Human Reproductive Disorder - PowerPoint PPT Presentation

Loading...

PPT – Human Reproductive Disorder PowerPoint presentation | free to download - id: 40ec30-YTFjZ



Loading


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation
Title:

Human Reproductive Disorder

Description:

Human Reproductive Disorder Xulan Dept. of G & O, the First Affiliated Hospital of Shantou University Medical College Introduction of Infertility Definition ... – PowerPoint PPT presentation

Number of Views:193
Avg rating:3.0/5.0
Slides: 55
Provided by: 20986
Learn more at: http://og.med.stu.edu.cn
Category:

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: Human Reproductive Disorder


1
Human Reproductive Disorder
  • Xulan
  • Dept. of G O, the First Affiliated Hospital of
    Shantou University Medical College

2
  • Introduction of Infertility
  • ? Definition
  • Fecund the ability to reproduce, typically used
    in context of women to become pregnant.
  • Infertility the inability to conceive after two
    years or more of trying with unprotected
    intercourse for couples.
  • ( WHO, one year)

3
  • Primary infertility no previous pregnancies have
    occurred
  • Secondary infertility a prior pregnancy has
    occurred, but inability to conceive again for two
    or more years exposure to intercourse, no matter
    how the result of the pregnancy is.

4
  • What are the chances of a fertile couple actively
    seeking pregnant in a single month or cycle?
    10-20
  • The accumulated pregnancy rate during two years
  • __chances of conceiving by 6 months 75
  • __chances of conceiving by 1 year90
  • __10-15of couples will require longer than one
    year to conceive.

5
  • Epidemiology and etiology of infertility
  • Causes
    Percentage
  • Female factors 30-50
  • Male factors 30
  • Both male and
  • female factors 20
  • unexplained factors 10
  • So, the initial evaluation should include both
    the partners.

6
  • ? Female Infertility
  • Causes
  • Ovulatory dysfunction 25.
  • Tubal factors 30-50
  • 3. Pelvic factors
  • 4. Cervical factors
  • 5. Extra-genital tract factors
  • 6. Others

7
Female Factors
Hypothalamus
Pituitary
Follopian tube
Uterine ovary
oocyte
Cervix
Extra-genital tract Fig.1sperm
Thyroid
Adrenal
8
  • Ovulatory dysfunction
  • 1. Hypothalamus amenarrhea or mensrtual disorder
  • -- Emotional depress
  • -- Psychological trauma
  • -- Environmental and Climate changes
  • 2. Pituitary diseases
  • --Sheehans syndrome
  • -- Pituitary tumor Hyperprolactinemia,
  • -- Empty sella syndrome

9
  • Ovary diseases
  • 1. Congenital dysformation
  • Turners syndrome(45,XO)
  • 2. Polycystic syndrom(PCO)
  • 3. Premature ovary failure(POF)
  • 4. Ovary functional tumors
  • 5. Insensitive to follicle stimulating
    hormones(FSH).
  • 6. Other endocrinologic diseases adrenal or
    thyroid dysfunction

10
(No Transcript)
11
  • ? Pelvic Factors
  • Tubal factors tubal blokage, adhension and
    hydrosalpinx
  • 1. Inflammations
  • --Chlamydia
  • --Gonorrhea
  • --Tubercle bacillus and so on
  • 2. Tubal dysformation
  • 3. Pelvic adhension endometriosis
  • 4. Abdominal or pelvic surgery
  • 5. Ectopic pregnancy

12
Fig.2
13
  • ?Pelvic factors
  • Pelvic Adhension
  • 1.Inflammations
  • --Chlamydia, turbercle bacillum, gonorrhea,
    staphylococci and so on
  • 2. Pelvic endometriosis
  • 3. Pelvic surgery
  • ?Reproductive system dysformation
  • -- Mayer-Rokitansky- Kuster-Hauser syndrome no
    uterus and vagina

14
  • -- Uterus didelphys
  • -- Uterus bicornis
  • -- Uterus septus
  • -- Uterus unicornis
  • -- Rudimentary horn of uterus
  • -- others

15
Fig.3
16
Fig.4
17
Fig.5
18
Fig.6
19
Fig.7
20
Fig.8
21
Fig.9
22
Fig.10
23
Fig.11
24
Fig.12
25
Fig.13-1
Fig.13-2
26
  • Cervical factors
  • -- Cervicitis
  • cervical erosion,
  • cervical polyps,
  • cervical hyperplasia
  • -- cervical stenosis
  • -- Cervical tumors leiomyoma
  • -- Cervical cancer

27
  • ?Extra-genital factors
  • -- Vulvo-vaginalitis
  • -- Vulvo-tumors
  • ? Others
  • --Immunological factors
  • autoimmune response
  • auto-antibodies AsAb, ACA, ANA, etc.
  • -- Genetic factors
  • -- Psychological factors
  • -- Unexplained causes

28
  • Evaluation and diagnosis
  • Initial evaluation
  • The initial visit is the most important the
    infertility is a problem of both of the couple
    so, the male partner should be present at the
    beginning.

29
  • 1. Taking history
  • -- marriage, menarche, menstruation
  • -- duration of sexual relationships with or
    without birth control
  • -- methods of birth control
  • -- reproductive history of both partners (ie
    children with previous partners/marriages)

30
  • 2. Physical examination (PE)
  • --General development
  • -- Secondary sexual characteristics
  • 3. Pelvic examination (PV)
  • -- Bimanual exam
  • -- Rectal-vaginal exam

31
  • 4. Breast exam masses and galactorrhea
  • 5. Laboratory
  • -- hormonal testing
  • -- urinary LH surge test
  • -- vaginal shedding cells test
  • -- cervical mucus test
  • -- post-coital spermcervical mucus test
  • 6. Assisted imaging examination
  • -- Ultrasound B continuous monitoring
  • -- HSG
  • -- Hysteroscopy
  • -- Laparoscopy

32
  • Treatment for female fertility
  • General therapy
  • -- Watchful waiting (provide more time for
    unassisted conception)
  • -- more frequent intercourse at mid-cycle
  • -- emotional support

33
  • 2. Special therapy
  • -- treatment of pelvic inflammation disease(PID)
  • -- hydrotubation
  • -- selective salpingogram and recanalization to
    make the obstructed site of the tube reopen under
    X-ray guidance
  • -- hysteroscopyremoval of submucous leiomyoma,
    endometrial polyps, complete or incomplete uterus
    septum and separation of the cavity adhension.
  • -- laparoscopy adhension separation, ovarian
    tumors and leiomyoma removal

34
  • Surgical approaches
  • -- ovary cysts and tumors
  • -- severe pelvic adhension
  • -- Leiomyomas out of uterus wall
  • Physical treatment for cervical erosion
  • -- laser light
  • -- crpyotherapy
  • -- electrotherapy
  • Anti-tuberculosis
  • -- endometrial tuberculosis
  • -- salpingotuberculosis.

35
  • Medication therapy
  • Ovulation induction
  • Clomiphene citrate(CC)
  • M5 50-150mg qn5
  • 2. CC/HMG/HCG
  • M5-9 CC 50-150mg
  • M10-11 HMG 75IU qd
  • 3. LHRH pulsive therapy
  • 4. Bromocriptine---hyperprolactinemia
  • 5. Metformin---PCO

36
  • 6. HMG/HCG
  • M3 HMG 75IU qd
  • F 18-25mm, EN 8-10mm
  • HCG10000IU qd
  • ? Progesterone supplement
  • 1. Post-ovulation, progesterone 10-20mg
  • qd7-10 days
  • 2. HCG 2000IU-5000IUq3d82
  • 3. Low dosage thyroid 20mg qd
  • ? Assisted reproductive technology (not
    discussed here)

37
  • Methods to monitor ovulation
  • -- Luteinizing Hormone monitoring
  • LH surge-- ovulation occurs after 34-36 hr,
  • BBT--simple, cheap, biphasic pattern,
  • -- Mid-luteal serum progesterone gt 15.7nmol/mL,
    peak
  • -- Premenstrual molimina 95 presence,
  • -- Mucus change thick and cellular, no
    crystalline fern,
  • -- Ultrasound monitoring follicle size 21-23 mm,
  • fluid in
    the cul-de-sac.

38
  • ? Male infertility
  • Causes
  • 1. PRE-TESTICULAR CAUSES OF INFERTILITY
  • a. Hypothalamic disease 
  • Isolated gonadotropin deficiency (Kallmann's
    syndrome) 
  • Isolated LH deficiency ("Fertile eunuch") 
  • Isolated FSH deficiency Congenital
    hypogonadrotropic syndromes

39
  • b. Pituitary disease 
  • Pituitary insufficiency (tumors, infiltrative
    processes, operation, radiation) 
  • Hyperprolactinemia 
  • Hemochromatosis 
  • Exogenous hormones (estrogen-androgen excess,
    glucocorticoid excess, hyper and hypothyroidism).

40
  • 2. TESTICULAR CAUSES OF INFERTILITY
  • Chromosomal abnormalities Klinefelter's syndrome
    (XXY, karayotype), XX disorder (sex reversal
    syndrome), XYY syndrome
  • Noonan's syndrome (male Turner's syndrome)
  • Myotonic dystrophy- Bilateral anorchia (vanishing
    testes syndrome)
  • Sertoli-cell-only syndrome (germinal cell aplasia)

41
  • Gonadotoxins (drugs, radiation)
  • Orchitis
  • Trauma
  • Systemic disease (renal failure, hepatic disease,
    sickle cell disease)
  • Defective androgen synthesis or action
  • Cryptorchidism
  • Varicocele

42
  • 3. POST-TESTICULAR CAUSES OF INFERTILITY
  • a. Disorders of sperm transport 
  • ? Congenital disorders 
  • ? Acquired disorders 
  • ? Functional disorders
  • b. Disorders of sperm motility or function 
  • ? Congenital defects of the sperm tail 
  • ? Maturation defects 
  • ? Immunologic disorders 
  • ? Infection
  • 3. Sexual dysfunction

43
Fig.14
44
Fig.15
45
Fig.16
46
Fig.17
47
  • ? Evaluation and diagnoses
  • 1.History collection
  • -- period of infertility without protected
    intercourse
  • -- present and previous marriage,
  • -- previous fertile history with partners,
  • -- frequency of intercourse,
  • -- method of birth control,
  • -- harmful habits cigarette, alcohol,
    drug-injection

48
  • 2. Physical examination
  • -- development of body height and ratio of
  • upper body sigment to low body sigment
  • -- Secondary sexual characteristics
  • Inadequate body hair
  • atypical genital hair distribution
  • gynecomastia

49
  • -- Exam of reproductive system
  • Size, masses (length, volume and mass) of
    scrotum
  • Use orchidometer if possible
  • Epididymis for scarring ,absence or induration
  • Vas deferense for absence or nodules
  • Varicocele
  • 3. Laboratory test
  • -- Semen analysis
  • -- Karyotype (chromosome)

50
  • Normal Values for Semen Analysis
  • Volume gt 2.0 mL
  • Sperm concentration gt 20 million/mL
  • Motility gt50
  • A gt25
  • AB gt50
  • morphology gt30 normal
  • Data from WHO, 1992

51
  • Abnormal Values for Semen Analysis
  • azoospermiano sperm found under microscope for
    at twice SA at two weeks interval
  • oligospermiasperm count less than 20 million
    per 1mL
  • asthenospermiathe percentage of normal
    morphology sperm less than 30

52
  • -- Endocrine test lt3
  • FSH,LH,T,PRL,E2,T3,T4,ACTH,TSH,GH
  • hyperprolactinemia--MR
  • -- Blood biochemistry
  • Liver enzymes and blood lipid
  • -- Immunologic antibody AsAb
  • -- Special and sperm function tests
  • Sperm-Cervical mucus interaction
  • Sperm penetration assays
  • Acrosome evaluation
  • Hypoosmotis swelling

53
  • -- Bacteriologic test
  • Bacterial culture for urine or prostate gland
    fluid
  • and drug sensitive test
  • Chlamydia trachomatis
  • Mycoplasma hominus
  • Ureaplasma urealyticulum
  • ? Treatment
  • 1. Surgical measures
  • -- Varicocelectomyvaricocele
  • -- Transurethral resection of ejaculatory duct

54
  • -- Microsurgical epididymal sperm aspiration
  • -- Ablation of pituitory Adenomas
  • -- Prophylactic surgical measuresundescended
    testes
  • 2. Medical measures
  • --Endocine therapy
  • HMG,HCG,CC,Bromocriptine
  • -- Treatment of infection
  • antibiotics
  • -- Empiric therapyherbal treatment
  • 3. Assisted reproductive techniques treatment
About PowerShow.com