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Understanding Infertility: Causes, Tests, and Treatments for Couples

Infertility affects 1 in 6 couples in the US, defined as unprotected sex for a year without pregnancy. Of infertility cases, 35% are due to female factors, 35% male, 20% both partners, and 10% are unexplained. Key issues include ovulation disorders, sperm quality, and anatomical blockages. Testing methods like hormone assessments and imaging techniques help diagnose infertility. Treatments range from hormone therapies to advanced reproductive technologies like IVF. Awareness and understanding of these factors can empower couples facing infertility.

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Understanding Infertility: Causes, Tests, and Treatments for Couples

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  1. 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 20-24 4.1% 30-34 9.4% 25-29 5.5% 35-39 19.7% 85% treated successfully Increase 1970-now-Why?

  2. Ovulation disorders Tube/uterus blockage Cervix Endometriosis Other Sperm count and defects Erectile or ejaculation deficiency What can cause infertility?Unexplained-18%Female Male Intrinsic vs. Extrinsic, Environmental

  3. 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

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

  5. 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

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

  7. Laparoscopy Can find adhesions, structural abnormality, etc

  8. Hysterosalpingogram Blocked tubes

  9. 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

  10. Sperm Count

  11. 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

  12. frozen eggs/ ovary transplant; cloned human embryo

  13. First test-tube baby

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

  15. IVFIn Vitro Fertilization and Embryo Transfer

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

  17. 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

  18. 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

  19. Egg retrieval, vaginal, with ultrasound

  20. Modifications if tube not blocked Gametes mixed for GIFT

  21. GIFT

  22. If fertilization needs help-transfer zygote ZIFT

  23. Intracytoplasmic sperm injection

  24. ICSI

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

  26. From CDC

  27. IVF Success Rates Stage Number of Women Cycle initiation 100 Ovulation 95 Oocyte retrieval 90 Fertilization 85 Embryo Transfer 70 Pregnancy 24 Birth 18

  28. From The Baby Business by Debora Spar

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

  30. 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

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