Semey state medical universty

Fatima farooq 443

Checked by; Galina Alexandrova
INFERTILITY

Infertility
Definitions
Under 35 yo

Over 35 yo

No conception after one

year of unprotected
intercourse
No conception after 6
months of unprotected
intercourse

Your Infertility Patient. . .

34 yo woman presents to your
clinic to discuss her concerns
about infertility

Psychosocial Issues
Expectations
Stress on Relationships
Stress on Finances
Alternatives- Adoption or Childless
Counseling, Support Groups

Etiologies
Male Factor
Tubal Factor
Ovulation Problem
Unexplained

40%
40%
10%
10%

Start with History. . .

What Clues Can You Find on History?

Male Factor

Tubal Factor

Ovulation

Semen Analysis
Normal values:
Volume
Count
Motility
Morphology

2-5cc
>20 million
>50%
>50% normal
(strict criteria >15%)

Male Factor Infertility

Evaluation:
Repeat semen analysis
Physical exam- varicocele, testicular size
Lab testing- testosterone, FSH, LH
Genetics for special cases
IUI (intrauterine insemination)
ICSI (intracytoplasmic sperm injection)
Donor sperm

Etiologies

Male Factor

40%

Tubal Factor

40%

Ovulation Problem
Unexplained

10%
10%

Hysterosalpingogram

HSG: Unilateral Blocked Tube

HSG: Tubal Infertility

HSG: Hydrosalpinx

HSG of DES daughter

Etiologies

Male Factor
Tubal Factor

40%
40%

Ovulation Problem

10%

Unexplained

10%

Ovulation Physiology
The LH (lutenizing hormone) surge occurs
34-36 hours prior to follicle rupture
Progesterone is increasingly produced after
the LH surge
Secretory changes to the endometrium
occur secondary to the increased
progesterone levels

Ovulation Predictor Kits

Salivary Estrogen: TCI

Ovulation Tester- 92% accurate

Add Saliva Sample

Non-Ovulatory Saliva
Pattern

High Estrogen/ Ovulatory

Saliva Pattern

Approach to Ovulation Disorders

Hypothyroidism
Prolactin Disorder
Hyperandrogenism- PCOS
Weight loss/ weight gain
Induce Ovulation
Clomid (clomiphene citrate)

Evaluate-

Traditional Infertility Evaluation

1)
2)
3)

4)
5)

Semen Analysis
Hysterosalpingogram (HSG)
Documentation of Ovulation
Post-coital Exam
Diagnostic Laparoscopy

Current Infertility Evalution

3)

Semen Analysis
Hysterosalpingogram (HSG)
Documentation of Ovulation

4)

Ovarian Reserve Testing

1)
2)

Ovarian Reserve Testing

Day #3 FSH (<10 mIU/ml) and estradiol (<80 pg/ml)
-Correlates with the functional status of the
ovaries and the quality of the oocytes
- FSH >15 only 5% success with IVF
- High estradiol level increases risk of
cancelling IVF cycle

REFRENCES
WIKIPEDIA
Shaws gyanecology
Pub med