Infertility: Reshmi Siby
Infertility: Reshmi Siby
Infertility: Reshmi Siby
RESHMI SIBY
DEFINITION
Infertility is defined as a failure to conceive within one
or more years of regular unprotected coitus.
Congenital
Thermal factors
Infections
General
Endocrine
Genetic
Iatrogenic
Immunologic
OBSTRUCTION
Trauma
Young’s syndrome
Surgery
BPH
Autoimmune reaction
Obesity
Anomalies of penis
QUALITATIVE OR QUANTITATIVE
CHANGES
Sperm abnormality
Ejaculatory defect
FEMALE SUBFERTILITY FACTORS
Tubal and peritoneal factors 25-35%
Ovulatory factors 30-40%
Endometriosis 1-10%
OR
Anovulation
Uterine problems
Cervical problems
Vaginal problems
OVULATORY FACTORS
Anovulation
Oligo ovulation
2. Endosalphingeal damage
Tubal endometriosis
Polyps
Mucus debris
UTERINE PROBLEMS
Tumors
Fibroids
Uterine hypoplasia
Endometriosis
Uterine synechiae
Pinhole os
Polyps
Physiologic defects
VAGINAL PROBLEMS
Atresia vagina
Transverse vaginal septum
Septate vagina
Narrow introitus
vaginitis
COMBINED CAUSES
General
Infrequent coitus, lack of knowledge, timing
Lubricants
Immunologic factors
INVESTIGATIONS
HEALTH HISTORY FOR MALES
General health
Nutrition
Illness
Radiation exposure
Surgeries
Sexual practices
Contraceptive devices
Alternative therapy
FOR FEMALES
Reproductive tract infections
Overall health
Endocrine problems
Surgeries
Occupational hazards
Nutrition
Ovulation
MENSTRUAL HISTORY
Age of menarche
Length, regularity and frequency
Amount of flow
Dysmenorrhea
Contraceptive use
Genital abnormalities
PHYSICAL ASSESSMENT IN FEMALES
General
Systemic
Gynecologic examination
Testicular biopsy
Vasogram
Karyotype analysis
Immunologic tests
Vaginal cytology
Hormone estimation
Endometrial biopsy
Sonography
DIRECT METHOD
Laparoscopy
Conclusive - pregnancy
TUBAL PATENCY TESTS
Dilatation and insufflation test(Rubin’s test)
HYSTEROSALPHINGOGRAPHY
Laparoscopy and chemopertubation
SONOHYSTEROSALPHINGOGRAPHY
HYSTEROSCOPY
Falloposcopy
Salpingoscopy
OTHER TESTS IN FEMALES
Cervical factor
Immunological studies
TREATMENT FOR INFERTILITY
COUPLE INSTRUCTIONS
Assurance
Body weight
Coital problems
MALE INFERTILITY
INDICATIONS FOR TREATMENT
Extreme oligospermia
Azoospermia
Impotency
TREATMENT- MEDICAL
General care
Vitamins E, C, D, B12 and folic acid
hCg
hMg+ hCg
Dopamine agonist
Clomiphene citrate
Antisperm antibodies
Antibiotics
TREATMENT- SURGICAL
Microsurgery
1. Vasoepididymostomy
2. Vasovasostomy
Surgery for varicocele, hydrocele
orchidopexy
IMPOTENCY
psychosexual treatment
Sildenafil
Tadalafil
FEMALE INFERTILITY MANAGEMENT
OVULATORY DYSFUNCTION
General
1. Psychotherapy
2. Reduction of weight
Drugs
1. Clomipehene citrate
2. hMG
3. FSH
4. hCg
5. GnRH
6. GnRH analogues
Hyperinsulinemia- metformin
Androgen excess- dexamethasone
Immunological factor
Dexamethasone 0.5 mg HS
UTEROVAGINAL SURGERY
Myomectomy
Metroplasty
Adhesiolysis
Amputation of cervix
THERAPEUTIC INSEMINATION/
ARTIFICIAL INSEMINATION
IUI may be
1. AIH (artificial insemination husband)
2. AID (artificial insemination donor)
Oligospermia or asthenospermia
Immune factor
Unexplained infertility
TECHNIQUE
Washing centrifuging and swim up methods are
commonly used
About 0.3ml of washed and centrifuged concentrated
sperm is injected through a flexible catheter within the
uterine cavity around the time of ovulation
Timing
Ovarian hyperstimulation
ARTIFICIAL INSEMINATION DONOR
Here semen of the donor is used
Indications
Untreatable azoospermia, asthenospermia
Genetic disease
Requirements
Donor
Specimen
ASSISTED REPRODUCTIVE TECHNIQUES
IVF ET – In vitro fetilization and embryo transfer
GIFT - gamate intrafallopian transfer
Oocyte retrieval
Endometriosis
Cervical hostility
Post procedure
Selective termination
GAMATE INTRA FALLOPIAN TRANSFER
Both the sperm and the unfertilized oocytes are
transferred into the fallopian tubes
In vivo
Pre requisites
Procedure
ZYGOTE INTRAFALLOPIAN TRANSFER
Involves oocyte retrieval by
transvaginal, USG guided aspiration
followed by culture and insemination
of oocytes in the laboratory
Asthenospermia, teratospermia