Infertility

Zaira, Dulce, Laura, Rachel, Heidi, Alexa, Lauren, Melina, and

Sydney
 What is infertility ?

Primary- Inability to become pregnant

Secondary- Inability to become

pregnant after previous pregnancy
 Incidence of Infertility

Decreased in the US from 2006-2010

Little evidence of changes in infertility

rates in over 20 years. 1990-2010
 Why is there a perception that there
has been an increase in infertility?

Increase in population
Married at older age
Increase awareness on fertility treatments
Infertility VS. Impaired Fecundity
 Five Reasons for Female
Infertility
1. Age (older than 35)
2. Smoking
3. Stress
4. Being overweight or underweight
5. Athletic training
 Five Reasons for Male
Infertility
1. Sperm production problems
2. Blockage of sperm transport
3. Sexual problems
(erection and ejaculation
problems)
4. Hormonal problems
5. Sperm antibodies
 Evaluation of Female
Infertility
Laboratory tests include: Imaging tests include:
Basal body Ultrasound
temperature Hysterosalpingography
Urine Sonohysterography
Progesterone Hysteroscopy
Thyroid function Laparoscopy
Prolactin level
Ovarian reserve
 Evaluation of Male Infertility
Laboratory tests include: Imaging tests include:

Semen analysis Transrectal

(sperm count) ultrasonography
Scrotal
ultrasonography
 Psychosocial Differences of Infertility in
Men vs. Women

Responses depend on a gender-specific diagnosis

Men experience many of the same emotions with
the same level of intensity when they find out
infertility is attributable to a male factor
 Common Psychosocial
Responses to Infertility
Female
1.Distress, stress, tension
2.Depression and sadness
3.Anxiety
4.Failure
5.Guilt
6.Fear, anger, frustration
7.Loneliness
8.Feelings of defectiveness
9.Loss of identity
10.Reduced self-control and
self-esteem
Male
1.Distress, stress, tension
2.Depression and sadness
3.Anxiety
4.Failure
5.Guilt
6.Fear, anger, frustration
7.Loneliness
8.Feelings of defectiveness
9.Loss of identity
10.Reduced self-control and
self-esteem
 However
Men tend to repress many of their emotions (i.e. anxiety).
Anxiety, distress, and depression are often more intense in
women
When infertility is not attributable to a male factor.
Women are reminded each month they are infertile
Have a more difficult time adjusting to social engagement
Often still feel partially responsible for infertility even if the
diagnosis is purely a male factor.
Many of these feelings originate and manifest from a different
place.
 Infertility Medications
Medications usage determined by:
A reproductive specialist
The type of infertility

Medications for ovarian stimulation may include:

Clomiphene Citrate (CC)
Synthetic Human Chorionic Gonadatropin (hCG)
Follicle Stimulating Hormone
Bromocriptine and Cabergoline
Gonadotropin-Releasing Hormone (GnRH)
 Infertility Medications
Continued
Medications to enhance fertility may
include:
Medrol
Doxycycline
Progesterone
Fertility Supplements
 Therapeutic Insemination
Artificial placement of sperm in the uterus
Types
Therapeutic Husband Insemination (THI)
Therapeutic Donor Insemination (TDI)
Indications
Male
Ejaculatory dysfunction
Anejaculation
Hypospadias
Female
Anatomic abnormalities
Vaginal Stenosis
Dyspareunia
 Insemination Techniques
Intrauterine Insemination (IUI)
Speculum inserted, cervix cleaned
Sperm placed into 1 ml syringe with attached cath
Cath inserted into upper uterus and sperm inserted
Intravaginal Insemination (IVI)
Rarely used
Can be done at home or in the clinic
Place a syringe into upper third of vagina and deposit
sperm
Intracervical Insemination (ICI)
Rarely used
Placement of a cath in cervical canal, but not uterus
Sperm sample is delivered to the canal
 In Vitro Fertilization
Most effective form of Assisted Reproductive
Technology (ART)
5-Step Process:
1.Fertility medications stimulate egg production
2.Eggs are retrieved using ultrasound and a hollow
needle
3.Male/father produces sperm sample
4.Sperm and eggs are combined in lab (fertilization)
5.Embryos are transferred to uterus using catheter
Able to use eggs, sperm, and embryos from donor
Surrogate mother may carry IVF embryo
One IVF cycle takes about 2 weeks
 Benefits and Costs of IVF
Painless for most women and effective
May cause multiple gestation if additional embryos
implanted
Success depends on:
Age and cause of infertility
Costs of IVF:
Time consuming, expensive, and invasive
Typical IVF costs $12,000 before
medications (additional $3,000-$5,000)
In rare cases, Ovarian Hyperstimulation Syndrome
may occur
 Gamete Intrafallopian
Transfer (GIFT)
Indications for GIFT Technique
History of failed Sperm and oocyte
infertility are mixed outside
treatment for of the woman
anovulation Inserted via
Unexplained laparoscopy
infertility Fertilized inside
Low sperm count fallopian tubes
 Zygote Intrafallopian Transfer
(ZIFT)
Laproscopic procedure
Oocyte is retrieved from the woman and IVF is
used
1 day later, Zygote is placed into the fallopian
tube
 Question #1
What are indications for therapeutic
insemination? (Select all that apply)
A. Male ejaculatory problems
B. Vaginal stenosis
C. Failed IVF
D.Hypospadias
 Question #2
True or False, Females typically do not
experience emotional turmoil if her significant
other is infertile?

A. True

B. False
 References
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 References cont.
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