The McCoughey Septuplets

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The McCoughey Septuplets
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Infertility 101

• Definitions
• Under 35 yo No conception after one year of
  unprotected intercourse
• Over 35 yo No conception after 6 months of
  unprotected intercourse

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Your Infertility Patient. . .

• 34 yo woman presents to your
• clinic to discuss her concerns
• about infertility

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Psychosocial Issues

• Expectations
• Stress on Relationships
• Stress on Finances
• Alternatives- Adoption or Childless
• Counseling, Support Groups

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Etiologies

• Male Factor 40
• Tubal Factor 40
• Ovulation Problem 10
• Unexplained 10

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Start with History. . . What Clues Can You
Find on History?

• Male Factor
• Tubal Factor
• Ovulation

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Semen Analysis

• Normal values
• Volume 2-5cc
• Count gt20 million
• Motility gt50
• Morphology gt50 normal
• (strict criteria gt15)

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Male Factor Infertility

• Evaluation
• Repeat semen analysis
• Physical exam- varicocele, testicular size
• Lab testing- testosterone, FSH, LH
• Genetics for special cases
• IUI (intrauterine insemination)
• ICSI (intracytoplasmic sperm injection)
• Donor sperm

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Etiologies

• Male Factor 40
• Tubal Factor 40
• Ovulation Problem 10
• Unexplained 10

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Hysterosalpingogram
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HSG Unilateral Blocked Tube
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HSG Tubal Infertility
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HSG Hydrosalpinx
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HSG of DES daughter
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Etiologies

• Male Factor 40
• Tubal Factor 40
• Ovulation Problem 10
• Unexplained 10

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Ovulation Physiology

• The LH (lutenizing hormone) surge occurs 34-36
  hours prior to follicle rupture
• Progesterone is increasingly produced after the
  LH surge
• Secretory changes to the endometrium occur
  secondary to the increased progesterone levels

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Ovulation Predictor Kits
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Salivary Estrogen TCI Ovulation Tester- 92
accurate
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Add Saliva Sample
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Non-Ovulatory Saliva Pattern
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High Estrogen/ Ovulatory Saliva Pattern
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Approach to Ovulation Disorders

• Evaluate- Hypothyroidism Prolactin
  Disorder Hyperandrogenism- PCOS Weight
  loss/ weight gain
• Induce Ovulation Clomid (clomiphene
  citrate)

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Traditional Infertility Evaluation

• Semen Analysis
• Hysterosalpingogram (HSG)
• Documentation of Ovulation
• Post-coital Exam
• Diagnostic Laparoscopy

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Current Infertility Evalution

• Semen Analysis
• Hysterosalpingogram (HSG)
• Documentation of Ovulation
• 4) Ovarian Reserve Testing

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Ovarian Reserve Testing

• Day 3 FSH (lt10 mIU/ml) and estradiol (lt80 pg/ml)
• -Correlates with the functional status of the
  ovaries and the quality of the oocytes
• - FSH gt15 only 5 success with IVF
• - High estradiol level increases risk of
  cancelling IVF cycle

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Unexplained Infertility

• 12-15 of couples
• 3 chance of achieving a pregnancy
• Treatment
• Superovulate with IUI
• (intrauterine insemination)-
• Clomid 12 success
• Pergonal 16
• IVF

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Infertility?