1.Infertility and Assisted Reproductive Technologies Tianjin Medical University General Hospital Obstetrics and Gynecology Department

2. content

Definition

Causes

Ovulatory factor

Cervical factor

Uterine- tubal factor

Peritoneal factor

Male factor

Unexplained infertility

Assisted reproductive technology

3.

Infertility affects approximately 10-15% of couples in the reproductive age group which makes it an important component of the practices of many physicians.

4. Definition

A couple is considered infertile after unsuccessfully attempting to achieve pregnancy for a certain period of time

(2 years, WHO 1 year )of sexual intercoursewithout using any type of contraception

Infertility is termedprimarywhen it occurs without any prior pregnancy andsecondary when it follows a previous conception.

5.

25% conceive within the first month, 60% within 6 months ,75% by 9 months ,and 90% by 12months.

The average time fertile couples take to conceive is 6 months.

6.

Female fertility is highest in the age range 20-24 years, and declines gradually after the age of 35 years.

In men, ageing has only a minor effect on fertility.

7. Human gamete oocyte sperm 8. oocyte Normal ovulation Hypothalamus Pulsatile secretion of GnRH pituitary FSHLHpositive feedbackovary Developmentproductione of folliclesostrogen LH surge Maturation ovulation Corpus luteum progesterone 9. sperm Normal sperm production

Spermatozoa are produced in the seminiferous tubules and undergo further maturation in the epididymis

Production of mature spermatozoa takes around 70 -80 days

Requires an enviroment of 1 below normal body temperature

After swimming through the favourable cervical mucus, spermatozoa are transported to the ampullary portion of the fallopian tube

Penetration and fertilisation of the oocyte takes place in the tubal ampulla.

10. 11.

Conception requires

Juxtaposition of the male and female gametesat the optimal stage of maturation

Transportation of the conceptus to the uterine cavity at a time when the endometrium is supportive of its continued development and implantation.

12. 13.

For these events to occur, the male and female reproductive systems must be both anatomically and physiologically intact, and coitus must with sufficient frequency.

Even when fertilization occurs ,more than 70% embryos are abnormal and fail to develop.

14.

The rate of conception declines gradually after the age of 35 years.

Reduced embryo quality

15. Causes

CausesPercentage

Female factors60 %

Male factors30 %

Both male and

female factors10 %

16. Female Factors

Ovulatory dysfunction

Pelvic factors

17.

1. Hypothalamic dysfunction;

GnRH

2. Pituitary Insufficiency;

3. Ovarian factor

Premature ovarian failure

PCOS

luteinized unruptured follicle syndrome

4. Others: thyroid or adrenal dysfunction;

Ovulatory dysfunction hypothalamus pituitary ovary 18. Pelvic factors

1.Tubal factors:

blockage,adhesion

inflamation gonococcus tuberculosis chlamydiatrachomatis

endometriosis operation

2.Uterine factors:

congenital anatomic abnormalities;

endometrium disorder;

3.Cervical factors:

Infection, cervix mucus abnormalities;

4.Extra-genital tract factors;

Infection, congenital abnormalities;

19. Male Factors

1. Abnormal spermatogenesis

oligospermia azoospermia asthenospermia

congenital chromosome abnormality ( Klinefeltersyndrome :47-XXY

infectious factors

varicocele

2. Obstructive

sperm transportabnormalities

3. Immunologic factors -antisperm antibody

4.Sexual dysfunction;

20. Both Male and Female Factors

1. Psychologicalfactors;

mental stress,anxiety

2. Immunologic factors

Isoimmunity- antisperm antibody

autoimmunity-AZP(antizona pellucida antibody)

21. Basic evaluations

Younger couples-1 year

Older couples-6 months

Some deceases corelation to infertility

endometriosis pelvic inflammation

menstruation disorder

22. The goals of infertility evaluation

Determine the probable cause of infertility

Provide accurate information regarding prognosis

Provide counseling support

Provide guidance regarding options for treatment

23. Male factor 24. History

There are advantages to having the male present during the initial interview. He may contribute valuable historical information. It also gives the physician the opportunity to emphasize that both partners are involved in the infertility investigation.

The male partner should to complete a semen analysis prior to the initial consultation.

25. Maleinfertilityquestionnaire

age

length of infertility

reproductive history

sexual history

Occupational and recreational activities

illnesses: parotitis,varicocele,

hypospadia

family history - hereditary diseases

26.

Infection: Prostatitis, orchiditis,

Surgery or trauma

Exposure to lead, radiation, chemotherapeutic agents

Excessive alcohol or cigarettes

27.

Lack of eithersexual hair or mascular build may indicated insufficient testosterone production.

The normal location of the urethral meatus should be ensured.

Testicular size

varicocele ,orchiditis, epididymitis

Rectal examination -prostatitis

Physical examination 28. Investigation 29. Semen analysis 30. Normal Values for Semen( following 2 to 7day period of abstinence)

volume2.0 mL

sperm concentration20 x 10 6/mL

motility 50 %

normal morphology15 %

WBC