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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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infertility1
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
Psychosocial Issues
  • Expectations
  • Stress on Relationships
  • Stress on Finances
  • Alternatives- Adoption or Childless
  • Counseling, Support Groups
slide5

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
slide6

HISTORY

  • TOXINS, DRUGS, SMOKING, ALCOHOL
  • PRIOR SURGERY
  • INFECTIONS
slide7
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
Semen Analysis

Normal values:

Volume 2-5cc

Count>20 million

Motility>50%

Morphology>50% normal

(strict criteria >15%)

slide14
Treatment: Surgical
    • Varicocele Ligation
slide16
Treatment: Surgical
    • Ejaculatory duct resection
slide17

Other Common Diagnoses

  • Genetic
  • Y Deletions
  • Klinefelters
  • Translocations
  • Cystic Fibrosis
slide18
Treatment: Surgical
    • Vasal reconstruction
slide20
Treatment: Surgical
    • Sperm retrieval,
    • Intracytoplasmicsperm injection
unexplained infertility
Unexplained Infertility
  • 12-15% of couples
  • 3% chance of achieving a pregnancy
  • Treatment:

Superovulate with IUI

(intrauterine insemination)-

Clomid12% success

Pergonal16%

IVF

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