Infertility

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Infertility
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Infertility facts

• affects 1 in 6 married couples of childbearing
  age
• have engaged in unprotected coitus for 1 year and
  havent become pregnant

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Infertility Facts

• can be due to
• failure to conceive, loss of conceptus
• origin of problem
• 35 female
• 35 male
• 20 both partners
• 10 unexplained

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Female factors
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Failure to ovulate

• often caused by low body fat or stress
• GnRH surge may be inadequate
• PCOS

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Tubal blockage

• Due to
• Endometriosis, scar tissue from STD, previous
  surgery
• Treatment surgery
• If surgery unsuccessful, IVF, GIFT and ZIFT are
  best options

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Uterine and cervical problems
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Vaginismus
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Causes of male infertility

• low sperm count (oligospermia) or absence of
  sperm (azoospermia)
• male may produce antibodies to his own sperm
• accessory glands / ducts may malfunction

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Intracervical or intrauterine insemination (ICI
/ IUI)

• Artificial insemination
• definition sperm introduced into female
  reproductive tract by means other than coitus
  (near cervix or in uterus)
• sperm can come from donor / sperm bank or from
  husband

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ICI / IUI, contd.

• usually, several ejaculations are pooled
• 60,000 babies / year born in US. as result of
  artificial insemination
• often used when male has low sperm count or
  antibodies present in ejaculate

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In vitro fertilization

• test - tube babies
• 1st performed in 1978 (Louise Joy Brown)
• often performed on infertile women with tubal
  blockage

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IVF Protocol

• GnRH agonist (e.g. Lupron) for 7 days
• FSH agonist (follistim, Gonal-F, Repronex) until
  follicles measure 17-20 mm in diameter (8-14
  days)
• hCG given to induce egg maturation
• Egg retrieval (transvaginally) 34-35 h later

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IVF protocol

• sperm and ova added to dish fertilization occurs
  12-14hrs.
• eggs transferred to new dish and cell division
  occurs
• embryos squirted into uterus (optimal stage
  blastocyst)
• Preimplantation genetic diagnosis (PGD)

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IVF Protocol, contd.

• 3 to 5 embryos are injected to increase chances
  of pregnancy
• woman given progestagen to prevent miscarriage

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IVF, contd.

• Ethical questions
• will it lead to selective breeding?
• up to what stage can research be done?
• if embryo dies in vitro, is it abortion, murder?
• what should be done w/ unwanted embryos?
• should government regulate research?

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GIFT and ZIFT

• GIFT gamete intrafallopian transfer
• useful for tubal blockage
• ova are collected and inserted into oviducts
  below point of blockage
• husbands sperm are placed in oviduct

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GIFT and ZIFT

• woman is treated with hormones to prevent
  miscarriage
• 28 successful
• ZIFT zygote intrafallopian transfer
• ZIFT is like IVF, only zygotes (1 cell stage) are
  inserted below blockage in oviduct (24 success
  rate)

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Others

• Ovarian stimulation protocol
• Surrogate pregnancy
• Adoption