Infertility

Dr. Saud H. Surbaya

 Definition

 The inability to conceive following unprotected sexual

Intercourse for
 • 1 year (age < 35) or 6 months (age >35)
 • Affects 15% of reproductive couples
 • Men and women equally affected
 Classification

 Primary infertility
a couple that has never conceived
 • Secondary infertility
infertility that occurs after previous pregnancy regardless
of outcome
Infertility etiologies

 Female ::
1- ovulation disorders
2- tubal, uterine or cervical factors
3- fibroids
4- endometriosis
5- autoimmune disorders ( DM, thyroid diseases )
6-eating disorders
Workup
 Complete Hormonal Evaluation

 • dehydroepiandrosterone sulfate (DHEAS),

 • Luteinizing Hormone
 • Follicle Stimulating Hormone
 • Estradiol
 • Progesterone
 • Prolactin
 • Testosterone
 • AMH
 Thyroid function tests
FSH

 FSH results can be increased with use of certain drugs,

including
 • cimetidine,
 • clomiphene,
 • levodopa.
 FSH results can be decreased with
 oral contraceptives,
 phenothiazines,
 and hormone treatments.
 Estradiol

 a level in the range of 150 to 500 pg/ml is reasonable for the

eighth day of a stimulated cycle.
 doubling of this level every 48 hours - sign of continued good
follicle development.
 failure to rise estradiol means :
follicles are not responding appropriately, and the oocytes
within will not be of good quality.
 illnesses ::
 HTN, anaemia, and impaired liver and kidney function
can affect estradiol levels.
 Drugs increasing esradiol ::
 Gluco-corticosteroids,
 ampicillin,
 estrogen-containing drugs,
 phenothiazines,
 and tetracyclines
LH

Levels increase due to ::

 anticonvulsants,
 clomiphene
while others cause LH to decrease ::
 oral contraceptives,
 digoxin
 Prolactin

Levels can rise::

 after exercise,
 high-protein meals,
 minor surgical procedures,
 following epileptic seizures
 due to physical or emotional stress
 Progesterone

Increases with:
 luteal ovarian cysts
 molar pregnancies, and
 with a rare form of ovarian cancer.
Androgen

 Testosterone is probably the most well-known androgen

and it affects the sexual functioning of both men and
women.
 Alcoholism and liver disease in males can decrease
testosterone levels.
 Drugs, including androgens and steroids, can also
decrease testosterone levels.
 Drugs rising testosterone levels:
anticonvulsants,
barbiturates, and
clomiphene
DHEAS
increase DHEAS levels
 Certain antidiabetic drugs (such as metformin, pioglitazone),
 prolactin,
 danazol,
 calcium channel blockers, and
 nicotine
Decrease levels include
 insulin,
 OC,
 corticosteroids,
 dopamine,
 hepatic enzyme inducers (carbamazepine, imipramine,
phenytoin),
 fish oil,
 and vitamin E.
Infertility etiologies

 Male::
1. Testicular injury
2. Exposure to chemicals or toxins
3. Use of anabolic steroids
4. Hormonal imbalances
5. Klinefelter syndrome
Semen Analysis
 Sperm morphology (size and shape).
Includes:
- an assessment of the head size,
- the midpiece appearance and the structure of the tail.
 Sperm motility (movement).
two aspects:
1. the activity of the sperm, looking for at least 40 percent
of the sperm to be active to be considered normal.
2. the quality of the movement.
 Semen volume (concentration).
 Low volume can indicate
1. a possible blockage,
2. an inadequately collected sample,
3. retrograde ejaculation and
4. dysfunction in the seminal vesicles or prostate.
 Sperm count.
The technical term for low sperm count is oligospermia.
Thanks !