1 INFERTILITY 1

Definitions Under 35 yoNo conception after one year of unprotected intercourse Over 35 yoNo conception after 6 months of unprotected intercourse

Psychosocial Issues Expectations Expectations Stress on Relationships Stress on Relationships Stress on Finances Stress on Finances Alternatives- Adoption or Childless Alternatives- Adoption or Childless Counseling, Support Groups Counseling, 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, ALCOHOL TOXINS, DRUGS, SMOKING, ALCOHOL PRIOR SURGERY PRIOR SURGERY INFECTIONS INFECTIONS

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

Semen Analysis Normal values: Volume 2-5cc Count>20 million Motility>50% Morphology>50% normal (strict criteria >15%)

COMMON DIAGNOSIS Varicocele

Treatment: Surgical Treatment: Surgical Varicocele Ligation Varicocele Ligation

Vasal Obstruction

Treatment: Surgical Treatment: Surgical Ejaculatory duct resection Ejaculatory duct resection

Other Common Diagnoses Genetic Y Deletions Klinefelters Translocations Cystic Fibrosi s

Treatment: Surgical Treatment: Surgical Vasal reconstruction Vasal reconstruction

IN-VITRO FERTILIZATION

Treatment: Surgical Treatment: Surgical Sperm retrieval, Sperm retrieval, Intracytoplasmic sperm injection Intracytoplasmic sperm injection

Unexplained Infertility 12-15% of couples 12-15% of couples 3% chance of achieving a pregnancy 3% chance of achieving a pregnancy Treatment: Treatment: Superovulate with IUI (intrauterine insemination)- Clomid12% success Pergonal16% IVF