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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


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
Semen Analysis

Normal values:

Volume 2-5cc

Count>20 million

Motility>50%

Morphology>50% normal

(strict criteria >15%)


COMMON DIAGNOSIS

Varicocele









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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