-
Infertility statistics
- • 15% of married couples of child-bearingage in the USA are considered infertile
- • 35% of cases are due to mother
- • 35% of cases are due to father
- • 20% of cases are due to both parents
- • 10% of cases the cause is unknown
-
INFERTILITY DIAGNOSED and TREATED
- • Cause of infertility can bediagnosed in up to 90% of cases
- • 50-60% of these cases can betreated successfully
-
FEMALE INFERTILITY BTWN. 20-39
- • 4.1% between 20-24 years
- • 5.5% between 25-29 years
- • 9.4% between 30-34
- • 19.7% between 35-39
-
WHAT ARE REASONS FOR FEMALE INFERTILITY?
- • Failure to ovulate
- • Tubal blockage
- • Failure to implant
- • Pregnancy loss (miscarriage)
- • Reduced sperm transport
- • Antibodies to sperm
-
FAILURE TO OVULATE, why?
main cause of infertility in women
- • Main cause of infertility inwomen
- • Hypothalamus (GnRH) orpituitary gland (LH, FSH) maynot be functioning adequately
-
TREATMENT OF FAILURE TO OVULATE:
- • GnRH stimulatory agonists can induce ovulation
- • Anti-estrogen e.g., Clomiphene (clomid) istaken orally and it inhibits the negative feedback of estrogens on GnRH, FSH &LH secretion (30 - 50% success rate)
- • Human menopausal gonadotropin whichcontains LH & FSH followed by hCG (which has similar effect
-
POLYCYSTIC OVARY DISEASE:
- • Obesity
- • Hirsutism
- • Virilization
- • Anovulation
- • Infertility
- • Amenorrhea or oligomenorrhea
- • Often have anovulatory spontaneousuterine bleeding
- • Increased insulin resistance and increasedrates of Type 2 diabetes mellitus
-
POLYCISTIC OVARY DISEASE details:
- • Combination of obesity and elevated levels of adrenal androgens leads to increased extraglandular aromatization to produce increased estrogen (estrone)
- • The increased estrogen level causes a NEGATIVE feedback effect on FSH which prevents the maturation of follicles and hence there is NO graafian follicle formation and NO ovulation
- • Simultaneously, it is believed that elevated estrogen causes a POSITIVE feedback on LH which results in an INCREASE in ovarian androgen production
- • Hence, there is an increase in BOTH ovarian and adrenal androgens which causes hirsutism/virilization and leads to increased levels of extra-glandular aromatization to produce increased estrogen (estrone)
- • The greater the obesity, the more strongly this sequence is perpetuated
-
POLYCISTIC OVARY DISEASE effects:
- • ↓ FSH
- • ↑ LH
- • ↑ adrenal and ovarian androgens
- • ↑ acyclic estrone (produced by aromatization)
- • ↓ cyclic estradiol
-
What is TUBAL BLOCKAGE?
- • 2nd leading cause of infertility in females
- • Blockage in oviduct blocks the passage of sperm or ova
- • Can be caused by scarring from sexually transmitted Infection e.g.,Chlamydia or Gonorrhea
- • Endometriosis is a condition where endometrium tissue grows outside of the uterus, such as inside the oviduct where it can cause scarring and blockage
-
TREATMENT of tubal blockage:
- • Gas (CO2 or air) injected into tubes
- • Transcervical balloon tuboplasty:balloon is inserted into obstructed tube and is inflated
- • Surgical repair, usually by laparoscopy
-
WHAT is absence of implantation and how is it treated?
- • A normal preembryo may reach theuterus, but the uterine surface is notreceptive to implantation
- • This problem can be treated effectivelyin some women by priming the uteruswith appropriate doses of estrogen andprogestogen
-
Pregnancy loss/miscarriage
- • 50 - 75% of all fertilized eggs do not complete development and many are lost before or soon after implantation, before the women realize that they are pregnant
- • 15% of known pregnancies end in miscarriage
- • Most early miscarriages occur because ofchromosomal abnormalities
- • Other early miscarriages have normal chromosomes and may occur for immunological reasons. Research is being conducted to understand if the parental major histocompatibility(MHC) antigens play a role in this.
-
Reduced sperm transport or antibodies to sperm
- • Female reproductive tract may not allowtransport of sperm due to hostilecervical mucus. This condition may bealleviated with estrogen.
- • Females vagina may be highly acidicwhich kills the sperm. This condition can be remedied with alkaline douches.
- • Some women may produce antibodiesto their male partner’s sperm
-
2 reasons for MALE INFERTILITY:
- • Low sperm count
- • Poor sperm transport
-
Male infertility from low sperm count
- • Leading cause of infertility in men
- • Inadequate functioning hypothalamusor pituitary gland may result inoligospermia (low sperm count) orazoospermia (absence of sperm)
- • Can be treated with GnRH stimulatoryagonists, gonadotropins, or the antiestrogenclomiphene
- Testes may not be capable of responding to gonadotropins because of damage from:
- • physical injury
- • cryptochodism (non-descended testes)
- • past infection of testes (e.g., mumps)
- • exposure to radiation or chemotherapy
- • exposure to environmental toxins
- • 8-13% of infertile men produceantibodies against their own sperm,because at some time sperm hadentered the body tissues outside ofreproductive tract
- • 1 in 1000 men are infertile becausethey are missing part of the Ychromosome
-
Causes of low sperm count
- • Smoking
- • Xenoestrogens
- • Anabolic steroids
- • Excessive alcohol consumption
- • Tight underwear
-
Male infertility from low sperm count
- • 8-13% of infertile men produce antibodies against their own sperm,because at some time sperm had entered the body tissues outside of reproductive tract
- • 1 in 1000 men are infertile because they are missing part of the Ychromosome
-
Assisted reproductivetechniques (ART)
- • Artificial insemination (AI)
- • In vitro fertilization (IVF)
- •Pre-implantation genetic diagnosis (PGD)
- • Gamete or zygote intra-fallopian transfer(GIFT)
- • Surrogate mothers and gestational carriers
-
Artificial insemination (AI)
- • When sperm are introduced into a woman’s reproductive tract by means other than coitus
- • Donor sperm may be from mom’s partner
- • Sperm may be donated from sperm bank
- • Donors typically masturbate and put sperm into a vial or ejaculate into a special condom during intercourse
-
In vitro fertilization (IVF) (Fig 16-3)
- • Egg retrieval is achieved by ovarian stimulation with gonadotropins or clomiphene
- • Ultrasound identifies mature follicles from which eggs can be harvested
- • Mom’s egg is fertilized by sperm outside of the body in a petri dish
- • Fertilized eggs are incubated for 5 days when the preembryo becomes a blastocyst
- • 2-3 or more tiny preembryos are inserted throughthe cervix into the uterus
- • Any remaining eggs and preembryos can befrozen for possible use in future IVF cycles
-
In Vitro Fertilization success rates:
- • Success rate per IVF cycle is 25 -30%
- • 35 - 40 % of births resulting from IVFare multiple babies (twins or more)
-
Preimplantation genetic diagnosis(PGD)
- • Genetic testing of a single cell taken from apreembryo prior to transfer of the embryo to the uterus during IVF
- • Used to screen preembryos for inheritedgenetic disorders
- • Average cost of each IVF/PGD cycle is over$20,000
-
Gamete (GIFT) or zygote (ZIFT)intrafallopian transfer (Fig 16-3)
- • Used in women with blocked oviducts orinfertile couples who wish to avoid fertilization outside of the the body
- • Via laparoscopy, egg and sperm or zygote are inserted into the oviduct proximal to thepoint of
- blockage so that fertilization and implantation can occur
- • Success rates for GIFT and ZIFT are 25 -30% which is similar to IVF
-
Surrogate mothers &gestational carriers (Fig 16-3)
- • Surrogate mother is inseminated by sperm of donor father, gets pregnant and delivers the child, and gives the child to the couple with whom she has a contract
- • Surrogate Mom is biological mother
- • Gestational carrier has a preembryo implanted in her uterus and she gestates and delivers this
- baby for the couple or person with whom she has a contract
- • Gestational carrier is not genetically related to the baby
|
|
