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1
INFERTILITY
1
INFERTILITY
DefinitionsDefinitions
Under 35 yoUnder 35 yo No conception after one No conception after one year of unprotected intercourseyear of unprotected intercourse
Over 35 yoOver 35 yo No conception after 6 No conception after 6 months of unprotected intercoursemonths of unprotected intercourse
Psychosocial Issues
ExpectationsExpectations Stress on RelationshipsStress on Relationships Stress on FinancesStress on Finances Alternatives- Adoption or ChildlessAlternatives- Adoption or Childless Counseling, Support GroupsCounseling, Support Groups
Male Infertility
•History- reproductive, sexual, medical, surgical, family, infectious,
toxic, pharmacologic, childhood, traumatic
•Exam- weight, height, body hair, thyroid, cardiac, lungs, abdomen,
genitalia, testes, prostate, neurologic
•Testing- Two semen analysis, gonadotropins, ASA, WBC’s, SPA,
SCSA, ultrasound, genetics
HISTORY
TOXINS, DRUGS, SMOKING, TOXINS, DRUGS, SMOKING, ALCOHOL ALCOHOL PRIOR SURGERYPRIOR SURGERYINFECTIONSINFECTIONS
Evaluation:Evaluation:Repeat semen analysisRepeat semen analysisPhysical exam- varicocele, testicular sizePhysical exam- varicocele, testicular sizeLab testing- testosterone, FSH, LHLab testing- testosterone, FSH, LHGenetics for special casesGenetics for special cases
ICSI (intracytoplasmic sperm injection)ICSI (intracytoplasmic sperm injection)Donor spermDonor sperm
Semen Analysis
Normal values:Normal values:
Volume Volume 2-5cc2-5cc
CountCount >20 million>20 million
MotilityMotility >50%>50%
MorphologyMorphology >50% normal >50% normal
(strict criteria (strict criteria >15%)>15%)
COMMON DIAGNOSIS
Varicocele
Treatment: Treatment: SurgicalSurgicalVaricocele Varicocele LigationLigation
Vasal Obstruction
Treatment: Treatment: SurgicalSurgicalEjaculatory Ejaculatory duct duct resectionresection
Other Common Diagnoses
Genetic
•Y Deletions
•Klinefelters
•Translocations
•Cystic Fibrosis
Treatment: Treatment: SurgicalSurgicalVasal Vasal reconstructreconstructionion
IN-VITRO FERTILIZATIONIN-VITRO FERTILIZATION
Treatment: Treatment: SurgicalSurgicalSperm Sperm retrieval,retrieval,
IntracytoplaIntracytoplasmicsperm smicsperm injectioninjection
Unexplained Infertility
12-15% of couples12-15% of couples 3% chance of achieving a pregnancy3% chance of achieving a pregnancy Treatment:Treatment:
Superovulate with IUI Superovulate with IUI (intrauterine insemination)- (intrauterine insemination)-
ClomidClomid 12% success12% successPergonalPergonal 16%16%
IVFIVF