Infertility

Front 1

how common is infertility

Back 1

-15% of couples
-10% unexplained, 10% combo, 40% female, 40% male

Front 2

preg rates an maternal age

Back 2

->35 drop off in fertility, around age 37 sig drops
-chromosomal abnormalities increase
-implantation rate decreases
-miscarriages increases

Front 3

infertility most common causes

Back 3

-Male factor** most common cause in males; sperm count (cause of low sperm count-unknown reasons common, anabolic steroids take long to wear off, hypothalmic issues, varicocele), concentration, motility, morphology
-Ovulation disorders** most common cause in females: PCOS most common ovulation disorder
-Peritoneal issues: Endometriosis
-Tubal issues
-Cervical issues & Uterine issues (less common)

Front 4

factors that affect infertility are

Back 4

1. extremes in wt
2. coital mistiming
3. coital infreq
4. smoking
5. drugs (anabolic steroids)

Front 5

factors that are commonly believed to affect infertility but may not

Back 5

nutrition, stress, male infection, eggs too small

Front 6

infertility workup

Back 6

1. semen analysis (40% of causes)
2. test ovulation (pregesterone)
3. tubal status (put die into tubes to see if they are open)
4. post-coital test: take cervical mucous and look for living sperm
5. day 3 blood test for FSH/estradiol
6. laparoscopy

Front 7

infertility tx

Back 7

1. intrauterine insemination
2. ovulation induction
3. laparoscopy
4. in vivo fertilization

Front 8

intrauterine insemination

Back 8

mixed with culture media, centrifuge, isolating sperm cells

Front 9

ovulation induction

Back 9

clomiphene citrate and follicle stimulating hormones (patient should consider whether they are a high-responder to OI drugs due to the risk of multiples)

Front 10

laparoscopy

Back 10

Consider whether patient needs laparoscopy or should go directly to IVF.

Front 11

treatment efficiency

Back 11

o Intrauterine insemination (IUI): 10%
o Clomiphene/IUI: 10%
o FSH/IUI: 10-20%
o Surgery: 10%
o IVF: 50%
o Frozen enbryo transfer: 30%

Front 12

what to expect

Back 12

o Dealing with infertility can be an emotional roller coaster. Patients should expect to have a logical plan of attack for dealing with infertility. Even so, it is not uncommon to feel a:
o Loss of Control
o Inconvenience
o Invasion of Privacy
o Frustration
o RRS nurses can help ease this process and are available for consultation to assist you.

Front 13

hyperstimulated ovary

Back 13

Put needle through vaginal wall into ovaries and aspirate follicles

Front 14

summary of IVF stimulation

Back 14

**?

Front 15

ICSI

Back 15

Sperm/ Pipette Inside Egg: pipette put through zona pellucida to put sperm inside! Intracellular sperm injection

Front 16

-Early Egg to 8 Cell Embryo

Back 16

Egg → becomes fertilized → 2 pronuclei → one pronucleus comes from the egg and the other from the sperm. Within a few hours → the fertilized egg will start to divide!!

Front 17

8 Cell to Blastocyst

Back 17

**

Front 18

*Eggs get old, chromosomes get old

Back 18

*all eggs stored in middle of meiosis I (by 6 months as a fetus female has all her eggs she will ever have)
*Eggs decrease in number as age increases
*Age 40 → has 40 y/o egg → less viable, age 30 → has 30 year old eggs → more viable

Front 19

Transvaginal Embryo Transfer:

Back 19

IVF: Abdominal sonogram- can see uterus and endometrium; Catheter in endometrium inserts embryo
Slip embryos in potential space in uterus
Cannot fall out

Front 20

differential in care

Back 20

o The best infertility centers have higher pregnancy rates while maintaining reduced triplet rates.
o Provide increased chance of achieving pregnancy with reduced chance of multiple births.
o For example, for women under 35, the general goal is to achieve a 50% pregnancy rate by replacing no more than 2 embryos.

Front 21

Treatment Risks

Back 21

o With many of these treatments, there is a significant chance of having multiples. Multiples have increased risks for mothers as well as babies.
o Mothers will multiples experience higher risk pregnancies and more complications.
o Unfortunately, 9.2% of triplet babies are born with a handicap. (National average)
o Clomiphene multiplesL5% (national average)
o FSH multiples: 20%
o IVF multiples: 30%

Front 22

Blastomere biopsy: IVF also allows us to biopsy embryos

Back 22

put hole in zonna pelucida and take out one cell, can be analyzed for chromosomal content and single gene disorder; ex. Can see if embryo has cystic fibrosis if parents were carriers