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Fertility Facts. Definition:unprotected sex for one year, not pregnant. Frequency: 1 out of 6 couples in the US. Responsibility: 35% female infertility 35% male 20% both 10% unknown. Maternal Age USA 20-244.1% 30-349.4% 25-295.5% 35-3919.7%. - PowerPoint PPT Presentation


  • Fertility FactsDefinition:unprotected sex for one year, not pregnantFrequency: 1 out of 6 couples in the US

    Responsibility: 35% female infertility 35% male 20% both 10% unknown

    Maternal Age USA20-244.1% 30-349.4%25-295.5% 35-3919.7%

    85% treated successfullyIncrease 1970-now-Why?

  • What can cause infertility?Unexplained-18%Female Male Ovulation disordersTube/uterus blockageCervixEndometriosisOtherSperm count and defectsErectile or ejaculation deficiencyIntrinsic vs. Extrinsic, Environmental

  • More detail on female infertilityOvulatory failure-polycystic ovarian syndrome (high androgen/estrogenlevels), resistant ovarian syndrome, gonadal dysgenesisImpaired gamete/zygote transport-pelvic inflammatory disease, endometriosisImplantation defects-progesterone lowSpontaneous abortion-chromosome abnormality

  • More detail on male infertilityCryptorchidism-Why?Chromosome disorders-gonadal dysgenesisObstructionsGonadotropin deficiencyResult in:Low sperm count, sperm of poor quality

  • Female Infertility TestsFor ovulationBasal body temperatureOvulation kit (LH surge)Other hormone tests (steroids)

    Post ovulatory blockLaparoscopy-fiber optic lookHysterosalpingogram-dyePost-coital /cervical mucous and spermSperm antibodiesEndometrial biopsy

  • Sperm good for 2-3 days, egg for 2

  • Can find adhesions, structural abnormality, etc

  • Hysterosalpingogram

    Blocked tubes

  • Male Infertility TestsSperm count/motility> 20 million sperm/mlCheck motility and morphology>50% motile>30% structurally normal If low check LH and androgen levelsTesticular biopsy

  • Sperm Count

  • Older, low tech treatments

    Drug treatment for ovulation blockIntrauterine inseminationTubal surgery

    High tech Assisted Reproduction Technologies IVF-in vitro fert and embryo transferGIFT-gamete intrafallopian tube transferZIFT-zygote intrafallopian tube transferIntracytoplasmic sperm injection

  • frozen eggs/ ovary transplant; cloned human embryo

  • First test-tubebaby

  • Assisted Reproductive TechnologyEstimate 1/100 births nowAround 40,000/yearCosts between $7,000 to 15,000 per attempt

  • IVF

    In Vitro Fertilization and Embryo Transfer

  • Basic Steps in IVF

    Ovary stimulationEgg retrieval Sperm retrieval-wash spermFertilizationEmbryo transferProgesterone

  • Drugs used for ovary stimulation

    Clomiphene (clomid)-anti-estrogenhMG (pergonal)-menopausal gonadotropin (FSH and LH)FSH-(metrodin)GnRHGnRH agonists (lupron)-FSH/LH first promoted, then inhibitedhCG-acts like LHStart with more than 1 eggIn a single cycle, could take clomid, pergonal, hCG shot, then progesterone

  • Why transfer more than one embryo?Increase the pregnancy rate

    Leads to increased risk of multiple pregnanciesIn future- Test embryos before transfersHLA-G measure of embryo health

  • Egg retrieval, vaginal, with ultrasound

  • Gametes mixed for GIFTModifications if tube not blocked

  • GIFT

  • If fertilization needs help-transfer zygoteZIFT

  • Intracytoplasmic sperm injection

  • ICSI

  • Additional twistsSurrogacyGestationalEgg donor plus gestationalEgg donor plus sperm donor plus gestationalFrozen embryosEgg donorsFrozen eggsCloning

  • From CDC

  • IVF Success Rates

    StageNumber of WomenCycle initiation100Ovulation 95Oocyte retrieval 90Fertilization 85Embryo Transfer 70Pregnancy 24Birth 18

  • From The Baby Business by Debora Spar

  • Risks of ART?To womanOverstimulation of ovary syndromeMultiple pregnanciesRisk of ovarian cancer (clomid, pergonal)To babyICSI associated with problems (XYY)

  • Discussion questions-what treatment(s) would you select given the following:Male with low sperm count30 year-old female not ovulating40 year-old female not ovulatingUndiagnosed infertility