Fertility Facts

Fertility Facts
Definition:unprotected sex for one year, not pregnant
What can cause infertility?
* Ovulation disorders
* Tube/uterus blockage
* Cervix
* Endometriosis
* Other
* Sperm count and defects
* Erectile or ejaculation deficiency

Intrinsic vs. Extrinsic, Environmental
More detail on female infertility
* Ovulatory failure-polycystic ovarian syndrome (high androgen/estrogenlevels), resistant ovarian syndrome, gonadal dysgenesis
* Impaired gamete/zygote transport-pelvic inflammatory disease, endometriosis
* Implantation defects-progesterone low
* Spontaneous abortion-chromosome abnormality

More detail on male infertility
* Cryptorchidism-Why?
* Chromosome disorders-gonadal dysgenesis
* Obstructions
* Gonadotropin deficiency
Result in:Low sperm count, sperm of poor quality

Female Infertility Tests
* For ovulation
* Post ovulatory block
Laparoscopy
Hysterosalpingogram
Blocked tubes
Male Infertility Tests
* Sperm count/motility
* If low check LH and androgen levels
* Testicular biopsy
Sperm Count
Older, low tech treatments
* Drug treatment for ovulation block
* Intrauterine insemination
* Tubal surgery

High tech Assisted Reproduction Technologies
* IVF-in vitro fert and embryo transfer
* GIFT-gamete intrafallopian tube transfer
* ZIFT-zygote intrafallopian tube transfer
* Intracytoplasmic sperm injection

frozen eggs/ ovary transplant; cloned human embryo
First test-tube baby

Assisted Reproductive Technology
* Estimate 1/100 births now
* Around 40,000/year
* Costs between $7,000 to 15,000 per attempt

IVF
In Vitro Fertilization and Embryo Transfer
Basic Steps in IVF
* Ovary stimulation
* Egg retrieval
* Sperm retrieval-wash sperm
* Fertilization
* Embryo transfer
* Progesterone
Drugs used for ovary stimulation
* Clomiphene (clomid)-anti-estrogen
* hMG (pergonal)-menopausal gonadotropin (FSH and LH)
* FSH-(metrodin)
* GnRH
* GnRH agonists (lupron)-FSH/LH first promoted, then inhibited
* hCG-acts like LH

Why transfer more than one embryo?
* Increase the pregnancy rate
* Leads to increased risk of multiple pregnancies
* In future- Test embryos before transfer
sHLA-G measure of embryo health
Egg retrieval, vaginal, with ultrasound
Gametes mixed for GIFT
Modifications if tube not blocked
If fertilization needs help-transfer zygote
ZIFT
Intracytoplasmic sperm injection
ICSI
Additional twists
* Surrogacy
o Gestational
o Egg donor plus gestational
o Egg donor plus sperm donor plus gestational
* Frozen embryos
* Egg donors
* Frozen eggs
* Cloning
From CDC
IVF Success Rates
Stage Number of Women

Fertility Facts.ppt