Asstprof Infertility is a disease of the reproductive system defined by the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse WHO ID: 710478
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INFERTILITYMs.Vijimol.GAsst.profSlide2Slide3
Infertility is “a disease of the reproductive system defined by the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse.”… (WHO)Subfertility: less fertile than a typical couple.Slide4
TYPES
Primary infertility
Couple Has Never conceived a child.
Secondary infertility
Woman has previously been pregnant, regardless of the outcome, and now is unable to conceiveSlide5
Causes of InfertilitySlide6
CAUSESOVULATION PROBLEMSTUBAL BLOCKAGEMALE ASSOCIATED INFERTILITYAGE RELATED FACTORSUTERINE PROBLEMSPREVIOUS TUBAL LIGATION
PREVIOUS VASECTOMY
UNEXPLAINED INFERTILITYSlide7
GENETIC CAUSESROBERTSONIAN TRANSLOCATION(Robertsonian translocation (ROB) is a rare form of chromosomal rearrangement that in humans occurs in the five chromosome pairs, namely 13, 14, 15, 21, and 22.
General factors like
DM,Thyroid
disorders
Hypothalamic factors
Environmental factors.---
chemicals,pesticides etcSlide8
genetic conditions with pre testicular effectsKallmans syndrome: causes male hypogonadism because of hypothalamo
gonado
tropin
releasing hormone(
GnRH
). …it will results in delay in pubertal development.
Prader-willi Syndrome: a rare congenital disorder characterized by learning difficulties, growth abnormalities, and obsessive eating, caused especially by the absence of certain genes normally present on the copy of chromosome 15 inherited from the father.Slide9
The Bardet–Biedl syndrome (BBS) is a human genetic disorder that produces many effects and affects many body systems. It is characterized principally by obesity, retinitis
pigmentosa
,
polydactyly
,
hypogonadism
, and renal failure in some cases.Slide10
Sickle cell anemia:a severe hereditary form of anaemia in which a mutated form of haemoglobin distorts the red blood cells into a crescent shape.Beta thalassemia (β thalassemias) are a group of inherited blood disorders. They are caused by reduced or absent synthesis of the beta chains of
hemoglobin
that result in variable outcomes ranging from severe
anemia
to clinically asymptomatic individuals.Slide11
cerebellar ataxia (ACA): The cerebellum is the area of the brain responsible for controlling muscle coordination. If it becomes inflamed or damaged,
suddenly
lose coordination. This is called acute cerebellar ataxia (ACA), or
cerebellitis
. Slide12
GENETIC CONDITIONS WITH TESTICULAR EFFECTSKlinefelter's syndrome — This syndrome involves the presence of abnormal sex chromosomes. A male normally has one X chromosome and one Y chromosome. The Y chromosome contains the genetic material with the codes that determine the male gender, and related masculine characteristics and development. Males with
Klinefelter's
syndrome have an extra X chromosome, which causes abnormal development of the testicles.Slide13
XYY SYNDROMEXYY syndrome is a genetic condition in which a human male has an extra male (Y) chromosome, giving a total of 47 chromosomes instead of the more usual 46. This produces a 47,XYY karyotype, which occurs every 1 in 1,000 male births.Slide14
XX MALE SYNDROMEXX male syndrome: A syndrome characterized by the presence of an XX sex chromosome complement in an individual with male genitalia including both testes but no sperm production (azoospermia).Slide15
NOONANS SYNDROMEKaryotype is normal 46,but the men shows dysmorphic features like webbed neck,short stature,low set ears etc…..at birth 75% will have
cryptochidism
that results in
infertility.if
testes is fully descended then fertility is
posible
. Slide16
Immotile cilia syndromeImmotile cilia syndrome, is a rare, autosomal recessive genetic disorder that causes a defect in the action of the cilia lining the respiratory tract and fallopian tube, and also of the flagella of sperm in males.Slide17
Azoospermia geneZero sperm countSlide18
GENETIC CONDITIONS WITH POST TESTICULAR EFFECTSPost testicular portion of the reproductive tract includes epididymis,vas deferens,seminal vesicles, and associated ejaculatory organs.
conditions include…
Wolfian
duct abnormalities--- absent of
epididymis,vas
deferns
etc.
Congenital absence of vas deferens Youngs syndrome: is a rare condition that encompasses a combination of syndromes such as bronchiectasis, rhinosinusitis and reduced fertility.Slide19
Epididymal obstruction.Myotonic dystrophy: is characterized by progressive muscle wasting and weakness.Adult polycystic kidney diseasesSlide20
DIAGNOSIS OF INFERTILITYDetailed fertility historyPhysical examination: testicular or reproductive examination post ejaculatory urine sample
Semen analysis
Blood tests
Post coital test
sperm antibody test
Testicular biopsy
Ultra sound
Fertilization test
PGDSlide21
Medical managementVitamin A and Vitamin C dietHormonal monitoring and ovulation period intercourse Advice for life style changes—
avoid
smoking,drugs
and increased use of coffee
rest and exercises
prevent overheating of testes.
Slide22
1. Intrauterine insemination (artificial insemination)S
perm
introduced into female reproductive tract by means other than coitus
sperm can come from donor / sperm bank or from husband
often
used when male has low sperm count or antibodies present in ejaculateSlide23
Artificial InseminationSlide24
2. In Vitro Fertilization(“test - tube babies”)
1st
performed in 1978 (Louise Joy Brown)
often performed on infertile women with tubal blockage
Sperm and egg combined in the lab, fertilization
Zygote placed back into the uterus
Very expensive and not always successful
Oldest woman in the US to give birth using in vitro was 62 years old and an Romanian woman gave birth at
66Slide25
In Vitro FertilizationSlide26
Intra cytoplasmic sperm injection(ICSI) The procedure involves a single sperm carefully injected into the center of an egg using micro needle.Slide27
ICSI TechniqueSlide28
4. GIFTGIFT = gamete intrafallopian
transferSlide29
5. ZIFT – Zygote Intrafallopian TransferSlide30
Other techniquesInvitro maturation: In this process follicles are harvested a few days before ovulation.Maature embryo is transferred .Embryo transfer: 5 days old embryo are transfering
.Slide31
9. Embryo transferSlide32
Egg donation Egg donation is when eggs from a donor are fertilised with your partner's sperm in a laboratory dish. The resulting embryos are then transferred to your uterus.Slide33
9. Surrogate motherWoman unable to have children may have IVF in another woman who has the childSlide34
ADOPTION