the
ejaculatory ducts are blocked, semen
may be ejaculated into the bladder.
Hormonal imbalance:
Hypogonadism, for example, can
lead to a testosterone deficiency.

5. • Genetic factors: A male should have an X and Y
chromosome. If a person has two X chromosomes and
one Y chromosome, as in Klinefelter syndrome, the
testicles will develop abnormally, and there will be low
testosterone and a low sperm count or no sperm.
• Mumps: If this occurs after puberty, inflammation of
the testicles may affect sperm production.
• Hypospadias: With this congenital anomaly, the
urethral opening is under the penis instead of at its tip.
Doctors usually surgically correct this condition during
infancy. If the correction is not done, it may be harder
for the sperm to reach the female’s cervix.
• Cystic fibrosis: This is a chronic disease that results in
the creation of sticky mucus. This mucus mainly affects
the lungs, but males may also have an absent vas
deferens. The vas deferens carries sperm from the
epididymis to the ejaculatory duct and the urethra.
Other
causes
• Radiation therapy or chemotherapy: These treatments
can both impair sperm production. In the case of
radiation therapy, the severity usually depends on how
near to the testicles the radiation occurred.
• Other diseases: Conditions that are sometimes linked
to lower fertility in males are anaemia, Cushing’s
syndrome, diabetes, and thyroid disease.
• Medications: Some medications increase the risk of
fertility problems in males. These include sulfasalazine
(Azulfidine) and anabolic steroids.
Other
causes
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6. INFERTILITY IN FEMALES
Problems with ovulation
Ovulation disorders make up
about 25% of infertility cases in
females. Ovulation is the monthly
release of an egg. The eggs may
never be released, or they may
only be released in some cycles.
Ovulation disorders can occur due
to:
• Hyperprolactinemia: If prolactin levels are
high and the female is not pregnant or
breastfeeding, it may affect ovulation and
fertility.
• Thyroid problems: An overactive or
underactive thyroid gland can lead to a
hormonal imbalance that interferes with
ovulation.
• Polycystic ovary syndrome (PCOS): This is
a hormonal condition that can cause
frequent or prolonged menstruation and
can interfere with ovulation.
Problems in the uterus or fallopian
tubes can also prevent the egg from
traveling from the ovary to the uterus,
or womb. If the egg does not travel, it
can be harder to conceive naturally.
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7. Other causes
include:
Chronic
conditions: These
include AIDS or
cancer.
Primary ovarian
insufficiency
(POI): The ovaries
stop working
normally before
the age of 40
years.
Poor egg quality: The
quality of the eggs may
interfere with
conception. As a female
ages, the number and
quality of the eggs
declines. Eggs that are
damaged or develop
genetic abnormalities
may also not be able to
sustain a pregnancy.
The older a female is,
the higher the risk.
Surgery: Pelvic
surgery can
sometimes cause
scarring or
damage to the
fallopian tubes.
Cervical surgery
can sometimes
cause scarring or
shortening of the
cervix. The cervix
is the neck of the
uterus.
Submucosal fibroids:
Benign or
noncancerous
tumours occur in the
muscular wall of the
uterus. They can
interfere with
implantation
or block the fallopian
tube, preventing
sperm from
fertilizing the egg.
Endometriosis: Cell
s that normally
occur within the
lining of the uterus
start growing
elsewhere in the
body.
Tubal ligation: In
females who have
chosen to have their
fallopian tubes
blocked, the process
can be reversed, but
the chances of
becoming fertile
again are not high.
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8. RISK FACTORS
There are certain risk factors that can increase the chance of
infertility for both sexes. These include:
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SMOKING
CHEMOTHERAPY
RADIATIONS
SEXUALLY
TRANSMITTED
INFECTIONS[STI]
AGE
NARCOTICS
EXPOSURE TO
CERTAIN CHEMICALS
OBESITY
STRESS
EXERCISE
NUTRITION
ALCOHOL MISUSE

9. DIAGNOSIS
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A person may want to visit a physician if there is no pregnancy after 12 months of trying.
If the female partner is over age 35 years, the couple may wish to see a doctor earlier, as fertility testing can
take time. For example, a person over 35 years may want to see a doctor after 6 months, while a person over
40 years may want to see a doctor as soon as they realize they are not becoming pregnant.
A doctor can give advice and carry out some preliminary assessments.
The doctor may ask about a person’s sexual habits and make recommendations regarding these. Tests are
available, but testing does not always reveal a specific cause.

10. FEMALES
A female will undergo a general physical
examination, and the doctor will ask
about medical history, medications,
menstruation cycle, and sexual habits.
•Blood test: This can assess hormone levels and whether
a female is ovulating.
•Hysterosalpingography: A technician injects fluid into
the uterus and takes X-rays to determine whether the
fluid travels properly out of the uterus and into the
fallopian tubes. If a blockage is present, surgery may be
necessary.
•Laparoscopy: A thin, flexible tube with a camera at the
end is inserted into the abdomen and pelvis, allowing a
doctor to look at the fallopian tubes, uterus, and
ovaries. This can reveal signs of endometriosis, scarring,
blockages, and some irregularities in the uterus and
fallopian tubes.
They will also
undergo a
gynaecologic
examination
and a number
of tests:
• ovarian reserve testing to count the
eggs after ovulation
• pelvic ultrasound to produce an
image of the uterus and ovaries
• thyroid function test, as this may
affect the hormonal balance
Other tests can
include:
MALES
The doctor will ask about medical history,
medications, and sexual habits and perform a
physical examination.
If a test shows an abnormality, the doctor may
recommend an examination of the testicles for lumps or
deformities and an exam of the shape and structure of
the penis.
• Semen analysis: A sample may be taken to test
for sperm concentration, motility, color, and
quality, as well as the presence of blood or
infection. Sperm counts can fluctuate, so
several samples may be necessary.
• Blood test: The lab will test for levels of
testosterone and other hormones.
• Ultrasound: This may reveal issues such as
ejaculatory duct obstruction or retrograde
ejaculation.
• Chlamydia test: Chlamydia can affect fertility,
but antibiotics can treat it. However,
antibiotics cannot cureany existing damage to
fertility.
In addition, the
doctor may
order the
following tests:
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11. INFERTILITY TREATMENT
Treatment to help a person conceive naturally will
depend on many factors, including the age of the
person who wishes to conceive, how long infertility
has lasted, personal preferences, and their general
state of health.
Frequency
of
intercourse
The first strategy a
couple trying to
conceive may wish
to try is having
sexual intercourse
more often around
the time of
ovulation.
Typically the menstrual
cycle lasts for about28–32
days. Counting from the first
day of the last period, a
female will usually ovulate
anywhere between day 11
and day 21.
Any person whose cycle is
shorter than 21 days or
longer than 35 days should
see their doctor for an
evaluation.
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Analyzing
ovulation
cycle

12. OTHER TREATMENTS
However, timing intercourse may not be
sufficient on its own to help a couple conceive.
Treatments will depend on the underlying cause
of infertility.
In males, this can include medications
for erectile dysfunction. Surgery may include a
procedure to remove a varicose vein in the
scrotum or repair a blocked epididymis.
In females, doctors can prescribe fertility
drugs to regulate or induce ovulation. These
can include clomiphene (Clomid, Seraphine),
letrozole (Femora), dopamine against
medications, and a variety of hormonal drugs.
If the fallopian tubes are blocked or scarred,
surgical repair may make it easier for eggs to
pass through. A person may also be advised to
undergo IVF.
Doctors may also treat endometriosis
with laparoscopic surgery. They make a small
incision in the abdomen and insert a thin,
flexible microscope with a light at the end,
called a laparoscope. The surgeon can then
remove implants and scar tissue, which may
reduce pain and aid fertility.
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13. The following methods are currently available for assisted or artificial conception:
• Intrauterine insemination (IUI): At the time of ovulation, a doctor inserts a fine
catheter through the cervix into the uterus to place a sperm sample directly into the
uterus.
• In vitro fertilization (IVF): Doctors place the sperm with unfertilized eggs in a petri
dish, where fertilization can take place. They then place the embryo in the uterus to
begin a pregnancy. IVF techniques can include intracytoplasmic sperm injection (ICSI)
and assisted hatching.
• Sperm or egg donation: If necessary, a person can use egg or sperm donation.
Fertility treatment with donor eggs can be done using IVF.
• Electric or vibratory stimulation to achieve ejaculation: It may be possible to help
a person achieve ejaculation with electric or vibratory stimulation. This can help a
male who cannot ejaculate normally, for example because of a spinal cord injury.
• Surgical sperm aspiration: The sperm is removed from a part of the male
reproductive tract such as the vas deferens, testicle, or epididymis. Doctors will use
IVF to fertilize the egg or freeze the sperm for later use.
ASSISTED CONCEPTION

14. THANK
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