infetility

8/17/2019 infetility

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INFERTILITYUNDER SUPERVISION OF

PROF:DOAA AEFTDR:EMAN GOMAA


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In ert tyInfertility is a crisis of te !ee"est #in!$ It treatens

%any as"ects of a co&"le's life( not only te"artners relationsi" to eac oter) *&t it alsoe+ects te% in!i,i!&ally an! teir relationsi" -itfrien!s an! fa%ily

.o&"les facin/ fertility callen/es often re%ar#tat it see%s to te% as if no one else as s&ciss&es$ D&e to te a!,ent of tecnolo/ies totreat s&c iss&es) !isc&ssin/ te to"ic of fertility

as *eco%e %ore acce"ta*le in to!ay's society$ Yet) te sti/%a associate! *y so%e "arts of teco%%&nity to fertility iss&es co%*ine! -it asense of isolation an!0or e1cl&sion for teco&"les$


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De2nition Te 4orl! 5ealt Or/ani6ation !e2nes infertility as

follo-s:

infertility is 7a !isease of te re"ro!&cti,e syste%

!e2ne! *y te fail&re to acie,e a clinical"re/nancy after 89 %onts or %ore of re/&lar&n"rotecte! se1&al interco&rse an! tere is nooter reason) s&c as *reastfee!in/ or

"ost"art&% a%enorroea;$ Pri%ary infertility is infertility in a co&"le -o

a,e ne,er a! a cil!$

Secon!ary infertility is fail&re to concei,e follo-in/a "re,io&s "re/nancy$

https://en.wikipedia.org/wiki/World_Health_Organizationhttps://en.wikipedia.org/wiki/Amenorrhoeahttps://en.wikipedia.org/wiki/Amenorrhoeahttps://en.wikipedia.org/wiki/World_Health_Organization


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Inci!ence Infertility a+ects a""ro1i%ately 8

of re"ro!&cti,e(a/e! co&"les$Its o,erall

"re,alence as *een sta*le !&rin/ te"ast =< years? o-e,er) a sift inetiolo/y an! "atient a/e as occ&rre!$As a -o%an's a/e increases) te

inci!ence infertility also increase$


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.a&ses

1-Causes of male infertility

Abnormal sperm production orfunction !&e to ,ario&s "ro*le%s) s&c as&n!escen!e! testicles) /enetic !efects) ealt"ro*le%s incl&!in/ !ia*etes) "rior infectionss&c as %&%"s) tra&%a or "rior s&r/eries onte testicles or in/&inal re/ion$ Enlar/e! ,eins

in te testes can increase *loo! @o- an! eat)a+ectin/ te n&%*er an! sa"e of s"er%$


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Problems with the delivery ofsperm !&e to se1&al "ro*le%s) s&c as "re%at&reeac&lation) se%en enterin/ te *la!!er instea! of

e%er/in/ tro&/ te "enis !&rin/ or/as% retro/ra!eeac&lation;) certain /enetic !iseases) s&c as cystic2*rosis) str&ct&ral "ro*le%s) s&c as *loc#a/e of te"art of te testicle tat contains s"er% e"i!i!y%is;) or!a%a/e or in&ry to te re"ro!&cti,e or/ans$ Men -o

a,e "re,io&sly &n!er/one a ,asecto%y an! !esire aret&rn of fertility -ill also nee! to eiter a,e te,asecto%y re,erse! or a,e s"er% retrie,e! tro&/ as&r/ical "roce!&re for &se in assiste! re"ro!&cti,etecniB&es$


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Overexposure to certain chemicalsand toxins, s&c as "estici!es) ra!iation)

to*acco s%o#e) alcool) %ari&ana) an!steroi!s incl&!in/ testosterone;$ Ina!!ition) freB&ent e1"os&re to eat) s&cas in sa&nas or ot t&*s) can ele,ate te

testic&lar te%"erat&re) i%"airin/ s"er%"ro!&ction$


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Damage related to cancer and itstreatment, incl&!in/ ra!iation or

ce%otera"y$ Treat%ent for cancercan i%"air s"er% "ro!&ction)so%eti%es se,erely$ Re%o,al of onetesticle !&e to cancer also %ay a+ect

%ale fertility


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!A"#A$%O& O' %&'($%"%$) %& *&

Fertility in %en reB&ires nor%al f&nctionin/ ofte y"otala%&s) "it&itary /lan!) an!testes$ Terefore) a ,ariety of !i+erentcon!itions can lea! to infertility$ Tee,al&ation of %ale infertility %ay "oint to an&n!erlyin/ ca&se) -ic can /&i!e treat%ent$A ealtcare "ro,i!er &s&ally *e/ins -it a%e!ical istory) "ysical e1a%ination) an! ase%en test$ Oter tests %ay *e nee!e!$


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+istory C A %an's "ast ealt an! %e!icalistory are i%"ortant in te "rocess ofe,al&ation$ A ealtcare "ro,i!er -ill as#

a*o&t cil!oo! /ro-t an! !e,elo"%ent?se1&al !e,elo"%ent !&rin/ "&*erty? se1&alistory? illnesses an! infections? s&r/eries?%e!ications? e1"os&re to certainen,iron%ental a/ents alcool) ra!iation)steroi!s) ce%otera"y) an! to1icce%icals;? an! any "re,io&s fertility testin/$


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Physical examination — A physical examination usually

includes measurement of height and weight, assessment of

body fat and muscle distribution, inspection of the skin and hair

pattern, and visual examination of the genitals and breasts . Special attention is given to features of testosterone deficiency,

which may include loss of facial and body hair and decrease in

the size of the testis.

Other conditions that might affect fertility include

!"aricocele, a varicose vein of the testicle !Absent vas deferens or thickening of the epididymis .


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Semen analysis Lab testing — A semen analysis #sperm count$ is a central part of the

evaluation of male infertility. %his analysis provides information about the

amount of semen and the number, motility, and shape of sperm. A man should avoid e&aculation #sex and masturbation$ for two to seven

days before providing the semen sample. 'deally, a sample should be

collected in a clinician(s office after masturbation) if this is not possible, theman may collect a sample at home in a sterile laboratory container or

chemical*free condom. %he sample should be delivered to the lab within

one hour of collection. 'f the initial semen analysis is abnormal, the clinician will often re+uest an

additional sample) this is best done one to two weeks later.


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Blood tests — lood tests provide information

about hormones that play a role in male fertility.

'f sperm concentration is low or the cliniciansuspects a hormonal problem, the clinician may

order blood tests to measure total testosterone,

luteinizing hormone #-$, follicle*stimulating

hormone #/S$, and prolactin #a pituitaryhormone$.


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enetic tests C If /enetic or cro%oso%ala*nor%alities are s&s"ecte!) s"eciali6e!*loo! tests %ay *e nee!e! to cec# for

a*sent or a*nor%al re/ions of te %alecro%oso%es Y cro%oso%e;$ So%e %eninerit /enes associate! -it cystic 2*rosistat can res&lt in %ale infertility !&e to a lo-s"er% co&nt$ 5o-e,er) tese %en !o nota,e te oter &s&al si/ns of cystic 2*rosis)s&c as l&n/ or /astrointestinal !isease$


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Other tests — 'f a blockage in the reproductive tract #epididymis or vas

deferens$ is suspected, a transrectal ultrasound test may be ordered. 'f retrograde e&aculation #movement of semen into the bladder$ is

suspected, a post*e&aculation urine sample is needed. A testicular biopsy #collection of a small tissue sample$ may berecommended in men with no sperm on the semen analysis. %he biopsy

can be done by surgically opening the testis or by fine*needle aspiration

#inserting a small needle into the testis and withdrawing a sample of

tissue$. An open biopsy is usually done in an operating room with general

anesthesia, while a fine*needle aspiration may be done with localanesthesia in an office setting. %he biopsy allows the physician to

examine the microscopic structure of the testes and determine if sperm

are present. %he presence of sperm production in the testes when there

are none in the e&aculate suggests blockage in the reproductive tract.


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2-Causes of female infertility

Ovary(30%):the commonest Cause of

primary infertility

Group I:HP Failure as in amenorrhea. Group II:HPDysfunction as PCO &

Idiopathic anovulation.

Group III :ovarian failure as Turner $ .


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Primary ovarian insufficiency, also called

early menopause, when the ovaries stop

working and menstruation ends before age 40.Although the cause is often unknown, certain

conditions are associated with early

menopause, including immune system

diseases, radiation or chemotherapy treatment,

and smoking.


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Uterine or cervicalabnormalities, including problems with the

opening of the cervix or cervical mucus, orabnormalities in the shape or cavity of theuterus. Benign tumors in the wall of theuterus that are common in women (uterine

fibroids) may rarely cause infertility byblocking the fallopian tube..


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• Fallopian tube damage or blockage, which

usually results from inflammation of the fallopian

tube (salpingitis). This can result from pelvicinflammatory disease, usually caused by sexually

transmitted infection, endometriosis or adhesions.

• Endometriosis, which occurs when endometrial

tissue implants and grows outside of the uterus— often affecting the function of the ovaries,

uterus and fallopian tubes.


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Pelvic adhesions, bands of scar tissue that

bind organs after pelvic infection, appendicitis,

or abdominal or pelvic surgery. Other causes in women include:

• Thyroid problems : Disorders of the thyroid

gland, either too much thyroid hormone(hyperthyroidism) or too little

(hypothyroidism), can interrupt the menstrual

cycle or cause infertility.


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• Cancer and its treatment: Certain cancers —

particularly female reproductive cancers — often

severely impair female fertility. Both radiation and

chemotherapy may affect a woman's ability toreproduce.

• Other conditions: Medical conditions associated with

delayed puberty or the absence of menstruation

(amenorrhea), such as celiac disease, Cushing'sdisease, sickle cell disease, kidney disease or diabetes,

can affect a woman's fertility. Also genetic abnormalities

can make conception and pregnancy less likely.


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Certain medications:Temporary infertility

may occur with the use of certain

medications. In most cases, fertility isrestored when the medication is stopped.


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/emale factors that affect fertility include the following categories

• 0ervical Stenosis or abnormalities of the mucus*sperm interaction

• 1terine 0ongenital or ac+uired defects) may affect endometrium or

myometrium) may be associated with primary infertility or with

pregnancy wastage and premature delivery• Ovarian Alteration in the fre+uency and duration of the menstrual

cycle—/ailure to ovulate is the most common infertility problem

• %ubal Abnormalities or damage to the fallopian tube) may be

congenital or ac+uired

• 2eritoneal Anatomic defects or physiologic dysfunctions #eg,infection, adhesions, adnexal masses$


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EVALUATION OF INFETILIT! IN "O#EN

#edical history — A woman(s past health and

medical history may provide some clues about the

cause of infertility. %he healthcare provider will

ask about childhood development) sexual

development during puberty) sexual history)

illnesses and infections) surgeries) medications

used) exposure to certain environmental agents#alcohol, radiation, steroids, chemotherapy, and

toxic chemicals$) and any previous fertility

evaluations.


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#enstr$al history — Amenorrhea #absent

menstrual periods$ usually signals an

absence of ovulation, which can causeinfertility. Oligomenorrhea #irregular

menstrual cycles$ can be a sign of irregular

ovulation) although oligomenorrhea does not

make pregnancy impossible, it can interferewith the ability to become pregnant.


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Physical examination — A physical examination

usually includes a general examination, with

special attention to any signs of hormone

deficiency or signs of other conditions that might

impair fertility. %he provider will also perform a

pelvic examination, which can identify

abnormalities of the reproductive tract and signsof low hormone levels. %he physical examination

may be performed by the patient(s primary care

provider, gynecologist, or infertility specialist.


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Blood tests — lood tests can provide

information about the levels of several hormones

that play a role in female fertility) in women, key

hormones are produced by the hypothalamus,

the pituitary gland, and the ovaries. %hese

hormones can include follicle*stimulating

hormone #/S$ and estradiol to assess how well

the ovaries are functioning, %S to test thyroid

function, and prolactin to assess the presence of

a benign pituitary tumor.


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Tests to e%al$ate o%$lation

Basal body tem&erat$re — 3onitoring of

basal body temperature #measured before

getting out of bed in the morning$ waspreviously recommended to determine if

ovulation occurred. A woman(s temperature

usually rises by 4.56/ to 7.46/ after ovulation.

owever, basal body temperature patterns canbe difficult to interpret and are not generally

recommended in the evaluation of infertility.


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'ormone le%els — -evels of luteinizing hormone #-$ rise

abruptly beginning approximately 89 hours before ovulation.

%his hormone surge can be detected using an over*the*

counter home urine test. owever, this kit fails to detect thehormone surge about 75 percent of the time. %herefore, a

clinician may recommend a blood test to confirm ovulation.

lood levels of the hormone progesterone are a more

accurate indicator of ovulation. :ormally, levels ofprogesterone rise after ovulation. A test to measure the

progesterone level is usually performed ;4 to ;< days after

the first day of a menstrual period.


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Tests to e%al$ate the $ter$s and (allo&ian

t$bes

1terine abnormalities that can contribute to

infertility include congenital structural abnormalities,

such as a uterine septum #a band of tissue that

makes the uterine cavity small$ ) fibroids) polyps)

and structural abnormalities that can result from

gynecologic procedures.

Scarring and obstruction of the fallopian tubes canoccur as a result of pelvic inflammatory disease,

endometriosis, or pelvic adhesions #scar tissue$

from abdominal infection or surgery.


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'ysterosal&ingogram

ysterosalpingogram #S=$ is used to help

identify structural abnormalities of the uterus and

fallopian tubes. 't involves inserting a small

catheter through the cervix and into the uterus. Ali+uid that can be seen on x*ray is in&ected through

the catheter, which fills the uterus and fallopian

tubes. An x*ray is taken after the li+uid is in&ected,

which shows the outline of the uterus and tubes.

An abnormally shaped uterus or blocked fallopian

tube would be visible on the x*ray.


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'ysterosco&y

'n a hysteroscopy, a small tube containing a light

source is inserted through the cervix and into the

uterus to directly visualize the lining of the uterus

and the sites where the fallopian tubes enter the

uterus. Air or fluid is in&ected to expand the uterus

and to allow the physician to see inside the uterus.

A hysteroscopy is usually performed in womenwho are thought to have an abnormal uterus, based

upon history, hysterosalpingogram, or ultrasound.


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Pel%ic $ltraso$nd — 'n a transvaginal ultrasound, a

small ultrasound probe is inserted into the vagina) this

provides a clearer image of the uterus and ovaries

than ultrasound that is performed through theabdomen. 't does not re+uire that the patient is

sedated or anesthetized, and has few to no risks. 't is

used to measure the size and shape of the uterus and

ovaries and to determine if there are structuralabnormalities #such as fibroids or ovarian cysts$. 'f

abnormalities are seen, further testing may be

needed.


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Sonohysterogram — 'nfusion of sterile

saline into the uterine cavity via a small

catheter placed through the cervical openingenhances visualization of the inside of the

uterus during transvaginal ultrasound.


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La&arosco&y — >uring laparoscopy, a thin, lighted

tube is inserted through a small incision in the

abdomen, allowing the physician to view the uterus,

ovaries, and fallopian tubes. -aparoscopy is performedas a day surgery procedure and re+uires that the

patient receive general anesthesia.

-aparoscopy can detect damage and obstruction of the

fallopian tubes, endometriosis, and other abnormalitiesof the pelvic structures. 't is the best test for diagnosis

of endometriosis or pelvic adhesions #scarring$.


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)enetic tests — =enetic testing may be

recommended if there is a suspicion that

genetic or chromosomal abnormalities arecontributing to infertility. %hese tests usually

re+uire a small blood sample, which is sent

to a laboratory for evaluation.


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E#OTIONAL SUPPOT *UIN) INFETILIT! EVALUATION

%he inability to become pregnant can lead to a

variety of emotions, including anxiety, depression,

anger, shame, and guilt. 'n one study,


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8*1nexplained infertility

'n the 1S, up to ;4@ of infertile couples have

unexplained infertility. 'n these cases abnormalities are

likely to be present but not detected by current

methods. 2ossible problems could be that the egg isnot released at the optimum time for fertilization, that it

may not enter the fallopian tube, sperm may not be able

to reach the egg, fertilization may fail to occur, transport

of the zygote may be disturbed, or implantation fails. 'tis increasingly recognized that egg +uality is of critical

importance and women of advanced maternal age have

eggs of reduced capacity for normal and successful

fertilization.


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:A damage

• >:A damage reduces fertility in female ovocytes,as caused by smoking, other xenobiotic >:A

damaging agents #such as radiation or

chemotherapy$ or accumulation of the oxidative

>:A damage 9*hydroxy*deoxyguanosine$• >:A damage reduces fertility in male sperm, as

caused by oxidative >:A damage, smoking, other

xenobiotic >:A damaging agents #such as drugs or

chemotherapy$ or other >:A damaging agents

including reactive oxygen species, fever or high

testicular temperature.


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•

5*=eneral factors

• >iabetes mellitus, thyroid disorders, undiagnosed and

untreated coeliac disease, adrenal disease$

• ypothalamic*pituitary factors• yperprolactinemia

• ypopituitarism

• %he presence of anti*thyroid antibodies

• nvironmental factors

%oxins such as glues, volatile organic solvents or silicones,

physical agents, chemical dusts, and pesticides. %obacco smokers are B4@ more likely to be infertile than non*smokers.

https://en.wikipedia.org/wiki/Diabetes_mellitushttps://en.wikipedia.org/wiki/Thyroidhttps://en.wikipedia.org/wiki/Coeliac_diseasehttps://en.wikipedia.org/wiki/Adrenalhttps://en.wikipedia.org/wiki/Hyperprolactinemiahttps://en.wikipedia.org/wiki/Anti-thyroid_antibodieshttps://en.wikipedia.org/wiki/Toxinhttps://en.wikipedia.org/wiki/Solventshttps://en.wikipedia.org/wiki/Siliconehttps://en.wikipedia.org/wiki/Pesticideshttps://en.wikipedia.org/wiki/Tobacco_smokerhttps://en.wikipedia.org/wiki/Tobacco_smokerhttps://en.wikipedia.org/wiki/Pesticideshttps://en.wikipedia.org/wiki/Siliconehttps://en.wikipedia.org/wiki/Solventshttps://en.wikipedia.org/wiki/Toxinhttps://en.wikipedia.org/wiki/Anti-thyroid_antibodieshttps://en.wikipedia.org/wiki/Hyperprolactinemiahttps://en.wikipedia.org/wiki/Adrenalhttps://en.wikipedia.org/wiki/Coeliac_diseasehttps://en.wikipedia.org/wiki/Thyroidhttps://en.wikipedia.org/wiki/Diabetes_mellitus


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• B*immunological antibodies against sperms may

performed in

a*male autoantibody b*female

*antibodies against blastocyst#'g3$

* antibodies against sperms#'g=$ formed incervical mucous.


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INFETILIT! TEAT#ENT

Treatment of infertility depends on the cause.

Treatment for men

Approaches that involve the male includetreatment for general sexual problems or lack

of healthy sperm. Treatment may include:

• Treating infections. Antibiotic treatmentmay cure an infection of the reproductive

tract, but doesn't always restore fertility.


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• Treatments for sexual intercourse

problems. Medication or counseling can help

improve fertility in conditions such as erectile

dysfunction or premature ejaculation.

• Hormone treatments and medications. Your

doctor may recommend hormone replacement

or medication in cases where infertility is causedby high or low levels of certain hormones or

problems with the way the body uses hormones.


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• Surgery. For example, a varicocele can

often be surgically corrected or an

obstructed vas deferens repaired. See'vasectomy reversal' and 'varicocele' below.

In cases where no sperm are present in the

ejaculate, sperm may often be retrieved

directly from the testicles.


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• Assisted reproductive technology

(ART). ART treatments involve obtaining

sperm through normal ejaculation, surgicalextraction or from donor individuals,

depending on your specific case and wishes.

The sperm is then inserted into the female

genital tract, or used to perform in vitro

fertilization or intracytoplasmic sperm

injection.


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Treatment for women

According to the cause : If ovarian cause

-PCO : INDUCTION of ovulation. -hyperprolactinemia :dopaminergic drugs . -LPD : PROGESTERONE in second half of the

cycle. - ovarian failure : no treatment.


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#edication Treatments (or Female In(ertility . xamples of these types of medications

include• 0lomiphene or 0lomiphene 0itrate

• =onadotropins or human chorionic gonadotro

pin #h0=$

romocriptine or cabergoline

https://www.nichd.nih.gov/health/topics/infertility/conditioninfo/Pages/treatments-women.aspx#clomiphenehttps://www.nichd.nih.gov/health/topics/infertility/conditioninfo/Pages/treatments-women.aspx#hcghttps://www.nichd.nih.gov/health/topics/infertility/conditioninfo/Pages/treatments-women.aspx#hcghttps://www.nichd.nih.gov/health/topics/infertility/conditioninfo/Pages/treatments-women.aspx#hcghttps://www.nichd.nih.gov/health/topics/infertility/conditioninfo/Pages/treatments-women.aspx#bromocriptinehttps://www.nichd.nih.gov/health/topics/infertility/conditioninfo/Pages/treatments-women.aspx#bromocriptinehttps://www.nichd.nih.gov/health/topics/infertility/conditioninfo/Pages/treatments-women.aspx#bromocriptinehttps://www.nichd.nih.gov/health/topics/infertility/conditioninfo/Pages/treatments-women.aspx#bromocriptinehttps://www.nichd.nih.gov/health/topics/infertility/conditioninfo/Pages/treatments-women.aspx#hcghttps://www.nichd.nih.gov/health/topics/infertility/conditioninfo/Pages/treatments-women.aspx#hcghttps://www.nichd.nih.gov/health/topics/infertility/conditioninfo/Pages/treatments-women.aspx#hcghttps://www.nichd.nih.gov/health/topics/infertility/conditioninfo/Pages/treatments-women.aspx#hcghttps://www.nichd.nih.gov/health/topics/infertility/conditioninfo/Pages/treatments-women.aspx#clomiphene


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• Surgical %reatments for /emale 'nfertility

'f disease of the fallopian tubes is the cause of

infertility, surgery can repair the tubes or remove

blockages in the tubes.

Surgery to remove patches of endometriosis has

been found to double the chances for pregnancy.

Surgery can also remove uterine fibroids, polyps,

or scarring, which can affect fertility.


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Assisted reproductive technology

In vitro fertilization (IVF) is the most common

ART technique. IVF involves stimulating andretrieving multiple mature eggs from a woman,

fertilizing them with a man's sperm in a dish in

a lab, and implanting the embryos in the uterusthree to five days after fertilization.


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Other techniques are sometimes used in an

IVF cycle, such as:

• Intracytoplasmic sperm injection (ICSI). asingle healthy sperm is injected directly into a

mature egg..

•

Assisted hatching. This technique attemptsto assist the implantation of the embryo into

the lining of the uterus by opening the outer

covering of the embryo (hatching).


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• Donor eggs or sperm. Most ART is done using the

woman's own eggs and her partner's sperm.

However, if there are severe problems with either the

eggs or sperm, you may choose to use eggs, spermor embryos from a known or anonymous donor.

Gestational carrier. Women who don't have afunctional uterus or for whom pregnancy poses a

serious health risk might choose IVF using agestational carrier. In this case, the couple's embryois placed in the uterus of the carrier for pregnancy.

Complicationsoftreatment


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Complications of treatment

Complications of female infertility treatment may include:

• Multiple pregnancy. The most common complication of infertility

Ovarian hyperstimulation syndrome (OHSS). Use of injectablefertility drugs to induce ovulation can cause OHSS, in which the

ovaries become swollen and painful. Symptoms may include mild

abdominal pain, bloating and nausea that lasts about a week, or

longer if you become pregnant. Rarely, a more severe form

causes rapid weight gain and shortness of breath requiring

emergency treatment.

Bleeding or infection. As with any invasive procedure, there is a

rare risk of bleeding or infection with assisted reproductive

technology. Premature delivery or low birth weight. The greatest risk factorfor low birth weight is a multiple fetus pregnancy.Birth defects. such as heart and digestive problems and cleft lipor cleft palate.


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• Complications of male infertility treatment

are rare and may occur following surgery

including infection, bruising, or lack ofefficacy with the procedure.


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T5AN YOU

infetility

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