Fertility Facts

Definition:unprotected sex for one year, not pregnant

Frequency: 1 out of 6 couples in the US
Responsibility: 35% female infertility
35% male
20% both
10% unknown
Maternal Age USA
20-24 4.1% 30-34 9.4%
25-29 5.5% 35-39 19.7%

85% treated successfully Increase 1970-now-Why?

 What can cause infertility?
Unexplained-18%
Female Male
• Ovulation disorders • Sperm count and
• Tube/uterus blockage defects
• Cervix • Erectile or ejaculation
• deficiency
Endometriosis
• Other

Intrinsic vs. Extrinsic, Environmental

More detail on female infertility
• Ovulatory failure-polycystic ovarian syndrome (high
androgen/estrogenlevels), resistant ovarian syndrome,
gonadal dysgenesis
• Impaired gamete/zygote transport-pelvic inflammatory
disease, endometriosis
• Implantation defects-progesterone low
• Spontaneous abortion-chromosome abnormality
 More detail on male infertility
•Cryptorchidism-Why?
•Chromosome disorders-gonadal dysgenesis
•Obstructions
•Gonadotropin deficiency
Result in:Low sperm count, sperm of poor
quality
 Female Infertility Tests
• For ovulation
• Basal body temperature
• Ovulation kit (LH surge)
• Other hormone tests (steroids)

• Post ovulatory block

•Laparoscopy-fiber optic look
•Hysterosalpingogram-dye
•Post-coital /cervical mucous and sperm
•Sperm antibodies
•Endometrial biopsy
Sperm good for 2-3 days, egg for 2
Can find adhesions, structural abnormality, etc
Hysterosalpingogram

Blocked tubes
 Male Infertility Tests
• Sperm count/motility
– > 20 million sperm/ml
– Check motility and morphology
• >50% motile
• >30% structurally normal

• If low check LH and androgen levels

•Testicular biopsy
Sperm Count
 Older, low tech treatments
• Drug treatment for ovulation block
• Intrauterine insemination
• Tubal surgery
High tech Assisted Reproduction Technologies
• IVF-in vitro fert and embryo transfer
•GIFT-gamete intrafallopian tube transfer
•ZIFT-zygote intrafallopian tube transfer
•Intracytoplasmic sperm injection
frozen eggs/ ovary transplant; cloned human embryo
First test-tube
baby
Assisted Reproductive Technology

• Estimate 1/100 births now

• Around 40,000/year
• Costs between $7,000 to 15,000 per attempt
 IVF

In Vitro Fertilization and Embryo

Transfer
Basic Steps in IVF

•Ovary stimulation
•Egg retrieval
•Sperm retrieval-wash sperm
•Fertilization
•Embryo transfer
•Progesterone
 Start with more than 1 egg
Drugs used for ovary stimulation

•Clomiphene (clomid)-anti-estrogen
•hMG (pergonal)-menopausal gonadotropin (FSH and LH)
•FSH-(metrodin)
•GnRH
•GnRH agonists (lupron)-FSH/LH first promoted, then inhibited
•hCG-acts like LH

In a single cycle, could take clomid, pergonal, hCG

shot, then progesterone
 Why transfer more than one
embryo?
• Increase the pregnancy rate

• Leads to increased risk of multiple

pregnancies
• In future- Test embryos before transfer
sHLA-G measure of embryo health
Egg retrieval, vaginal, with ultrasound
Modifications if tube not blocked

Gametes mixed for GIFT

GIFT
If fertilization needs help-transfer zygote
ZIFT
Intracytoplasmic sperm injection
ICSI
 Additional twists
• Surrogacy
– Gestational
– Egg donor plus gestational
– Egg donor plus sperm donor plus gestational
• Frozen embryos
• Egg donors
• Frozen eggs
• Cloning
From CDC
 IVF Success Rates

Stage Number of Women

Cycle initiation 100
Ovulation 95
Oocyte retrieval 90
Fertilization 85
Embryo Transfer 70
Pregnancy 24
Birth 18
From The Baby Business by Debora Spar
 Risks of ART?
• To woman
– Overstimulation of ovary syndrome
– Multiple pregnancies
– Risk of ovarian cancer (clomid, pergonal)
• To baby
– ICSI associated with problems (XYY)
 Discussion questions-what treatment(s)
would you select given the following:
• Male with low sperm count
• 30 year-old female not ovulating
• 40 year-old female not ovulating
• Undiagnosed infertility