INFERTILITY

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INFERTILITY

• Anna Mae Smith, MPAS, PA-C

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Definition

• Infertility is one year of unprotected coitus
  without conception
• The term "primary infertility" is applied to the
  couple who has never achieved a pregnancy
• "secondary infertility" implies that at least one
  previous conception has taken place

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Tx Goals

• To identify the cause of the infertility
• To provide a basis for potentially successful
  treatment options
• To provide a realistic prognosis
• To offer emotional support

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Fecundability

• 20-25 of couples will conceive/cycle
• 50 should conceive after 3-4mos
• 95 should conceive after 1 yr

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Major Causes
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Female Infertility Etiologies

• Unexplained
• Cervical/mucus
• Endometrial/uterine
• Pelvic/peritoneal
• Tubal
• Central (CNS)
• 
  

• 10
• 2-3
• 2-3
• 5-10
• 30-50
• 40

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Other Etiologies

• PID
• Cx conization/cautery
• Smoking
• DES exposure
• IUD
• Endometriosis
• PCOF

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Others

• Age - fertility decreases after the age of 30!
• Even if severely low sperm count present the
  female prior to the age of 30 may compensate by
  her fertility!
• Maximum fecundity is around 25

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First visit

• Have both come to all visits!!
• Get a complete history
• Sexual history!!
• Educate!!

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Manly Questions

• Infertility duration
• Prior fertility in relationship(s)
• Medical surgical history
• Meds (anabolic steroids, cancer chemotherapy,
  sulfasalazine, nitrofurantoin)
• Alcohol, drugs, pot
• Occupational exposures
• Sexual dysfunction
• Tight fitting underwear/pants
• Previous testing

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Womanly Questions

• Infertility duration
• Detailed menstrual history
• Prior pregnancies
• Fertility in other relationships
• IUDs, OCPs, Depo
• Frequency of intercourse/sexual dysfunction

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Womanly Questions

• Gynecologic history (PID, endometriosis,
  fibroids, cervical dysplasia)
• DES exposure
• Medical and surgical history
• Medications
• Previous tests and therapy

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DRUGS

• Cause hyperprolactinemia
• Neuroleptic, antidepressant, and hypotensive
  drugs and drugs for gastrointestinal symptoms
• Recreational drugs such as marijuana and cocaine
• Spontaneous galactorrhoea must be ascertained and
  further investigated for suspected
  hyperprolactinemia

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TESTS

• Thyroid
• Midcycle progesterone level /or luteal phase
  progesterone level
• FSH/ LH
• Cortisol
• Hystersalpingogram
• Laporoscopy
• Postcoital Test

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Treatment

• Education
• BBTs/menstrual calendar
• Clomiphene
• Pergonal
• Artificial insemination
• IVF

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Male Infertility

• Sperm production idiopathic or certain known
  entities such as mumps, endocrine disorders
  immunological disorders
• Anatomical abnormalities that obstruct the
  genital tractvaricocele.

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Sperm Count

• Fresh sample (to lab within 30 mins.) most sperm
  in initial ejaculate
• Male should be abstinent for 48 to 72 hours
• sperm concentration 20 million per ml
• total count 60 million
• ejaculate volume 1.5 ml
• total motile count 30 million
• viable sperm 50
• normal shapes (morphology) 60

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Sperm Terms

• Normozoospermia
• Normal ejaculate
• Asthenozoospermia
• Teratozoospermia
• Azoospermia
• Aspermia

• Normal ejaculate
• Sperm concentration
• No spermatozoa in the ejaculate
• No ejaculate

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Male/Female Infertility

• Endocrine - gonadotropins, bromocriptine
• Surgery to repair anatomical conditions
• Artificial insemination
• IVF - in vitro fertilization (ET embryo transfer)
• ZIFT zygote (embryo) intra-fallopian transfer
• GIFT - gamete intra fallopian transfer
• ICSI Intracytoplasmic sperm injection
• microsurgical fertilization

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Environmental changes

• Vitamins
• Baggy shorts
• Sex not every niteevery other
• Diet changes
• Stop smoking

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