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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 USA20-24 4.1% 30-34 9.4%25-29 5.5% 35-39 19.7%
85% treated successfully Increase 1970-now-Why?
What can cause infertility?Unexplained-18%
Female Male
• Ovulation disorders• Tube/uterus blockage• Cervix• Endometriosis• Other
• Sperm count and defects
• Erectile or ejaculation deficiency
Intrinsic vs. Extrinsic, Environmental
More detail on female infertility• Ovulatory failure-polycystic ovarian syndrome (high
androgen/estrogenlevels), resistant ovarian syndrome, gonadal dysgenesis
• Impaired gamete/zygote transport-pelvic inflammatory disease, endometriosis
• Implantation defects-progesterone low
• Spontaneous abortion-chromosome abnormality
More detail on male infertility
• Cryptorchidism-Why?
• Chromosome disorders-gonadal dysgenesis
• Obstructions
• Gonadotropin deficiency
Result in:Low sperm count, sperm of poor quality
Female Infertility Tests
• For ovulation• Basal body temperature• Ovulation kit (LH surge)• Other hormone tests (steroids)
• Post ovulatory block•Laparoscopy-fiber optic look•Hysterosalpingogram-dye•Post-coital /cervical mucous and sperm•Sperm antibodies•Endometrial biopsy
Male Infertility Tests
• Sperm count/motility– > 20 million sperm/ml– Check motility and morphology
• >50% motile
• >30% structurally normal
• If low check LH and androgen levels•Testicular biopsy
Older, low tech treatments
• Drug treatment for ovulation block• Intrauterine insemination• Tubal surgery
High tech Assisted Reproduction Technologies• IVF-in vitro fert and embryo transfer•GIFT-gamete intrafallopian tube transfer•ZIFT-zygote intrafallopian tube transfer•Intracytoplasmic sperm injection
Assisted Reproductive Technology
• Estimate 1/100 births now
• Around 40,000/year
• Costs between $7,000 to 15,000 per attempt
Basic Steps in IVF
•Ovary stimulation•Egg retrieval •Sperm retrieval-wash sperm•Fertilization•Embryo transfer•Progesterone
Drugs used for ovary stimulation
•Clomiphene (clomid)-anti-estrogen•hMG (pergonal)-menopausal gonadotropin (FSH and LH)•FSH-(metrodin)•GnRH•GnRH agonists (lupron)-FSH/LH first promoted, then inhibited•hCG-acts like LH
Start with more than 1 egg
In 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 pregnancies
• In future- Test embryos before transfer
sHLA-G measure of embryo health
Additional twists
• Surrogacy– Gestational– Egg donor plus gestational– Egg donor plus sperm donor plus gestational
• Frozen embryos• Egg donors• Frozen eggs• Cloning
IVF Success Rates
Stage Number of WomenCycle initiation 100Ovulation 95Oocyte retrieval 90Fertilization 85Embryo Transfer 70Pregnancy 24Birth 18
Risks of ART?
• To woman– Overstimulation of ovary syndrome– Multiple pregnancies– Risk of ovarian cancer (clomid, pergonal)
• To baby– ICSI associated with problems (XYY)