What is infertility?

Infertility is failure to conceive within one or more years of regular unprotected coitus

TYPES OF INFERTILITY Primary Infertility  Secondary Infertility  .

INCIDENCE OF INFERTILITY      Worldwide 8-15% of 8couples suffer some form of infertility problems Male factor(30%) Female factor(30%) Both factors (30%) Unexplained factors(10%) .

PRIMARY INFERTILITY It denotes those patients who have never conceived. .


It indicates previous pregnancy ,but failure to conceive subsequently.




Defective spermatogenesis Obstruction of the efferent duct system Failure to deposit sperms high in the vagina Errors in the seminal fluid

It is caused due to  Congenital causes ,namely,  Undescended testes  Hypospadias  Thermal factors  Infection  Genetic factors  Endocrine factors  Iatrogenic  Immunological factors






 After the age of 35 years in women & 40 years in man .WHEN TO INVESTIGATE ? Infertile couple should be investigated after 1 year of regular unprotected exposure with adequate frequency.interval is shortened to 6 months. .

INVESTIGATIONS IN MALES           History Examination Routine investigation Semen analysis Hormonal assay Testicular biopsy Transrectal USG Karyotype analysis Immunological tests Diagnostic laparoscopy .

FEMALE INVESTIGATIONS          History Examinations Hysterosalpingography Laparoscopy USG Hormonal assay Endometrial biopsy Vaginal cytology BBT CHART .










TREATMENT Reporter: Pamela T. Santos.N. . R.


Bravelle) Gonal. (Clomid.MEDICAL TREATMENT for Infertile Females       Clomiphene citrate (Clomid.Bravelle) Human Chorionic Gonadotropin (Ovidrel. Pregnyl) GonadotropinGonadotropin-Releasing Hormone (Gn-RH) (GnBromocriptine (Parlodel) Parlodel) . Pregnyl) Ovidrel. Serophene) Serophene) Human Menopausal Gonadotropin (hMg) ± Repronex hMg) Follicle Stimulating Hormone (Gonal-F.


which stimulate the growth of an ovarian follicle containing an egg. It causes the pituitary gland to release more FSH and LH. Serophene). Clomiphene (Clomid. . drug is taken orally and stimulates ovulation in women who have polycystic ovary syndrome (PCOS) or other ovulatory disorders. Serophene). This Clomid.

Unlike clomiphene. (Repronex). Bravelle). This drug contains both FSH and LH. This injected medication is for Repronex). women who don't ovulate on their own due to the failure of the pituitary gland to stimulate ovulation. hMG. . stimulating the ovaries to mature egg follicles. FSH works by Gonal. which clomiphene.Bravelle). or hMG. FollicleFollicle-stimulating hormone. or FSH. stimulates the pituitary gland. (Gonal-F. hMG and other gonadotropins directly stimulate the ovaries. gonadotropin.  Human menopausal gonadotropin.

Pregnyl). prolactin. . FSH. Gn-RH analogs deliver Gnconstant Gn-RH to the pituitary gland.   Human chorionic gonadotropin. treatment is for women with irregular ovulatory cycles or who ovulate prematurely ² before the lead follicle is mature enough ² during hMG treatment. hMG and clomiphene. GonadotropinGonadotropin-releasing hormone (Gn-RH) analogs. This (Gnanalogs. Bromocriptine inhibits prolactin production. gonadotropin. Used in combination with clomiphene. Pregnyl). Bromocriptine (Parlodel). whose ovulation cycles are irregular due to elevated levels of prolactin. which alters hormone Gnproduction so that a doctor can induce follicle growth with FSH. the hormone that stimulates milk production in new mothers. This medication is for women Parlodel). this drug stimulates the follicle to release its egg (ovulate). or HCG. (Ovidrel. (Ovidrel.

. Babies born labor. the greater the number of fetuses. These risks are greater for triplets than for twins or single pregnancies. prematurely are at increased risk of health and developmental problems. the fetuses. Generally.Complications of Fertility Drugs   Risk of multiple pregnancies The use of these drugs requires careful monitoring using blood tests. hormone tests and ultrasound measurement of ovarian follicle size. higher the risk of premature labor.



and heat. In the first two cases. keeping the testicles from overheating helps to prevent a low sperm count. . hot. In terms of heat. the fact of the matter is that the testicles tend to produce less sperm when they are too hot. and whirlpools. heat. stopping the drug or alcohol abuse or quitting smoking can often help to resolve a low sperm count. Therefore. hot baths. These factors include things like drug or alcohol abuse.  avoid the environmental factors that can cause a low sperm count. saunas. smoking. This means that the man who is trying to conceive should avoid things like tight underwear.

This results in increased FSH and estrogen. lycopene. all of which are believed to help with sperm production. zinc. LH stimulating testosterone and spermatogenesis. and Vitamin C.  Antiestrogens (clomid and tamoxifen) act on estrogen tamoxifen) receptors in the hypothalamus preventing feedback inhibition by estrogen.  Finally. nutritional and dietary supplements may be effective treatment options for a low sperm count. lycopene. Medically speaking. These would include things like ginseng. . the treatments for a low sperm count tend to be the same as some of the female infertility treatments.

but this usually ameliorates with time. and retrograde ejaculation. failure of ejaculation. or the psychological reaction to infertility. low libido. Infrequent and poorly timed intercourse may result from incorrect advice.6 .COITAL DISORDERS Male coital disorders impacting fertility include erectile dysfunction (impotence). Many men have problems with sexual performance after first learning about their infertility.

such as an antihypertensive or a tranquilizer. Erectile dysfunction may respond to sex behavior therapy. but these are seldom needed in men with infertility. that may be contributing to the sexual disorder should be stopped temporarily or permanently. or cholinergic antihistamines. imipramine. imipramine.Specific Treatment    A drug. intrapenile injections of vasodilators and physical approaches with pumps and rubber occlusion devices to initiate and maintain erections or penile implants. . administration of phosphodiesterase 5 inhibitors. such as brompheniramine or ephedrine. Some men with failure of ejaculation or retrograde ejaculation may be able to ejaculate during intercourse with the administration of phosphodiesterase 5 inhibitors.

are the male gonads.9(25*$1 The epididymis is a whitish mass of tightly coiled tubes cupped against the testicles. tubes that carry sperm to the ampullary gland and prostatic ducts. It acts as a maturation and storage place for sperm before they pass into the vas deferens.0$/(5(352'8&7. The testes. the organs that produce sperm cells . also known as the testicles. The vas deferens also known as the sperm duct is a thin tube approximately 17 inches long that starts from the epididymis to the pelvic cavity.

SURGICAL TREATMENT FOR MALES    Vasoepididymostomy Vasovasostomy Orchidopexy .

. Vasovasostomy is a form of microsurgery first performed by Earl Owen in 1971.Vasovasostomy   connection of the vas to the vas. is a surgery by which vasectomies are reversed.


and the  presence of autoantibodies which disrupt normal sperm activity.  In most cases the vas deferens can be reattached but. the shorter the interval. the higher the chance of success. The likelihood of pregnancy is somewhat lower (30 to 60 percent). . in many cases.  including blockages in the vas deferens.  If blockage at the level of the epididymis is suspected. a vaso-epidymostomy (connecting the vas vasoto the epididymis) can be performed. and can depend on female partner factors. Generally. fertility is not achieved. epididymis) Return of sperm to the ejaculate ranges from roughly 30 to 90 percent. and may depend greatly on the length of time from the vasectomy.  There are several reasons for this.

 Vasectomy reversal can be effective regardless of how long it's been since the original vasectomy. . one may have a lower chance of having enough healthy sperm in one's own semen to father a child. However. if more than 15 years have passed since the original vasectomy.

Vasoepididymostomy   Vasoepididymostomy is a surgery by which vasectomies are reversed. . It involves connection of the severed vas deferens to the epididymis and is more technically demanding than the vasovasostomy. vasovasostomy.

vas-deferensthe covering around the testis is replaced. For a vasectomy reversal that involves a vasoepididymostomy. epididymis is inspected and an individual tubule is selected to enter and connect to the vas deferens. Once the vas-deferens-epididymis connection is completed. vasoepididymostomy. . the findings from the vasal fluid are reviewed showing epididymal obstruction. This ³inner´ layer is supported with an ³outer´ layer of radially placed 9-0 sutures 9to strengthen the connection.   an opened epididymal tubule is connected to the cut end of the vas deferens with 4 to 6 small (10-0) simple sutures placed (10around the circumference of each. The (tunica vaginalis). the epididymis is exposed by opening the outer testis covering (tunica vaginalis).


typically before they reach the age of two. It is performed by a pediatric urologist or surgeon cryptorchidism.Orchiopexy (or orchidopexy) orchidopexy)  surgery to move an undescended testicle into the scrotum and permanently fix it there. Some patients remain undiagnosed until their teenage years and undergo the surgery at that time. on boys with cryptorchidism. .


If caught early enough and the blood torsion. If the blood supply has been interrupted for too long. the less successful the procedure. and through other small opening(s) performs the procedure. then an orchiectomy must be performed  . The undescended testicle may be located within the normal line of descent (for example. in the inguinal canal) canal) or high in the scrotum or ectopically . However. The higher the testicle. this operation can be performed to prevent further occurrence of torsion. Orchiopexy can also be performed to resolve a testicular torsion.The surgeon may use an endoscope through the umbilicus to locate the testicle. supply can be restored to the testicle. the procedure has a high success rate overall.


ASSISTED REPRODUCTIVE TECHNOLOGY( females) Intra uterine insemination (IUI)  In vitro fertilization & embryo transfer (IVF(IVF-ET)  Gamete intra fallopian transfer (GIFT)    Zygote intrafallopian transfer (ZIFT) Intracytoplasmic sperm injection .

 is the process by which sperm is placed into the reproductive tract of a female for the purpose of impregnating the female by using means other than sexual intercourse or NI. Intrauterine Insemination eg. .Artificial Insemination eg. NI.

and the sperm donor is the genetic or biological father of the child.  This is done using either sperm from the woman's male partner or sperm from a sperm donor (donor sperm) in cases where the male partner produces no sperm or the woman has no male partner (i. In cases where donor sperm is used the woman is the gestational and genetic mother of the child produced.. single lesbians). women and lesbians). .e.

where a woman has no male partner mothers. or sperm which has been frozen and thawed. is placed in the cervix (intracervical insemination ± ICI) and into the female's uterus (intrauterine insemination ± IUI) by artificial means. Today.  In humans. and the sperm is provided by a sperm donor. freshly ejaculated sperm. donor. the process is also and more commonly used in the case of choice mothers.Specifically. (video)  . artificial insemination was originally developed as a means of helping couples to conceive where there were 'male factor' problems of a physical or psychological nature affecting the male partner which prevented or impeded conception.

fertilizing them with a man's sperm in a dish in a laboratory and implanting the embryos in the uterus three to five days after fertilization. . IVF involves retrieving mature eggs from a woman.In vitro fertilization (IVF)  This is the most effective ART technique.

cervical factor infertility. .Recommended for:  Women wherein both fallopian tubes are blocked. unexplained infertility. Possible Complication  IVF increases your chances of having more than one baby at a time because multiple fertilized eggs are often implanted into your uterus so that there is a greater chance one will develop into a baby. such as endometriosis.  It's also widely used for a number of other conditions.  IVF also requires frequent blood tests and daily hormone injections. male factor infertility and ovulation disorders.

and placed in one of tubes. fertilization to take place inside the woman's uterus. along with the man's sperm. allows Asch. the Fallopian tubes.Gamete intrafallopian transfer (GIFT)  is a tool of assisted reproductive technology against infertility.[1] . The technique. which was pioneered by endocrinologist Ricardo Asch. Eggs are infertility. removed from a woman's ovaries.

First. The ovaries. It takes. and placed back into the woman's Fallopian tubes using a laparoscope. the woman must take a fertility drug to stimulate egg production in the ovaries. be harvested approximately 36 hours later. laparoscope. doctor will monitor the growth of the ovarian follicles. on average. mixed with the man's sperm. . four to six weeks to complete a cycle of GIFT. the woman will be injected with Human chorionic gonadotropin (hCG). The eggs will hCG). and once they are mature.

fertilised. The procedure is a spin-off of the gamete spinintrafallopian transfer (GIFT) procedure. and in vitro fertilised.Zygote intrafallopian transfer (ZIFT)  is an infertility treatment where a blockage in the fallopian tubes prevents the normal binding of sperm to the egg. ovaries. Egg cells are removed from a woman's ovaries. . The resulting zygote is placed into the fallopian tube by the use laparoscopy. ZIFT has a success rate of 64. of laparoscopy.8% in all cases.

harvested approximately 36 hours later. The doctor will monitor the growth of the ovarian follicles. the woman will be injected with human chorionic gonadotropins (hCG). the woman must take a fertility medication to stimulate egg production in the ovaries. After fertilization in the laboratory the resulting early embryos or zygotes are placed into the woman's fallopian tubes using a laparoscope . First. usually retrieval. It takes. The eggs will be hCG). five weeks to complete a cycle of ZIFT. by transvaginal ovum retrieval. and once they are mature. on average.


Intracytoplasmic sperm injection (ICSI)   is an in vitro fertilization procedure in which a single sperm is injected directly into an egg. egg. . This technique consists of a microscopic technique (micromanipulation) in which a single sperm is injected directly into an egg to achieve fertilization in conjunction with the standard IVF procedure.

For men with low sperm concentrations. ICSI has been especially helpful in couples who have previously failed to achieve conception with standard techniques. ICSI dramatically improves the likelihood of fertilization (vide0) .

Surgical Interventions for Females .

tumor). refers fibroidectomy.Myomectomy  sometimes also known as fibroidectomy. . also known as fibroids (non(non-cancerous tumor). leiomyomas. to the surgical removal of uterine leiomyomas. In contrast to a hysterectomy the uterus remains preserved and the woman retains her reproductive potential.


conditions such as:      Endometriosis .Operative Laparoscopy  operative laparoscopy is done to help diagnose. such as ovarian cysts Fibroids These medical conditions often causes infertility .endometrial-like endometrialcells which appear and flourish in areas outside the uterine cavity Pelvic adhesions .thin or stretched scar Ectopic pregnancy Pelvic or ovarian masses. and treat.


Complications and Ethical Issues on Infertility and Treatment .


If overstimulated. Severe cases require emergency treatment. Rarely. Younger women and those who have polycystic ovary syndrome have a higher risk of developing OHSS than do other women. causing abdominal swelling and shortness of breath. although pregnancy may delay recovery. This accumulation of fluid can deplete blood volume and lower blood pressure. If too many babies are conceived. overstimulated. Ovarian hyperstimulation syndrome (OHSS). fetuses.Complications of treatment   Multiple pregnancy. a woman's ovaries may enlarge and cause pain and bloating. Mild to moderate symptoms often resolve without treatment. . the removal of one or more fetuses (multifetal pregnancy reduction) is possible to improve survival odds for the other fetuses. fluid accumulates in the abdominal cavity and chest. The most common complication of ART is multiple pregnancy.

Low birth weight.   Bleeding or infection. As with any invasive procedure. Birth defects. . The greatest risk factor for low birth weight is a multiple pregnancy. there is a risk of bleeding or infection with assisted reproductive technology. More research is necessary to confirm this possible connection. There is some concern about the possible relationship between ART and birth defects.

. host of health problems. premature birth. provoking ethical analysis because of the link between multiple pregnancies. and a birth. embryos not transferred in vivo. IVF and other fertility treatments have resulted in an increase in multiple births.Ethical Issues on Infertility and its Treatment    HighHigh-cost treatments are out of financial reach for some couples. births. ProPro-life opposition to the destruction of vivo.

" The Vatican instruction argues that reproductive technology tempts man "to go beyond the limits of a reasonable dominion over nature.  Religious leaders' opinions on fertility treatments ("respect for human life and its origins and on the dignity of procreation³ )." . "God¶s way is still the best way.

then fertility treatments for men with ICSI) abnormal sperm (in particular ICSI) only defer the underlying problem to the next male generation. . Infertility caused by DNA defects on the Y chromosome is passed on from father to son. If natural selection is the primary error correction mechanism that prevents random mutations on the Y chromosome.

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