Download
infertility in vitro fertilization ivf and genetic testing n.
Skip this Video
Loading SlideShow in 5 Seconds..
Infertility, In Vitro Fertilization (IVF) and Genetic Testing PowerPoint Presentation
Download Presentation
Infertility, In Vitro Fertilization (IVF) and Genetic Testing

Infertility, In Vitro Fertilization (IVF) and Genetic Testing

298 Views Download Presentation
Download Presentation

Infertility, In Vitro Fertilization (IVF) and Genetic Testing

- - - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript

  1. Infertility, In Vitro Fertilization (IVF) and Genetic Testing Michele Evans, M.D.

  2. Outline • Infertility • Treatment options • In Vitro Fertilization • Genetic Testing • Preconception • Preimplantation • Prenatal • Controversies

  3. Normal Fertility Hull, et al: Br Med J 1985:291;1693

  4. Overview of Infertility • Definition: 1 year of well-timed, unprotected intercourse without a pregnancy • 10-15% of population is infertile (subfertile)

  5. Causes of Infertility

  6. Female Reproductive Organs

  7. FSH (+) E2 (-) Developing follicle FSH=Follicle Stimulating Hormone E2=Estradiol Physiology

  8. Causes of Female Infertility • Ovary • Tubes • Uterus • Cervix • Hormones • Chromosomes

  9. Causes of Female Infertility - Ovary • AGE • Problems with ovulation • Premature ovarian failure

  10. Ovary - Female Age • Women are born with their lifetime egg supply • 4 million at 20 weeks gestation • 400,000 at birth • 100,000 eggs left at time of puberty • Fertility initially declines at age 27 • Significant decline at age 37-38 • Rare pregnancies after age 44

  11. Percentage of Married Women Who are Infertile From 3 national U.S. surveys Menken et al, Science 1989;23:1389

  12. Ovarian Reserve Testing

  13. Clinical pregnancy per cycleas function of both FSH and age Pearlstone et al, Fertil Steril 1992:58:674

  14. Prevalence of genetically abnormal oocytes in infertile women Abnormal (%)

  15. Ovary - Ovulation

  16. Ovary - Ovulation • History • Regular menses (90%) • Premenstrual symptoms • Patient self-testing • BBT, urinary ovulation kits (LH) • Laboratory tests • Mid-luteal serum progesterone > 10 ng/mL • Endometrial biopsy

  17. Ovary - Causes of Anovulation • Hormone imbalance • Obesity • Anorexia • Significant stress • Patients display: • Irregular menstrual cycles • Skipped cycles • Minimal or absent premenstrual symptoms

  18. Ovary – Premature Ovarian Failure • Menopause prior to age 40 • ↓Estrogen • ↑FSH • Causes • Autoimmune • Genetic • Idiopathic • 1-2% pregnancy rate

  19. Causes of Female Infertility – Fallopian Tubes • Infection (chlamydia) • Endometriosis • Tubal ligation (female sterilization)

  20. Open Tubes

  21. Blocked Tubes

  22. Female Infertility - Uterus • Uterus • Fibroids • Polyps • Mullerian (congenital) defects • Absent • Bicornuate/Septum • Asherman’s syndrome

  23. Female Reproductive Organs

  24. Female Infertility • Uterine muscle tumor • Benign (>95%) • 25-30% of women

  25. Normal Shape of Uterus

  26. Fibroid Uterus

  27. Female Infertility - Uterus • Uterus • Tumors • Fibroids • Polyps • Mullerian defects (congenital) • Absent uterus • Bicornuate/septate • Asherman’s syndrome

  28. Mullerian Defect

  29. Treatment with Hysteroscopy

  30. Treatment with Laparoscopy

  31. Female Infertility - Uterus • Uterus • Tumors • Fibroids • Polyps • Mullerian defects (congenital) • Absent uterus • Bicornuate/septate • Asherman’s syndrome

  32. Female Infertility - Cervix • Cervix • Post-surgical • Stenosis • Mucus changes

  33. Female Infertility - Hormones • Endocrine abnormality (hormones) • Thyroid • Prolactin • Polycystic ovary syndrome (PCOS) • Estrogen, insulin • Hypothalamic hypogonadism • Stress • Exercise (ballet dancer)

  34. Other Causes of Female Infertility • Others • Chromosome abnormalities • Turner’s syndrome (XO) • Androgen Insensitivity (XY) • Male pseudohermaphrodite • Female phenotype • Blind vaginal canal • Inguinal hernia (50%)

  35. Causes of Male Infertility • Abnormality in sperm production • Abnormality in sperm function • Obstruction in the ductal system

  36. Male Reproductive Organs

  37. Sperm: Semen Analysis • Volume: > 2 mL • Concentration: > 20,000,000 per mL • Motility: > 50% • Normal morphology: > 40% normal • Krueger strict criteria: > 14% normal • Best predictor of fertilizing ability

  38. Normal Sperm Morphology

  39. Abnormal Morphology

  40. Abnormal Morphology

  41. Sperm • How many are needed for fertilization? • Natural conception • 20,000,000 • Intra-uterine insemination • 1,000,000 • In-vitro fertilization (IVF) • 10,000 • Intra-cytoplasmic sperm injection (ICSI) • 1

  42. Fertilization • Binding to zona pellucida • Penetration of oocyte • Decondensation and aster formation • Pronucleus formation

  43. Causes of Male Infertility • Abnormality in sperm production • Abnormality in sperm function • Obstruction in the ductal system

  44. Abnormalities of Sperm Production • Genetic • Y chromosome microdeletions • Damage to testes – anatomical • Cryptorchidism • Varicocele • Infection • Mumps orchitis • Gonadotoxins

  45. Abnormalities of Sperm Function • Antisperm antibodies • Genital tract inflammation • prostatitis • Varicocele • Failure of acrosome reaction • Problems with sperm binding/penetration

  46. Obstructions in Ductal System • Vasectomy • Congenital bilateral absence of the vas deferens • Epididymis/ejaculatory ducts • Congenital or acquired

  47. Male Infertility - Lifestyle • Tobacco • Marijuana • Alcohol • Cocaine • Steroids (can be permanent) • Heat • Exercise

  48. Infertility: Initial Evaluation • Eggs • Ovulation • Egg quality • Sperm • Presence • Quality • Gamete transport/Implantation • Hysterosalpingogram

  49. Unexplained Infertility • Work-up is negative • 15-20 % of couples

  50. Treatments • Observation (improve timing) • Clomiphene citrate + intrauterine insemination (IUI) • FSH + IUI • IVF • Egg donation