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Infertility Overview, Approach and Evaluation

This Presentation includes Male & Female Infertility Overview, approach & evaluation. Infertility is a disease defined by the failure to get a successful pregnancy after 12 months of timed unprotected intercourse or therapeutic donor insemination.<br><br>Eden fertility center is a unique fertility clinic with advanced facilities and state-of-the-art equipment to make sure of the best patient care. We deliver the most advanced fertility treatments in Newport Beach & Fullerton CA<br><br>Eden Centers for Advanced Fertility offers patients the most advanced treatment solutions & also gives excellent quality patient care. We are a group of highly trained specialists who've innovative concepts for fertility treatment based upon three main principles: individualized patient care, excellent medical service & effective benefits.<br><br>Services We Offer -<br>Fertility Treatments<br>Third-Party Reproduction<br>Genetic Testing<br>Male Infertility<br>Egg Freezing - Oocyte Preservation<br>Fertility Preservation<br><br>Schedule An Appointment <br>https://www.edenfertilitycenters.com/<br><br>Newport Beach Office <br>20360 SW Birch Street, Suite 200<br>Newport Beach, CA 92660<br>Toll-Free: 855-566-1616<br>Local: 949-688-1003<br><br>Fullerton Office <br>2720 N Harbor Blvd, Suite 220<br>Fullerton, CA 92835<br>Toll-Free: 855-566-1616<br>Local: 657-243-8300

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Infertility Overview, Approach and Evaluation

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  1. Infertility Overview, approach and evaluation Vitaly A. Kushnir MD

  2. Infertility • A disease defined by failure to achieve a successful pregnancy after 12 month of timed unprotected intercourse or therapeutic donor insemination. • Earlier evaluation and treatment may be justified based on history and physical exam and is warranted after 6 month in women older than 35 years. • Occurs in 12% of all couples ASRM, Fertil Steril. 2013

  3. Etiology of Infertility • Normal ovulation • Patent fallopian tubes • An endometrium and corpus luteum to allow implantation and maintenance of a pregnancy • Normal spermatogenesis, reproductive anatomy and sexual function • Sperm must traverse the cervix, uterus and fallopian tube and fertilize the oocyte

  4. Etiology of Infertility

  5. Causes of Female Infertility • Ovary • Tubes • Uterus • Cervix • Hormones • Genetics

  6. Age and Female Fertility Conception rate per month: 1st 20, 3rd 50, 6th 75, 12th 90

  7. Aging and Ovarian Reserve Gleicher N, Kushnir VA, Barad DH. Endocrinology. 2013 Oct;154(10):3498-501

  8. Oocyte Aneuploidy and Age

  9. Ovarian Reserve The Lancet, Volume 376, Issue 9744, Pages 911 - 921

  10. Normal range for AMH PCO DOR Kelsey TW et al. PLoS ONE 2011

  11. Ovary - Causes of Anovulation • Hormone Imbalance • Polycystic Ovary Syndrome (PCOS) • Premature Ovarian Failure (POF) • Diminished Ovarian Reserve (DOR) • Functional Hypothalamic Amenorrhea (FHA) • Exercise, Stress, Malnutrition, Chronic illness

  12. Ovulation • Menstrual History • Basal Body Temperature • OPK – LH Surge • Endometrial biopsy • Mid-luteal progesterone Wilcox AJ et al. N Engl J Med 1995

  13. Diagnosis of PCOS Two of the following three criteria are required: 1. Oligo/Anovulation 2. Hyperandrogenism -clinical (hirsutism or male pattern alopecia) or -biochemical (TT>70ng/dL, A4>245ng/dL, DHEAS>248ug/dL) 3. Polycystic Ovaries on Ultrasound ≥12 follicles [2-9mm diameter] or -ovarian volume >10cm3 in either ovary Other etiologies must be excluded such as Nonclassical Congenital Adrenal Hyperplasia, androgen secreting tumors, Cushing syndrome, thyroid dysfunction and hyperprolactinaemia Rotterdam Criteria

  14. Female Infertility – Fallopian Tubes Appendicitis 4 RR ruptured uncomplicated no increased risk Tuberculosis DES IUD • Chlamydia, GC • PID • 1st episode: 11-12% • 2nd episode: 23 • 3rd episode: 54% • Endometriosis • Tubal ligation Evaluation: HSG & Laparoscopy

  15. Female Infertility – Fallopian Tubes

  16. Normal HSG

  17. Abnormal HSG • Hydrosalpinges • Adverse effect on IVF pregnancy outcome • Fluid drains into endometrial cavity • Rapid reaccumulation of fluid post aspiration • Tubal occlusion increases pregnancy outcome • Salpingectomy may effect ovarian function

  18. Female Infertility - Uterus • Fibroids • Polyps • Asherman Adhesions • Mullerian Anomalies

  19. 3D Sono, HSN, HSG

  20. Hysteroscopy & Laparoscopy Marcoux S et al. N Engl J Med 1997

  21. Inflammation in Reproduction Weiss G, Goldsmith LT, Taylor RN, Bellet D, Taylor HS. Reproductive Sciences. 2009;16(2):216-229.

  22. Male Factor

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

  24. Male Reproductive Organs

  25. Sperm • How many are needed for fertilization? • Natural conception • >5,000,000 • Intra-uterine insemination (IUI) • 1,000,000 • In-vitro fertilization (IVF) • 10,000 • Intra-cytoplasmic sperm injection (ICSI) • 1

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

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

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

  29. Normal Semen ParametersWHO 2010

  30. Sperm Morphology

  31. Vaginal Lubricants

  32. Evaluation of Oligospermia • History and Physical • Serum hormones • FSH, TSH, Prolactin, Testosterone • Postejaculate Urine • Semen Fructose • Genetics • Karyotype • Y Chromosome Microdeletions • Cystic Fibrosis

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

  34. Infertility: Key Points • Eggs • Ovulation • Egg quality & reserve (Age, AMH, FSH, E2) • Sperm • Presence • Quality • Gamete transport/Implantation • Hysterosalpingogram • 3D Sonogram

  35. Contact Us Eden Fertility Centers combines the very latest in fertility treatment technology with luxury-level care to provide your family the very best chance of welcoming a new life into your home.  Thank You Schedule An Appointment Call (855) 566-1616www.edenfertilitycenters.com

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