Fertility Facts
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Transcript of Fertility Facts
Fertility Facts
Definition:unprotected sex for one year, not pregnant
Frequency: 1 out of 6 couples in the US
Responsibility: 35% female infertility 35% male 20% both 10% unknown
Maternal Age USA20-24 4.1% 30-34 9.4%25-29 5.5% 35-39 19.7%
85% treated successfully Increase 1970-now-Why?
What can cause infertility?Unexplained-18%
Female Male
• Ovulation disorders• Tube/uterus blockage• Cervix• Endometriosis• Other
• Sperm count and defects
• Erectile or ejaculation deficiency
Intrinsic vs. Extrinsic, Environmental
More detail on female infertility• Ovulatory failure-polycystic ovarian syndrome (high
androgen/estrogenlevels), resistant ovarian syndrome, gonadal dysgenesis
• Impaired gamete/zygote transport-pelvic inflammatory disease, endometriosis
• Implantation defects-progesterone low
• Spontaneous abortion-chromosome abnormality
More detail on male infertility
• Cryptorchidism-Why?
• Chromosome disorders-gonadal dysgenesis
• Obstructions
• Gonadotropin deficiency
Result in:Low sperm count, sperm of poor quality
Female Infertility Tests
• For ovulation• Basal body temperature• Ovulation kit (LH surge)• Other hormone tests (steroids)
• Post ovulatory block•Laparoscopy-fiber optic look•Hysterosalpingogram-dye•Post-coital /cervical mucous and sperm•Sperm antibodies•Endometrial biopsy
Sperm good for 2-3 days, egg for 2
Can find adhesions, structural abnormality, etc
Hysterosalpingogram
Blocked tubes
Male Infertility Tests
• Sperm count/motility– > 20 million sperm/ml– Check motility and morphology
• >50% motile
• >30% structurally normal
• If low check LH and androgen levels•Testicular biopsy
Sperm Count
Older, low tech treatments
• Drug treatment for ovulation block• Intrauterine insemination• Tubal surgery
High tech Assisted Reproduction Technologies• IVF-in vitro fert and embryo transfer•GIFT-gamete intrafallopian tube transfer•ZIFT-zygote intrafallopian tube transfer•Intracytoplasmic sperm injection
frozen eggs/ ovary transplant; cloned human embryo
First test-tubebaby
Assisted Reproductive Technology
• Estimate 1/100 births now
• Around 40,000/year
• Costs between $7,000 to 15,000 per attempt
IVF
In Vitro Fertilization and Embryo Transfer
Basic Steps in IVF
•Ovary stimulation•Egg retrieval •Sperm retrieval-wash sperm•Fertilization•Embryo transfer•Progesterone
Drugs used for ovary stimulation
•Clomiphene (clomid)-anti-estrogen•hMG (pergonal)-menopausal gonadotropin (FSH and LH)•FSH-(metrodin)•GnRH•GnRH agonists (lupron)-FSH/LH first promoted, then inhibited•hCG-acts like LH
Start with more than 1 egg
In a single cycle, could take clomid, pergonal, hCG shot, then progesterone
Why transfer more than one embryo?
• Increase the pregnancy rate
• Leads to increased risk of multiple pregnancies
• In future- Test embryos before transfer
sHLA-G measure of embryo health
Egg retrieval, vaginal, with ultrasound
Gametes mixed for GIFT
Modifications if tube not blocked
GIFT
If fertilization needs help-transfer zygoteZIFT
Intracytoplasmic sperm injection
ICSI
Additional twists
• Surrogacy– Gestational– Egg donor plus gestational– Egg donor plus sperm donor plus gestational
• Frozen embryos• Egg donors• Frozen eggs• Cloning
From CDC
IVF Success Rates
Stage Number of WomenCycle initiation 100Ovulation 95Oocyte retrieval 90Fertilization 85Embryo Transfer 70Pregnancy 24Birth 18
From The Baby Business by Debora Spar
Risks of ART?
• To woman– Overstimulation of ovary syndrome– Multiple pregnancies– Risk of ovarian cancer (clomid, pergonal)
• To baby– ICSI associated with problems (XYY)
Discussion questions-what treatment(s) would you select given the following:
• Male with low sperm count
• 30 year-old female not ovulating
• 40 year-old female not ovulating
• Undiagnosed infertility