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INFERTILITY. 1. INFERTILITY. Definitions Under 35 yo No conception after one year of unprotected intercourse Over 35 yo No conception after 6 months of unprotected intercourse. Psychosocial Issues. Expectations Stress on Relationships Stress on Finances
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INFERTILITY Definitions Under 35 yo No conception after one year of unprotected intercourse Over 35 yo No conception after 6 months of unprotected intercourse
Psychosocial Issues • Expectations • Stress on Relationships • Stress on Finances • Alternatives- Adoption or Childless • 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 • PRIOR SURGERY • 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 • Varicocele Ligation
Treatment: Surgical • Ejaculatory duct resection
Other Common Diagnoses • Genetic • Y Deletions • Klinefelters • Translocations • Cystic Fibrosis
Treatment: Surgical • Vasal reconstruction
Treatment: Surgical • Sperm retrieval, • Intracytoplasmicsperm injection
Unexplained Infertility • 12-15% of couples • 3% chance of achieving a pregnancy • Treatment: Superovulate with IUI (intrauterine insemination)- Clomid12% success Pergonal16% IVF