2. 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 USA
% %
% %
85% treated successfully
Increase 1970-now-Why?

3. 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

4. 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

5. More detail on male infertility
Cryptorchidism-Why?
Chromosome disorders-gonadal dysgenesis
Obstructions
Gonadotropin deficiency
Result in:Low sperm count, sperm of poor quality

6. 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

7. Sperm good for 2-3 days, egg for 2

8. Laparoscopy
Can find adhesions, structural abnormality, etc

9. Hysterosalpingogram
Blocked tubes

10. 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

11. Sperm Count

13. 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

14. frozen eggs/ ovary transplant; cloned human embryo

15. First test-tube
baby

16. Assisted Reproductive Technology
Estimate 1/100 births now
Around 40,000/year
Costs between $7,000 to 15,000 per attempt

17. IVF In Vitro Fertilization and Embryo Transfer

18. Basic Steps in IVF
Ovary stimulation
Egg retrieval
Sperm retrieval-wash sperm
Fertilization
Embryo transfer
Progesterone

19. Start with more than 1 egg
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
In a single cycle, could take clomid, pergonal, hCG shot, then progesterone

20. 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

23. Egg retrieval, vaginal, with ultrasound

25. Modifications if tube not blocked
Gametes mixed for GIFT

27. GIFT

28. If fertilization needs help-transfer zygote
ZIFT

30. Intracytoplasmic sperm injection

31. ICSI

32. Additional twists Surrogacy Frozen embryos Egg donors Frozen eggs
Gestational
Egg donor plus gestational
Egg donor plus sperm donor plus gestational
Frozen embryos
Egg donors
Frozen eggs
Cloning

33. From CDC

35. IVF Success Rates
Stage Number of Women
Cycle initiation 100
Ovulation 95
Oocyte retrieval 90
Fertilization 85
Embryo Transfer 70
Pregnancy 24
Birth

36. From The Baby Business by Debora Spar

38. Risks of ART? To woman To baby Overstimulation of ovary syndrome
Multiple pregnancies
Risk of ovarian cancer (clomid, pergonal)
To baby
ICSI associated with problems (XYY)

39. Discussion questions-what treatment(s) would you select given the following:
Male with low sperm count
30 year-old female not ovulating
40 year-old female not ovulating
Undiagnosed infertility