INFERTILITYPowerPoint Presentation2002 Statistics from the CDCDefinitionAge Factor in InfertilityInfertility ManagementEtiologic Factors in InfertilityMale Factors in InfertilitySlide 9Slide 10Slide 11Slide 12Slide 13MALE FACTORSMale Factors Physiological AbnormalitiesMale Clinical EvaluationSemen Analysis ValuesSlide 18FEMALE FACTORSDisorders of OvulationOther Female FactorsFemale Factors: Clinical EvaluationSlide 23Basal Body TemperatureSlide 25Slide 26Summary of Diagnostic TestsEndometriosis http://www.ivf.com/endohtml.htmlEndometriosisSlide 30Endometriosis and InfertilityTreatment of Endometriosis: Hormonal Approach http://www.mayoclinic.com/health/endometriosis/DS00289/DSECTION=treatments-and-drugsTreatment of Endometriosis: Adverse Events (Danazol)Other hormonal treatment approachesSlide 35Treatment of Endometriosis: Surgical ApproachTREATMENT SUCESS AFTER SURGICAL REPAIR STATISTICS COURTESY OF : Miguel F. da Cunha, Ph.D. The University of Texas - Houston Health Science CenterTREATMENT OUTCOMES with ejaculatory problemsASSISTED REPRODUCTIVE TECHNIQUES http://www.nlm.nih.gov/medlineplus/infertility.htmlFood For Thought……THE ENDINFERTILITYINFERTILITYINFERTILITYINFERTILITYPatricia M. DillonPatricia M. DillonUpdated Spring 2009Updated Spring 2009ByByProfessor Unn HidleProfessor Unn HidleInfertility affects about 5.3 million Americans, or Infertility affects about 5.3 million Americans, or 9 percent of the reproductive age population, 9 percent of the reproductive age population, according to the American Society for according to the American Society for Reproductive Medicine. Reproductive Medicine. Usually 70-80% of couples that do not use any Usually 70-80% of couples that do not use any birth control conceive within a year and 80-90% birth control conceive within a year and 80-90% conceive within 2 years. conceive within 2 years.2002 Statistics from the CDC2002 Statistics from the CDCNumber/Percent of women ages 15-44 with Number/Percent of women ages 15-44 with impaired fecundity (impaired ability to have impaired fecundity (impaired ability to have children): 7.3 million or 11.8%children): 7.3 million or 11.8%Number of married women ages 15-44 that are Number of married women ages 15-44 that are infertile (unable to get pregnant for infertile (unable to get pregnant for at least 12 at least 12 consecutive monthsconsecutive months): 2.1 million): 2.1 millionPercent of married women ages 15-44 that are Percent of married women ages 15-44 that are infertile: 7.4%infertile: 7.4%Number of women ages 15-44 who have ever Number of women ages 15-44 who have ever used infertility services: 7.3 millionused infertility services: 7.3 millionDefinitionDefinitionUnprotected coital exposure for 12 months Unprotected coital exposure for 12 months without conception. without conception. (15% - 20% of U.S. Couples)(15% - 20% of U.S. Couples)A physician will generally initiate a medical A physician will generally initiate a medical evaluation only if a couple has not conceived after evaluation only if a couple has not conceived after one year of trying, or, if the woman is over 35, one year of trying, or, if the woman is over 35, after six months.after six months.Of note, with the increase in infertility Of note, with the increase in infertility services/clinics in the later years, many services/clinics in the later years, many physicians will initiate infertility treatments sooner. physicians will initiate infertility treatments sooner.Age Factor in InfertilityAge Factor in InfertilityIf the woman and man are approximately 25 years old, there is a 50% chance that the couple will conceive within 5 months. After age 35, the ability to become pregnant in the woman decreases noticeably. After menopause the ability to conceive disappears completelyPregnancy rates for men decrease considerably after age 45. However, unlike women, a man’s sperm can fertilize an egg into senescence (old age).Infertility ManagementInfertility ManagementAssess and treat causes of infertilityAssess and treat causes of infertilityProvide Provide accurate informationaccurate information and dispel myths and dispel mythshttp://www.ihr.com/infertility/http://www.ihr.com/infertility/Identify expectations and stressIdentify expectations and stressCounsel couples and provide emotional supportCounsel couples and provide emotional supportEtiologic Factors in InfertilityEtiologic Factors in InfertilityMale FactorMale Factor40%40%Tubal FactorTubal Factor40%40%Ovulation ProblemOvulation Problem10%10%UnexplainedUnexplained10%10%Male Factors in Male Factors in InfertilityInfertilityMale infertility most commonly occurs because of: Anatomical inadequaciesPoor sperm motilityShort lifespan (a normal sperm has a lifespan of about 4 days) Delivery issueInadequate sperm productionNo sperm at all.Male Factors in Male Factors in InfertilityInfertilityEtiological reasons for problems or lack of sperm include: Endocrine dysfunctionCryptorchidism, varicocele, hypospadius, and epispadiusExposure to toxic chemicals or radiation (envirnomental) Genetic disorders, such as Klinefelter’s syndrome Testicular exposure to high temperatures such as taking frequent, long, hot tub baths, occupations that increase heat to the testes (i.e. cab driver) and wearing constrictive clothing (i.e. tight jeans)alcohol, tobacco, or drug abuse A severe mumps infection as an adolescent or adult.VARICOCELEVARICOCELECourtesy of: Netter, F.H., The CIBA Collection & Miguel F. da Cunha, Ph.D., The University of Texas – Houston Health Science CenterCourtesy of www.andrologia.lazio.it/varicocele.jpg(incompetent veins along the spermatic cord)CRYPTORCHIDISCRYPTORCHIDISMMCourtesy of UCLA Media book from: www.crump.ucla.edu:8801/NM-Mediabook/figures/REPRODUCTIVE/cryptorchidism.gifFrom: Netter, F.H., The CIBA CollectionCourtesy: http://www.hypospadias.net/HYPOSPADIASHYPOSPADIAShttp://www.rnweb.com/be_core/content/journals/k/data/2001/0202/screen/k2a089f01.jpgCourtesy: Contemporary Pediatrics® ArchiveInfants Curtesy of: http://cai.md.chula.ac.th/lesson/atlas Un-repaired Adult MaleCourtesy of: http://www.epispadias-info.com/photos.htmlFEMALFEMALE infantE infantMALEMALEinfantinfantFrom: Netter, F.H., The CIBA CollectionEPISPADIAEPISPADIASSMALE FACTORSMALE FACTORSRetrograde ejaculation (semen reflux into the bladder) due toSpinal Cord Damage resulting