This presentation covers the topic such as Male & Female Infertility Overview, approach & evaluation. Infertility is a condition in couples, failed to get a successful pregnancy after twelve months of timed unprotected intercourse or therapeutic donor insemination. Eden fertility center serves as a unique fertility clinic with advanced facilities and state-of-the-art equipment to ensure excellent patient care. We deliver possibly the most advanced fertility treatments in Newport Beach & Fullerton CA Eden Centers for Advanced Fertility offers patients the most advanced treatment solutions & also gives excellent quality patient care. We are a group of highly trained specialists who've innovative concepts for fertility treatment depending on three main principles: individualized personal care, excellent medical service & effective benefits. Services We Offer - Fertility Treatments Third-Party Reproduction Genetic Testing Male Infertility Egg Freezing - Oocyte Preservation Fertility Preservation

1. Infertility
Overview, approach and evaluation
Vitaly A. Kushnir MD

2. Infertility
• A disease defined by failure to achieve a
successful pregnancy after 12 month of timed
unprotected intercourse or therapeutic donor
insemination.
• Earlier evaluation and treatment may be justified
based on history and physical exam and is
warranted after 6 month in women older than
35 years.
• Occurs in 12% of all couples
ASRM, Fertil Steril. 2013

3. Etiology of Infertility
 Normal spermatogenesis,
reproductive anatomy and sexual
function
 Sperm must traverse the cervix,
uterus and fallopian tube and
fertilize the oocyte
 Normal ovulation
 Patent fallopian tubes
 An endometrium and corpus luteum
to allow implantation and
maintenance of a pregnancy

4. Etiology of Infertility

5. Causes of Female Infertility
 Ovary
 Tubes
 Uterus
 Cervix
 Hormones
 Genetics

6. Age and Female Fertility
Conception rate per month:
1st 20, 3rd 50, 6th 75, 12th 90

7. Maternal Age (years) Risk of Down Syndrome
15 - 19 1 / 1250
20 - 24 1 / 1400
25 - 29 1 / 1100
30 - 31 1 / 900
32 1 / 750
33 1 / 625
34 1 / 500
35 1 / 350
36 1 / 275
37 1 / 225
38 1 / 175
39 1 / 140
40 1 / 100
41 1 / 85
42 1 / 65
43 1 / 50
44 1 / 40
45 and older 1 / 25

8. Aging and Ovarian Reserve
Gleicher N, Kushnir VA, Barad DH.
Endocrinology. 2013 Oct;154(10):3498-501

9. Oocyte Aneuploidy and Age

10. Ovarian Reserve
The Lancet, Volume 376, Issue 9744, Pages 911 - 921

11. Normal range for AMH
Kelsey TW et al. PLoS ONE 2011
PCO
DOR

12. Ovary - Causes of Anovulation
 Hormone Imbalance
 Polycystic Ovary Syndrome (PCOS)
 Premature Ovarian Failure (POF)
 Diminished Ovarian Reserve (DOR)
 Functional Hypothalamic Amenorrhea (FHA)
 Exercise, Stress, Malnutrition, Chronic illness

13. Ovulation
 Menstrual History
 Basal Body Temperature
 OPK – LH Surge
 Endometrial biopsy
 Mid-luteal progesterone 96.5
97
97.5
98
98.5
99
1
3
5
7
9
11
13
15
17
19
21
23
25
27
Wilcox AJ et al. N Engl J Med 1995

14. Diagnosis of PCOS
Two of the following three criteria are required:
1. Oligo/Anovulation
2. Hyperandrogenism
-clinical (hirsutism or male pattern alopecia) or
-biochemical (TT>70ng/dL, A4>245ng/dL, DHEAS>248ug/dL)
3. Polycystic Ovaries on Ultrasound
≥12 follicles [2-9mm diameter] or
-ovarian volume >10cm3 in either ovary
Other etiologies must be excluded such as Nonclassical Congenital Adrenal
Hyperplasia, androgen secreting tumors, Cushing syndrome, thyroid dysfunction and
hyperprolactinaemia
Rotterdam Criteria

15. Female Infertility – Fallopian Tubes
 Chlamydia, GC
 PID
 1st episode: 11-12%
 2nd episode: 23
 3rd episode: 54%
 Endometriosis
 Tubal ligation
 Appendicitis
 4 RR ruptured
 uncomplicated no
increased risk
 Tuberculosis
 DES
 IUD
Evaluation: HSG & Laparoscopy

16. Female Infertility – Fallopian Tubes

17. Normal HSG

18. Abnormal HSG
Hydrosalpinges
• Adverse effect on IVF pregnancy outcome
• Fluid drains into endometrial cavity
• Rapid reaccumulation of fluid post aspiration
• Tubal occlusion increases pregnancy outcome
• Salpingectomy may effect ovarian function

19. Female Infertility - Uterus
 Fibroids
 Polyps
 Asherman Adhesions
 Mullerian Anomalies

20. 3D Sono, HSN, HSG

21. Hysteroscopy & Laparoscopy
Marcoux S et al. N Engl J Med 1997

22. Inflammation in Reproduction
Weiss G, Goldsmith LT, Taylor RN, Bellet D, Taylor HS.
Reproductive Sciences. 2009;16(2):216-229.

23. Male Factor

24. Causes of Male Infertility
 Abnormality in sperm production
 Abnormality in sperm function
 Obstruction in the ductal system

25. Male Reproductive Organs

26. Sperm
 How many are needed for fertilization?
 Natural conception
 >5,000,000
 Intra-uterine insemination (IUI)
 1,000,000
 In-vitro fertilization (IVF)
 10,000
 Intra-cytoplasmic sperm injection (ICSI)
 1

27. Abnormalities of Sperm Production
 Genetic
 Y chromosome microdeletions
 Damage to testes
 Cryptorchidism
 Varicocele
 Infection
 Mumps orchitis
 Gonadotoxins

28. Abnormalities of Sperm Function
 Antisperm antibodies
 Genital tract inflammation
 Prostatitis
 Varicocele
 Failure of acrosome reaction
 Problems with sperm binding/penetration

29. Obstructions in Ductal System
 Vasectomy
 Congenital bilateral absence of the vas deferens
-Cystic Fibrosis
 Epididymis/ejaculatory ducts
-Congenital or acquired

30. Normal Semen Parameters
WHO 2010
Parameter Lower Reference Limit
Semen volume (ml) 1.5
Sperm concentration (106/ml) 15
Total sperm number (106/ejaculate) 39
Progressive motility (PR, %) 32
Total motility (PR +NP, %) 40
Vitality (live sperms, %) 58
Sperm morphology (NF, %) 4
pH* ≥7.2
Leucocyte* (106/ml) <1
MAR/Immunobead test* (%) <50

31. Sperm Morphology

32. Vaginal Lubricants

33. Evaluation of Oligospermia
 History and Physical
 Serum hormones
 FSH, TSH, Prolactin, Testosterone
 Postejaculate Urine
 Semen Fructose
 Genetics
 Karyotype
 Y Chromosome Microdeletions
 Cystic Fibrosis

34. Male Infertility - Lifestyle
 Tobacco
 Marijuana
 Alcohol
 Cocaine
 Steroids (can be permanent)
 Heat
 Exercise

35. Infertility: Key Points
 Eggs
 Ovulation
 Egg quality & reserve (Age, AMH, FSH, E2)
 Sperm
 Presence
 Quality
 Gamete transport/Implantation
 Hysterosalpingogram
 3D Sonogram

36. Contact Us
Eden Fertility Centers combines the very latest in
fertility treatment technology with luxury-level
care to provide your family the very best chance
of welcoming a new life into your home.
Thank You
Schedule An Appointment
Call (855) 566-1616
www.edenfertilitycenters.com