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Infertility

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by

Aditi Srinivasan

on 3 June 2014

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Transcript of Infertility

What is Infertility?
Infertility is the inability to conceive children after
one year

of trying (or six months if a woman is 35 or older).
4 Steps of Pregnancy Process
1. Woman's body
releases egg
from ovary
2. Egg travels through fallopian tube to uterus
3. Sperm fertilizes egg
4. Fertilized egg implants itself into uterus
Prevalence
Infertility results when any of these 4 steps are disrupted
Risk Factors
Tobacco use
Decreases sperm count and increases the risk of erectile dysfunction in men
Increases chance of miscarriage in women
Alcohol consumption
Increases risk of birth defects in newborn
Decreases sperm count and motility
Medications
or
health problems
that affect hormone levels
Affects frequency of ovulation in women
Affects sperm generation in men
Affects 10 - 15% of couples in the US
40% of complications are associated with the man, 40% with the woman, and 20% with the two combined
1.5 million married women in the US between the ages of 15 and 44 are infertile
Symptoms
These could be signs that you need to visit a doctor
Women
Age
As women grow older, the number and quality of their eggs decrease
Extreme OR infrequent exercise
Complications with ovulation in women
Being underweight
Causes malnutrition in the embryo
B
o
t
h
Men
Environmental toxins (pesticides and lead)
Causes reduction in sperm health
Heat

can impair sperm production
Radiation or chemotherapy
Causes damage to the germinal epithelium lining the tubules where germ cells are produced
Leads to impaired spermatogenesis
Obesity
Affects sperm count in men
Women
Irregular or painful menstrual cycle
heavier or lighter bleeding
infrequent
abnormal back or pelvic pain
Prior miscarriages
Men
Symptoms for men can be vague and difficult to identify
Symptoms Related to
Ovulation
Symptoms related to
Hormonal Imbalances
Skin changes
increased acne
Loss of hair
Weight gain
Hair growth on lips, chest, and chin
Changes in hair growth
Changes in sexual desire
Pain, lump, or swelling in genital area
Problems with erection and ejaculation
Causes
Women
Ovulation Disorders
Prevent the ovaries from releasing eggs
polycystic ovarian syndrome (PCOS)
Uterine or Cervical abnormalities
defects in the shape of the uterus and cervix opening or mucus
Fallopian tube damage
results from inflammation of the fallopian tube, usually caused by pelvic inflammatory disease
Endometriosis
occurs when endometrium tissue grows outside the uterus
severely affects the function of the ovaries, uterus and fallopian tubes
Ovarian insufficiency
when ovaries stop working and menstruation ends before the age of 40
Men
Abnormal sperm
function or production
Abnormalities with the
delivery of sperm
due to sexual problems, genetic diseases, and structural problems
variocele
- abnormal enlargement of veins in the scrotum
Men

Infertility Treatments
Treatment of infertility depends on various factors, including age and how long a couple has been infertile.

Sperm retrieval
surgical sperm aspiration reclaims sperm if ejaculatory duct is blocked
electric stimulation used to achieve ejaculation
Women
Tubal reanastomosis
reversal of tubal ligation
Salpingectomy
Salpingostomy
Fimbrioplasty
removes blockages in the opening of the ovary where the egg is released
Tests
Women
Hysterosalpingography
X-ray of the uterus and fallopian tubes
Laparascopy
a minor surgery to allow the doctor to see inside the abdomen
a small incision is made in the abdomen through which the uterus and fallopian tubes can be seen
Ovulation tests
ensures that the woman ovulates regularly
includes daily temperature checks, urine samples, and basic ovulation testing kit found at drugstores
Pap smear
detects problems affecting the cervix including cervical cancer and sexually transmitted diseases
Men
Semen analysis
Evaluates sperm count, shape, and motility
B
o
t
h
Hormone testing
Blood test that primarily checks for imbalances in testosterone, estrogen, and progesterone levels
Ultrasound
provides an image of the uterus and fallopian tubes
detects conditions such as retrograde ejaculation and ejaculatory duct obstruction.
Genetic testing
Checks for chromosomal and hereditary disorders that cause infertility
There are many sources of infertility in women due to the anatomy of the female body, therefore there are many tests available to check for infertility.
There are fewer specific tests available for men because there are fewer easily identifiable sources of infertility.
Surgery, hormones, and the use of assisted reproductive technology
Assisted Reproductive Technology
Fertility treatments used to achieve pregnancy by artificial means through the handling of sperm and egg.
In Vitro Fertilization (IVF) -
the most common ART method
involves combining egg and sperm in a laboratory dish, and implanting the embryos in the uterus 3 -5 days after fertilization
Intrauterine Insemination (IUI)
Healthy sperm are placed directly in the uterus around the time the woman's ovary releases eggs ready to be fertilized
I
Intracytoplasmic Sperm Injection (ICSI)
A single, healthy sperm is directly inserted into a mature egg
Used if fertilization fails during previous IVF attempts
Zygote intrafallopian transfer (ZIFT)
similar to IVF
embryo is transferred to the fallopian tube instead of the uterus.
Surgical
Success Rates
Hormones
Chlomiphene citrate (Clomid, Serophine)
anti-estrogen drug
causes release of GnRH , FSH and LH
acts on pituitary gland to stimulate ovaries to release eggs
promotes spermatogenesis
oral
Human menopausal gonadotropin (hMG) (Repronex, Pergonal, Metrodin)
combines both FSH and LH (luteinizing hormone).
acts directly on ovaries
promotes spermatogenesis
injected
Success rates have roughly
doubled
within the past 10 years
range from
15 - 20%
for Intrauterine Insemination (IUI) to
50%
for donor eggs
Assisted Reproductive Technology treatments, such as IVF, have success rates of
30 - 35%
for women under the age of 35 and
15 - 20%
for women over the age of 35
The earlier the better - higher success rates for younger couples
Millions of babies are born each year because of infertility treatments, according to the Center for Disease Control Reports
Complications
Multiple pregnancy
hormones cause multiples ova to be released
Ovarian hyperstimulation syndrome (OHSS)
swollen ovaries
Bleeding or infection
consequence of surgical procedure
Premature delivery or low birth weight
consequence of multiple pregnancy
Costs
IUI cycle:
$865
;
IVF cycle using fresh embryos (not including medications):
$8,158
; Total average cost:
$12,400
Medications for IVF:
$3,000 to $5,000
per fresh cycle
Additional cost of ICSI procedure:
$1,544
Additional cost of PGD procedure:
$3,550
(Statistics taken from the National Infertility Association)
INFERTILITY

By Aditi Srinivasan and Neha Prasad

Gamete intrafallopian transfer (GIFT)
eggs and sperm inserted into the woman's fallopian tube.
fertilization occurs in the woman's body
Donor eggs or sperm
Gestational carrier
(surrogacy)
Preimplantation Genetic Diagnosis
Genetic screening to identify abnormal embryos
Follicle Stimulating Hormone (FSH), (Follistim, Fertinex, Bravelle, Gonal-F)
causes ovaries to begin ovulation
acts on ovaries
promotes spermatogenesis
injected
Gonadotropin-releasing hormone (GnRH) analog
for women who don't ovulate regularly each month
act on the pituitary gland to change when the body ovulates
injected or nasal spray
Metformin (Glucophage)
This drug helps lower the high levels of male hormones in women
oral
Bromocriptine (Parlodel)
used for women with ovulation problems due to high levels of prolactin
Prolactin is a hormone that causes milk production.
Gonadotropin Releasing Hormone Agonist (Lupron, Zoladex, and Synarel)
pretends to be GnRh to stimulate ovulation
Gonadotropin Releasing Hormone Antagonist (Antagon and Cetrotide)
blocks effect of GnRH (competitive inhibition with receptors instead of enzymes)
Video

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