INFERTILITY

INFERTILITY
Presentation by:Dr. Anna Mae Smith, MPAS, PA-C
Lock Haven University

Definition: Infertility is one year of unprotected coitus without conception
The term "primary infertility" is applied to the couple who has never achieved a pregnancy
"secondary infertility" implies that at least one previous conception has taken place

Tx Goals
– To identify the cause of the infertility
– To provide a basis for potentially successful treatment options
– To provide a realistic prognosis
– To offer emotional support

Fecundability
Female Infertility Etiologies
Unexplained
Cervical/mucus
Endometrial/uterine
Pelvic/peritoneal
Tubal
Central (CNS)
First visit
Have both come to all visits!!
Get a complete history
Sexual history!!
Educate!!
Manly Questions
Infertility duration
Prior fertility in relationship(s)
Medical & surgical history
Meds (anabolic steroids, cancer chemotherapy, sulfasalazine, nitrofurantoin)
Alcohol, drugs, pot
Occupational exposures
Sexual dysfunction
Tight fitting underwear/pants
Previous testing
Womanly Questions
Infertility duration
Detailed menstrual history
Prior pregnancies
Fertility in other relationships
IUD’s, OCP’s, Depo
Frequency of intercourse / sexual dysfunction

Womanly Questions
Gynecologic history (PID, endometriosis, fibroids, cervical dysplasia)
DES exposure
Medical and surgical history
Medications
Previous tests and therapy


TESTS
Thyroid
Midcycle progesterone level &/or luteal phase progesterone level
FSH/ LH
Cortisol
Hystersalpingogram
Laporoscopy
Postcoital Test

Treatment
Education
BBT’s/menstrual calendar
Clomiphene
Pergonal
Artificial insemination
IVF


Male Infertility
Sperm production… idiopathic or certain known entities such as mumps, endocrine disorders & immunological disorders
Anatomical abnormalities that obstruct the genital tract…varicocele.
Sperm Count
Fresh sample (to lab within 30 mins.) –most sperm in initial ejaculate
Male should be abstinent for 48 to 72 hours
sperm concentration > 20 million per ml
total count > 60 million
ejaculate volume > 1.5 ml
total motile count > 30 million
viable sperm > 50%
normal shapes (morphology) > 60%


Sperm Terms
Normozoospermia
Normal ejaculate
Asthenozoospermia
Teratozoospermia
Azoospermia
Aspermia

Normal ejaculate
Sperm concentration <20 × 106 /ml <50% spermatozoa with forward progression <30% spermatozoa with normal morphology No spermatozoa in the ejaculate No ejaculate Male/Female Infertility Endocrine - gonadotropins, bromocriptine Surgery to repair anatomical conditions Artificial insemination IVF - in vitro fertilization (ET embryo transfer) ZIFT – zygote (embryo) intra-fallopian transfer GIFT - gamete intra fallopian transfer ICSI – Intracytoplasmic sperm injection Microsurgical fertilization Environmental changes Vitamins Baggy shorts Sex not every nite…every other Diet changes Stop smoking

Male/Female Infertility.ppt