Infertility

Fertility Sub fertility Sterility Infertility: Diminished capacity to conceive and bear a childSterility: Absolute and irreversible inability to conceiveClinically: Involuntary failure to conceive after 12 months of unprotected frequent intercourse. Primary: No previous pregnancySecondary: Previous pregnancies what ever the outcome.Prevalence: 10-15% 1/3 In the Female 1/3 in the male 1/3 in the couple

combined

FACTORS AFFECTING FERTILITY:

Age

Psychological Health

General Health

DISORDERS:1. Involving each of the major physical

events that are necessary to produce a pregnancy.

2. Production of a healthy eggs.3. Production of a healthy sperm.4. Transportation of the sperm to the site

of fertilization.5. Transportation of the egg and zygote to

the uterus for implantation.6. Successful implantation in a receptive

endometrium7. Presence of other factors.

No OOCYTES production and OOCYTES abnormalities:

Failure to ovulate

The disorders are grouped into three general categories:

Hypothalamus]

Pituitary ]

Ovarian ] Dysfunction

HYPOTHALAMUS = Abnormalities of

weight, body composition.

Strenuous Ex. Stress, travel

PITUITARY: Hyperprolactinaemia

Hypothyroidism

OVARIAN: PCOS

Premature ovarian failure

ANATOMIC ABNORMALITIES:

TUBAL FACTOR: 20%

Pelvic Infection adhesion

Rupture appendicitis

Septic abortion

Previous surgery

IUCD

Ectopic Pregnancy

UTERINE FIBROID:ENDOMETRIOSIS :

Ectopic EndometriumPresence of tissue that resembles endometrium outside its normal positon.Glands and stroma = responsive to gonadal hormone. Increase in prostaglandin inflammatory response fibrosis and scarring.

MALE INFERTILITYTESTES: Under GnRH1 - Steroidogenesis Leydig cells between seminiferous tubule Testesterone – (LH)2 – Spermatogenesis

Sertoli cells (inhibin) – (FSH)Both lead to production of healthy spermatozoa.Cryptoorchidism:Infection – orchitis – mumpsOccupation – excess heat, radiation,

toxic

Lifestyle – smoking, alcoholDrugs- salfasalyasinEjaculation – disorders – Retrograde

Premature Ejeculation - Impotence Congenital abnormalities Chromosomal anomalies Traumatic causes Coital Abnormalities Vascular Hormonal Inflammatory Immunological Environmental

EXAMINATION:

General Health

Presence of 20 sexual characteristics

Genital Examination

Epididymis

Testes

INVESTIGATION:

Hormonal Testesterone FSHChromosome KaryotypeSemen Analysis

Volume - 2 – 6mlLiquefa - within 30 min.Density - 20-250 million/mlMotility - > 50% progressive movement

AZOOSPERMIA

ObstructiveNon obstructive

PRINCIPLE OF MANAGEMENTDeal with the couple together

AIM OF INVESTIGATION: To give an explanation of the cause To form basis for treatment. Prognosis

IN THE FEMALE: Rubella status Check for ovulation

● Basal body temperature chart● Serum progesterone D21-22

(28 day cycle)● LH Surge● Ultrasound (TVU)

S. Prolactin LH / FSH ratio Thyroid function test Endometrial biopsy

EVALUATION OF FALLOPIAN TUBE

Chlamydia titre

Laparoscopy

Hysteroscopy

Hysterosalpigography (HSG)

Tubal insufflation – CO2

POST COITAL TEST

Once evaluation is complete, treatment of infertile couple is directed by the findings.

WOMEN = Anovulatory cycles

Correct underlying cause/ Weight

Hyperprolactinaemia

Hypothyroidism

Ovulation InductionClomaphine citrate……Multiple ?

Gonadotrophine, injection…OHSS ?

Surgery:

Tubal

Endometriosis

Assisted Conception A.R.T

AIH - IUI ZIFT

GIFT

IVF

ICSI