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Infertility

Inability to conceive a child or sustain a pregnancy to childbirth Pregnancy has not occurred after at least 1 year of engaging in unprotected sexual intercourse Affects 14% of couples desiring children

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Types of infertility:

Primary infertility - refers to a couple who has never established a pregnancy Secondary infertility - refers to couple who has conceived previously but are currently unable to establish a subsequent pregnancy

Male Infertility Factors

Inadequate sperm count Obstruction or impaired sperm motility Ejaculation problems

Male factor:
Obstruction in seminiferous tubules , duct, or vessels preventing movement of spermatozoa Qualitative or quantitative changes in the seminal fluid preventing sperm mobility (movement of sperm). Problem in ejaculation or deposition preventing spermatozoa from being placed close enough to the woman’s cervix to allow ready penetration and fertilization.

– Causes of inadequate sperm:
Chronic infection Congenital anomalies Varicocele Increase in body temperature Trauma to the testes Endocrine imbalances Drug or excessive alcohol use Environmental factor

–Obstruction or impaired sperm motility: – Mumps or orchitis – Anomalies of the penis – Extreme obesity

Female Infertility Factors

Cervical problems Vaginal problems Unexplained infertility

Ovarian factor:
Anovulation- most common cause of infertility in women 1. genetic abnormality 2.hormonal imbalance 3. ovarian tumor 4. stress 5.decreased body weight

Tubal factor:
– Pelvic inflammatory disease

Uterine factor:
– – – – Tumor ( fibroma) Congenitally deformed uterine cavity Endometriosis Inadequate endometrium formation

Common Sites 0f Endometriosis Formation

Cervical factor:
– Characteristic of cervical mucus – Infection/inflammation of cervix

Coital factor :
– pH of the vagina: alkaline pH is optimum (8) – Presence of sperm-immobilizing/sperm agglutinating antibodies

Fertility Assessment
Fertility testing
Semen analysis Ovulation monitoring Tubal patency assessment

Semen Analysis
Number of sperm Appearance of sperm Motility of sperm Sperm penetration

semen analysis:
– count: 20 million / ml or 50 million /ejaculation – volume: 2.5ml - 6 ml – Motility: >75% – Quality of motion: graded 1-4 (poor to excellent) – Morphology: more than 70% normal

Ovulation Monitoring
Record basal body temperature Ovulation by test strip
Assesses upsurge of LH that occurs before ovulation

Tubal Patency
Sonohysterography
Ultrasound to inspect uterus

Hysterosalpingography
Radiologic exam of fallopian tubes

Infertility evaluation:
Male factor: Semen analysis Post-coital test-mucus is examined microscopically between 2- 12hrs after coitus –Satisfactory test- many motile spermatozoa seen per high power field –Unsatisfactory result: No spermatozoa are seen Majority of spermatozoa are immotile Very few spermatozoa are present
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Motility is characterized as shaking movement rather than forward movement Hostile cervical mucus is present

– Sperm antibodies: maybe measured in
– Seminal plasma – Male serum – Female reproductive tract fluids – Female serum

– Test of fertilizing capacity of spermatozoa: Measurement of sperm acrosin-enzyme in sperm head that responsible for preliminary changes in the sperm zona-free hamster ovum penetration test Human ovum fertilization test Coital factor: Taking history of coital frequency, pattern and technique Anatomic evaluation of the position of the cervix with relationship to the vagina Post coital testing .

Cervical factor:
– Cervix is the first major barrier encountered by sperm after arrival in the female reproductive tract 1.Abnormalities in the cervix or the cervical mucus – Abnormal position of the cervix( prolapse or uterine retroversion – Chronic infection – Previous cervical surgery – Presence of sperm antibody in the cervical mucus

2.mucus quality: - pH -bacteriologic culture for microorganism
Uterine factor: * role of uterus in reproduction: - retention of the zygote after arrival from the fallopian tube - provision of suitable environment for implantation - protection of embryo /fetus from the external environment

– Hysterography- visualize contour of the uterine cavity – Hysteroscopy –visualize uterine cavity to detect anomalous development, polyps or tumors

Tubal factor: - functions: 1.mechanical function- act to : -conveys recently ovulated ova into fallopian tube -permits spermatozoa to enter the oviduct -effects transfer of the blastocyst into the uterine cavity

Ovarian factor: -function: serve as repository for oocytes, they
release mature oocytes at regular interval throughout reproductive life - secrete steroid hormones that influence the structure and function of tissue in reproductive tract, promoting fertility

*documentation of ovulation: a. basal body temperature records demonstrate a 14 day elevation of basal temp.( progesterone-thermogenic effect) b. Blood progesterone level c. endometrial biopsy- secretory endometrial pattern

Treatment : – Correction of male factor: a. Medical - correction of underlying deficiencies - artificial donor insemination b. surgical - reversal of sterilization - varicocele surgery

c. assisted reproductive technologies 1. in vitro fertilization and embryo transfer IVF) 2. gamete intrafallopian tube transfer(GIFT) 3. assisted fertilization

– Correction of ovarian factor: 1. induction of ovulation: - correction of underlying endocrine disorder - clomiphene citrate to correct hypothalamic function - human menopausal gonadotropin - bromocryptine for anovulation due to prolactin excess - glucocorticoids for androgen excess

Assisted Reproductive Techniques

Artificial insemination In vitro fertilization Gamete intrafallopian transfer Zygote intrafallopian transfer Surrogate embryo transfer

Artificial insemination – instillation of sperm into the female reproductive tract to aid conception - technique of micromanipulation that thins the zona pellucida and inject sperm into the ovum in an effort to enhance fertilization In vitro fertilization (IVF)– removing 1 or more mature oocytes from a woman’s ovary by laparoscopy and then fertilizing them by exposing them to sperm under laboratory conditions outside the woman’s body (placed on a dish together with the sperm)

Embryo Transfer (ET)– ova transfer; insertion of laboratory grown fertilized ovum into the woman’s uterus approx. 40 hours after fertilization where 1 or more of them will implant and grow
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ARTIFICIAL INSEMINATION

IN VITRO FERTILIZATION

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Gamete intrafallopian transfer (GIFT) –
ova and sperm are instilled in the patent fallopian tube within a matter of hours without waiting for the fertilization to occur in the laboratory

Zygote intrafallopian transfer (ZIFT) –
retrieval of oocytes, culture and insemination of oocytes in the laboratory; fertilized eggs are transferred in the patent fallopian tube within 24 hours

Surrogate embryo transfer –oocyte from a donor is fertilized by the recipient woman’s male partner’s sperm and placed in the recipient’s uterus by ET or GIFT Intravaginal culture Blastomere analysis

ALWAYS KNOW YOUR DATE

END

Thank You!
Good Luck!

Happy Oathtaking!

Sexuality and Sexual Identity

Terms
Biologic gender-chromosomal sex male: XY female: XX Gender identity/ sexual identity-inner sense of being a male or female Gender role- male or female behavior a
person exhibits
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Sexual Orientation
Heterosexuality-opposite sex Homosexuality- same sex Bisexuality- both sex Transsexuality- person of one biologic gender, feels as if he/she should be of the opposite gender
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Sexual Expression
Celibacy- abstinence from sex Masturbation-self stimulation for erotic pleasure Erotic stimulation-use of visual materials for sexual arousal Fetishism-sexual arousal from objects or situation
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Sexual Expression
Transvestism-dresses to take on the role of the opposite person Voyeurism-peeping tom Sadomasochism:sadism-inflicting pain;masochism-receiving pain

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Necrophilia – sex with the dead Zoophilia/ Bestiality– sex with animals Urophilia – sex after urinating the partner Pedophilia – sex with children Exhibitionism Cuprophilia – sex after defecating the partner

Sexual Harassment
Unwanted, repeated sexual advances, remarks or behavior toward another
Offensive to recipient Interferes with job performance TYPES: 1. quid pro quo/equal exchange 2. hostile work environment
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Disorders of Sexual Functioning

Sexual Desire Disorders- lack of desire for sexual relation
Inhibited sexual desire

Sexual Arousal Disorders
Failure to achieve orgasm

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Disorders of Sexual Functioning
Orgasm Disorders Erectile dysfunction/impotence causes: aging, atherosclerososis, diabetes mgt: sildenafil (viagra), tadalafil ( cialis) Premature ejaculation Pain Disorders - Vaginismus-involuntary contraction - Dyspareunia/Vestibulitis

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