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Follicle Stimulating Hormone (FSH)
is secreted from the pituitary and acts on the ovaries to recruit eggs.
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When the egg reserve declines with age, the _________ __________ by producing a higher level of ____ to make eggs available for the cycle.
The pituitary compensates; FSH
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A high _______ level at the beginning of the cycle reflects a diminishing egg supply.
FSH
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FSH level should be less than ____________ on cycle day 2 or 3.
10 mIU/ml
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A baseline FSH level higher than __________ is rarely associated with pregnancy even with aggressive treatment.
15 mIU/ml
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Antimullerian Hormone (AMH)
is secreted from the antral follicles of the ovaries and correlate with the egg reserve.
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Women with higher AMH values tend to have more ?
eggs and thus respond better to ovarian stimulation.
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Unlike FSH which has to be drawn at the beginning of the cycle, AMH level can be checked
at any time of the cycle.
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An AMH level of __________ or higher is considered to be normal.
1.0 ng/ml
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For women with very low egg reserve (AMH <0.5 ng/ml and <5 antral follicles) the high cost of medications and low chance of success would make IVF very cost ineffective.
Their treatment should be limited to ovulation induction or donor egg IVF.
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A careful history can often suggest the cause of
infertility
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Irregular periods can indicate problem with?
ovulation.
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Short cycles (<25 days) can be early signs of?
diminished ovarian reserve (aging ovaries).
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Long cycles (>35 days) are usually caused by emotional or physical stress and are easier to treat with?
medications.
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Excessive facial or body hair, weight gain, or milky breast discharge can indicate?
hormonal imbalances that can impair ovulation.
-
symptoms that are often found in polycystic ovary syndrome and thyroid conditions?
excessive facial or body hair, weight gain, milky breast discharge
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Prior STD treatment for chlamydia, condyloma (HPV), herpes, or syphilis can suggest?
tubal damage and pelvic adhesions.
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Prior abnormal Pap smear with treatment to the cervix such as conization, cryosurgery, or LEEP can result in?
cervical stenosis or constriction of the cervix that can impede the movement of sperm into the uterus, where they can survive for several days.
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Pain during menstruation or intercourse can indicate?
endometriosis
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What is endometriosis?
a condition in which menstrual implants colonize the pelvis outside of the uterus.
-
These implants can lead to scarring of the pelvic structures causes?
impairing the ability of the tubes to pick up the egg.
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Heavy menstrual flow (with clots) can indicate?
abnormalities within the uterine cavity such as fibroid tumors or polyps
-
Fibroid tumors or polyps can prevent?
embryo implantation through their destabilizing effect on the endometrium.
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Recurrent miscarriages can indicate?
multiple problems and will require extensive testing.
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Prior abdominal operations such as appendectomy, myomectomy, or tubal surgery can suggest?
pelvic adhesions and tubal problems.
-
Hormonal Evaluation is conducted to assess?
ovarian function
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Prior male reproductive surgery such as varicocele repair, hernia repair, and vasectomy reversal can lead to?
development of anti-sperm antibodies.
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Sperm are considered as foreign by the?
immune system
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Surgeries can cause a break of the _________ _______ _________ to allow sperm to enter the vascular system and be recognized by the immune system.
semen-blood barrier
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Anti-sperm antibodies can bind to the head of the sperm to prevent?
fertilization or bind to the tail to impair motility
-
Prior male reproductive infections that involve the prostate, the epididymis, and the testes can lead?
to production of anti-sperm antibodies.
-
pus in the semen can lower?
sperm viability
-
History of diabetes or hypertension can make a man susceptible to ?
erectile dysfunction and sexual difficulty
-
Antihypertension drugs such as the calcium channel blockers can impair ?
- sperm motility and fertilization potential by impeding the movement of calcium ion
- Alternative medications should be used if possible.
-
Decreased libido may suggest a?
hormonal imbalance
-
Abnormal release of pituitary hormones can lead to?
- suboptimal production of testosterone
- leading to abnormal sperm production
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Semen Volume
normal semen volume is 2-4 ml.
-
Low volume semen can result from?
- dehydration
- faulty collection technique.
-
Persistent low volume (? 1 ml) can indicate?
retrograde ejaculation
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Retrograde ejaculation?
a condition in which the semen flows backward into the bladder during ejaculation
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Semen Concentration
The normal sperm concentration is >20 million per ml of semen.
-
Concentration less than 15 million/ml usually requires IVF
Sperm concentration is a critical factor.
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Sperm Motility
At least 50% of sperm must be motile in order for the sample to be normal.
-
motility > 30% is usually sufficient for __________, provided that the sperm count is adequate.
IUI
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Motility < 30% usually requires
- IVF
- Sperm motility is a critical factor
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Morphology – Using the Kruger strict criteria?
the structure of the sperm can be rigorously evaluated.
-
Normal semen has at least _____ of sperm with perfect morphology.
7%
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Morphology values of 3%-6% are ?
- ‘subnormal’ but can still lead to pregnancy without requiring IVF.
- Morphology of < 2% usually requires IVF/ICSI.
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Progression
assesses the ability of sperm to move forward.
-
Sperm have to move forward in order to reach the egg and to successfully penetrate?
the shell of the egg for fertilization.
-
what is Direct anti-sperm antibody screen?
checks for the presence of antibodies in the semen
-
Antibodies that attach to the tail can ______ sperm motility while those bound to the head can prevent ____________
impair ; fertilization
-
The presence of significant ________-________ ____________ usually means IVF as treatment.
anti-sperm antibodies
-
If the first semen analysis is abnormal,
a second analysis is required to confirm.
-
Cystic fibrosis screening?
Cystic fibrosis is a genetic disease that impairs the ability of the body to make secretions.
-
CF Affected individuals produce _______ _______ in the lungs and GI tract making them susceptible to serious infections.
Thick mucus
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Men who have no sperm in the semen due to occlusion or absence of the ____ _________ have 1 in 4 risk of having the mutations and should be tested.
vas deferens
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Chromosomal analysis
Some men with severely low sperm count <3 million/ml may have abnormal chromosomes and their sperm should not be used
-
Y deletions mutation in men with severely low sperm count
- <3 million/ml, certain regions of the Y chromosome that are responsible for sperm production may be missing
- these mutations can be passed to the male offspring.
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Sperm Chromosome Structural Assay?
measures the prevalence of DNA fragmentation within the sperm head.
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Vitrification:
freeze embryos by taking cells from room temperature to -196 degrees C in a fraction of a second
-
vitrification completely avoids formation of
ice crystals.
-
The results are higher rates of embryo survival and live births with?
vitrifiction
-
With some modifications, the vitrification process for embryos can be
adapted to allow successful freezing of oocytes (eggs).
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