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so in general terms what does it take to get pregnant?
- enough sperm in an adequate amount of volume
- healthy egg to be fertilized
- pathway for the egg and the sperm to meet
What are some abnormalities in women that can lead to infertility?
- oviducts are occluded or scarred which cause the sperm to have a hard time to get to the egg or fertilize it
- scarred fallopian tubes or damaged cilia so the egg can't go down to the uterus
- fibroids or polyps or another uterine anomaly that can harm the implantation of the embryo
- endometriosis can damage the tubo-ovarian structure and it can even have a negative effect even if there is no obvious anommaly
What are some abnormalities that can lead to a male being infertile?
- hypogonadism which decreases the testosterone level and equals poor semen
- retrograde ejaculation- ejaculation into the bladder
- ejaculatory duct obstruction
- absence of vas deferens
- varicocele- varicose vein int he scrotum that leads to a warmer that normal environment for the sperm
- gene defect: valence transloation or hormone deficiency which could cause vasospermia
So when can a person say that she/he is infertile?
When they have had unprotected sex for 12 months
What is the difference between 1 and 2 infertility?
- 1: pt or couple has never been able to conceive
- 2: pt or couple has conceived but is having a difficult time now
A woman comes to the office wanting to be evaluated for infertility and you want to see the anatomy to make sure there is no obvious reasons for the infertility, what do you do?
Hysterosalpingogram: a radioopaque dye is injected into the uterus and then this flows down to the tubes.
What is the easiest way to asses for ovulation and what are other ways that you can assess for them?
- A menstrual history is the easiest way.
- Measuring the temp is also a good way since .5 increase to the basal temp is indicative if ovulation due to progesterone from the CL
- OTC ovulation tests use an elissa test which looks for an LH surge in urine
How can we detect for the ovarian reserve
- antral follicle count
- anti-mullerian hormone
- cycle 3 FSH levels
So what can tell us if the response to the fertility treatment will be poor?
when we do the tests to check for the ovarian reserve. Ie. antral follicle count, anti-mullerian hormone, and the cycle 3 FSH levels
What can be causes for non-ovulation?
- Increased prolactin and hypothyroidism
- anorexia cnan cause hypothalamic disfunction and lack of ovulation
What are the treatments for infertility in a male?
it depends on what the cause is but if it is varicocele then do sx and if it is hypogonadism then use med to stimulate gonadotropin release
What are the treatments for infertility in females?
- so it depends on why but
- tubal occlusion: sx but they are often unsuccessful
- ovulatory disfunction: then give meds that can induce ovulation and fertility drugs like clomofin citrate which is an estrogen receptor antagonist that results is hypothalamic and pituitary increase in GnRH, FSH and LH. If that doesn't work then injection of FSH can be used that often results in ovulation.
What are the side effects of some of the fertility treatments?
more than one oocyte can be released causing twins, triplets..
What is intrauterine insemination (IUI)?
Washed sperm from partner or sperm bank is placed in the patient that doesn't require hormonal treatment and we do this when the sperm coincides with ovulation
What is in vitro- fertilization?
- So this is a little more complicated but
- first we have to give the patient high levels of FSH (ovulation inducting) to stimulate the growth of the follicle and to overcome the negative feedback of the hypothalamic-pituitaray ovarian axis.
- Growth of these oocytes is monitored using vaginal ultrasounds until several follicles are large enough to anticipate that a mature egg is housed within.
- Then there is a transvaginal retrieval using an ultrasound guided needle and the egg is aspirated and examined and the oocyte is isolated. Then the oocytes a re incubated invitri with sperm until fertilization occurs which is usually a couple of hours. Embyos then develop in-vitro for an additional few days and are then transferred into the uterus. For proper implantation to occur, the uterine endometrium must be stimulated with estrogen to promote the proliferation followed by progesterone to promote the secretion of nutrients.
What is intracytosplasmic sperm injection and why is it favored favored by some?
So here a single sperm is injected into a matte oocyte to achieve fertilization. The fertilized egg is monitores for normal development in-vitro prior to being transferred into the uterus so we can go genetic testing.
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