INFERTILITY

Ms.Vijimol.GAsst.prof

Infertility is “a disease of the reproductive system defined by the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse.”… (WHO)

Subfertility: less fertile than a typical couple.

TYPES

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Primary infertilityCouple Has Never conceived a

child.

Secondary infertilityWoman has previously been pregnant, regardless of the

outcome, and now is unable to conceive

CAUSES OF INFERTILITY

CAUSES OVULATION PROBLEMS TUBAL BLOCKAGE MALE ASSOCIATED INFERTILITY AGE RELATED FACTORS UTERINE PROBLEMS PREVIOUS TUBAL LIGATION PREVIOUS VASECTOMY UNEXPLAINED INFERTILITY

GENETIC CAUSES ROBERTSONIAN

TRANSLOCATION(Robertsonian translocation (ROB) is a rare form of chromosomal rearrangement that in humans occurs in the five chromosome pairs, namely 13, 14, 15, 21, and 22.

General factors like DM,Thyroid disorders

Hypothalamic factors Environmental factors.---

chemicals,pesticides etc

GENETIC CONDITIONS WITH PRE TESTICULAR EFFECTS Kallmans syndrome: causes male

hypogonadism because of hypothalamo gonado tropin releasing hormone(GnRH). …it will results in delay in pubertal development.

Prader-willi Syndrome: a rare congenital disorder characterized by learning difficulties, growth abnormalities, and obsessive eating, caused especially by the absence of certain genes normally present on the copy of chromosome 15 inherited from the father.

The Bardet–Biedl syndrome (BBS) is a human genetic disorder that produces many effects and affects many body systems. It is characterized principally by obesity, retinitis pigmentosa, polydactyly, hypogonadism, and renal failure in some cases.

Sickle cell anemia:a severe hereditary form of anaemia in which a mutated form of haemoglobin distorts the red blood cells into a crescent shape.

Beta thalassemia (β thalassemias) are a group of inherited blood disorders. They are caused by reduced or absent synthesis of the beta chains of hemoglobin that result in variable outcomes ranging from severe anemia to clinically asymptomatic individuals.

cerebellar ataxia (ACA): The cerebellum is the area of the brain responsible for controlling muscle coordination. If it becomes inflamed or damaged, suddenly lose coordination. This is called acute cerebellar ataxia (ACA), or cerebellitis.

GENETIC CONDITIONS WITH TESTICULAR EFFECTS Klinefelter's syndrome — This

syndrome involves the presence of abnormal sex chromosomes. A male normally has one X chromosome and one Y chromosome. The Y chromosome contains the genetic material with the codes that determine the male gender, and related masculine characteristics and development. Males with Klinefelter's syndrome have an extra X chromosome, which causes abnormal development of the testicles.

XYY SYNDROME XYY syndrome is a genetic condition in

which a human male has an extra male (Y) chromosome, giving a total of 47 chromosomes instead of the more usual 46. This produces a 47,XYY karyotype, which occurs every 1 in 1,000 male births.

XX MALE SYNDROME XX male syndrome: A syndrome

characterized by the presence of an XX sex chromosome complement in an individual with male genitalia including both testes but no sperm production (azoospermia).

NOONANS SYNDROME Karyotype is normal 46,but the men

shows dysmorphic features like webbed neck,short stature,low set ears etc…..at birth 75% will have cryptochidism that results in infertility.if testes is fully descended then fertility is posible.

IMMOTILE CILIA SYNDROME Immotile cilia syndrome, is a rare,

autosomal recessive genetic disorder that causes a defect in the action of the cilia lining the respiratory tract and fallopian tube, and also of the flagella of sperm in males.

AZOOSPERMIA GENE Zero sperm count

GENETIC CONDITIONS WITH POST TESTICULAR EFFECTSPost testicular portion of the reproductive tract includes epididymis,vas deferens,seminal vesicles, and associated ejaculatory organs. conditions include…1. Wolfian duct abnormalities--- absent of

epididymis,vas deferns etc.2. Congenital absence of vas deferens3. Youngs syndrome: is a rare condition

that encompasses a combination of syndromes such as bronchiectasis, rhinosinusitis and reduced fertility.

Epididymal obstruction. Myotonic dystrophy: is characterized by

progressive muscle wasting and weakness. Adult polycystic kidney diseases

DIAGNOSIS OF INFERTILITY Detailed fertility history Physical examination: testicular or reproductive

examination post ejaculatory urine sample Semen analysis Blood tests Post coital test sperm antibody test Testicular biopsy Ultra sound Fertilization test PGD

MEDICAL MANAGEMENT Vitamin A and Vitamin C diet Hormonal monitoring and ovulation period

intercourse Advice for life style changes— avoid smoking,drugs and increased use of coffee rest and exercises prevent overheating of testes.

1. INTRAUTERINE INSEMINATION (ARTIFICIAL INSEMINATION)

Sperm introduced into female reproductive tract by means other than coitus

sperm can come from donor / sperm bank or from husband

often used when male has low sperm count or antibodies present in ejaculate

ARTIFICIAL INSEMINATION

2. IN VITRO FERTILIZATION(“TEST - TUBE BABIES”)

1st performed in 1978 (Louise Joy Brown) often performed on infertile women with tubal

blockage Sperm and egg combined in the lab,

fertilization Zygote placed back into the uterus Very expensive and not always successful Oldest woman in the US to give birth using in

vitro was 62 years old and an Romanian woman gave birth at 66

IN VITRO FERTILIZATION

INTRA CYTOPLASMIC SPERM INJECTION(ICSI) The procedure involves a single sperm

carefully injected into the center of an egg using micro needle.

ICSI TECHNIQUE

4. GIFT

GIFT = gamete intrafallopian transfer

5. ZIFT – ZYGOTE INTRAFALLOPIAN TRANSFER

OTHER TECHNIQUES Invitro maturation: In this process

follicles are harvested a few days before ovulation.Maature embryo is transferred .

Embryo transfer: 5 days old embryo are transfering.

9. EMBRYO TRANSFER

EGG DONATION Egg donation is when eggs from a donor

are fertilised with your partner's sperm in a laboratory dish. The resulting embryos are then transferred to your uterus.

9. SURROGATE MOTHER

Woman unable to have children may have IVF in another woman who has the child

ADOPTION