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The McCoughey Septuplets

The McCoughey Septuplets. Infertility 101. Definitions Under 35 yo No conception after one year of unprotected intercourse Over 35 yo No conception after 6 months of unprotected intercourse. Your Infertility Patient. 34 yo woman presents to your

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The McCoughey Septuplets

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  1. The McCoughey Septuplets

  2. Infertility 101 Definitions Under 35 yo No conception after one year of unprotected intercourse Over 35 yo No conception after 6 months of unprotected intercourse

  3. Your Infertility Patient. . . 34 yo woman presents to your clinic to discuss her concerns about infertility

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

  5. Etiologies • Male Factor 40% • Tubal Factor 40% • Ovulation Problem 10% • Unexplained 10%

  6. Start with History. . .What Clues Can You Find on History? • Male Factor • Tubal Factor • Ovulation

  7. Semen Analysis Normal values: Volume 2-5cc Count >20 million Motility >50% Morphology >50% normal (strict criteria >15%)

  8. Male Factor Infertility Evaluation: Repeat semen analysis Physical exam- varicocele, testicular size Lab testing- testosterone, FSH, LH Genetics for special cases IUI (intrauterine insemination) ICSI (intracytoplasmic sperm injection) Donor sperm

  9. Etiologies • Male Factor 40% • Tubal Factor 40% • Ovulation Problem 10% • Unexplained 10%

  10. Hysterosalpingogram

  11. HSG: Unilateral Blocked Tube

  12. HSG: Tubal Infertility

  13. HSG: Hydrosalpinx

  14. HSG of DES daughter

  15. Etiologies • Male Factor 40% • Tubal Factor 40% • Ovulation Problem 10% • Unexplained 10%

  16. Ovulation Physiology • The LH (lutenizing hormone) surge occurs 34-36 hours prior to follicle rupture • Progesterone is increasingly produced after the LH surge • Secretory changes to the endometrium occur secondary to the increased progesterone levels

  17. Ovulation Predictor Kits

  18. Salivary Estrogen: TCI Ovulation Tester- 92% accurate

  19. Add Saliva Sample

  20. Non-Ovulatory Saliva Pattern

  21. High Estrogen/ Ovulatory Saliva Pattern

  22. Approach to Ovulation Disorders • Evaluate- Hypothyroidism Prolactin Disorder Hyperandrogenism- PCOS Weight loss/ weight gain • Induce Ovulation Clomid (clomiphene citrate)

  23. Traditional Infertility Evaluation • Semen Analysis • Hysterosalpingogram (HSG) • Documentation of Ovulation • Post-coital Exam • Diagnostic Laparoscopy

  24. Current Infertility Evalution • Semen Analysis • Hysterosalpingogram (HSG) • Documentation of Ovulation 4) Ovarian Reserve Testing

  25. Ovarian Reserve Testing Day #3 FSH (<10 mIU/ml) and estradiol (<80 pg/ml) -Correlates with the functional status of the ovaries and the quality of the oocytes - FSH >15 only 5% success with IVF - High estradiol level increases risk of cancelling IVF cycle

  26. Unexplained Infertility • 12-15% of couples • 3% chance of achieving a pregnancy • Treatment: Superovulate with IUI (intrauterine insemination)- Clomid 12% success Pergonal 16% IVF

  27. Infertility?

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