Infertility facts

1
Infertility facts

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

2
Infertility Facts

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

3
Failure to ovulate

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

4
Tubal blockage

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

5
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

6
Intrauterine insemination (artificial
insemination)

• definition sperm introduced into female
  reproductive tract by means other than coitus
• sperm can come from donor / sperm bank or from
  husband

7
IUI, contd.

• usually, several ejaculations are pooled
• 6000 babies / year born in US. as result of
  artificial insemination
• often used when male has low sperm count or
  antibodies present in ejaculate

8
In vitro fertilization

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

9
IVF Protocol

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

10
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 at 4- to 32-cell
  stage (optimal blastocyst stage)

11
IVF Protocol, contd.

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

12
IVF Protocol, contd.

• new variations / improvements
• Intracytoplasmic sperm injection (ICSI)
• use of frozen embryos
• 27,000 attempts made per year 18.6 successful
  (success rates are increasing)
• http//www.advancedfertility.com/sampleivfcalendar
  .htm

13
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?

14
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

15
GIFT and ZIFT

• woman is treated with hormones to prevent
  miscarriage
• 4200 attempts made / year 28 successful
• ZIFT zygote intrafallopian transfer
• ZIFT is like IVF, only zygotes (1 cell stage) are
  inserted below blockage in oviduct (24 success
  rate)

16
Others

• Ovarian stimulation protocol
• Surrogate pregnancy
• Adoption