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Infertility

Infertility. He-Feng Huang Women’s Hospital, School of Medicine, Zhejiang University. Where we come from?. Infertility. Definition: The inability to achieve pregnancy after regular unprotected intercourse for a period of 1 year.

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Infertility

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  1. Infertility He-Feng Huang Women’s Hospital, School of Medicine, Zhejiang University

  2. Where we come from?

  3. Infertility Definition: The inability to achieve pregnancy after regular unprotected intercourse for a period of 1 year. • Primary infertility: never conceived within 1 year • Secondary infertility: after a previous pregnancy, unable to conceive again within a 1 year period.

  4. Etiology • Female factors • Male factors • Female and male factors

  5. Female Factor • Ovulatory disorders • Tubal factors • Uterine factors • Cervical factors • Vulval and vaginal factors

  6. Ovulatory disorders • Hypothalamic dysfunction • Pituitary dysfunction • Ovarian factor • Others Hypothalamic-pituitary-ovary axis

  7. Hypothalamic dysfunction • Psychological factors: Stress, Disturbance, Anorexia derived from mental stimulus • Chronic consumptive diseases: Tuberculosis , Severe malnutrition, Anorexia nervosa

  8. Pituitary dysfunction • Pituitary tumors: Pituitary adenoma • Pituitary lesions: Empty sella syndrome • Sheehan’s Syndrome

  9. Ovarian factors • PCOS • LUFS • POF • Ovary insensitivity syndrome • Congenital abnormality • Surgery or X-ray • Ovarian endometriosis • Ovarian tumor

  10. PCOS Symptom Menses disturbance and infertility hirsutism, acne, obesity (BMI ≥ 25) Diagnosis (1)irregular menses or anovulation (2)experimental or clinical hyperandrogenism (3)polycystic ovarian morphology observed by ultrasound Accord with 2 points of the three. Follow-up for whole life

  11. Others • Thyroid disorder • Adrenal dysfunction

  12. Tubal factors • Inflammation • Surgery of ectopic pregnancy Tubal ovarian effusion Tubal blockage, hydrosalpinx (HSG) Ectopic pregnancy

  13. Tubal factors • Tubal ligation • Tubal abnormality Tubal ligation Tuberculosis fallopian tube

  14. Increase of tubal factors • STD • Repeated intro-uterine manipulation • Repeated drug abortion

  15. Uterine factors • Uterine developmental abnormality Congenital absence of the uterus Uterine malformation • Endometrial abnormality Endometrial tuberculosis Asherman syndrome • Uterine tumor

  16. Uterine developmental abnormality

  17. Intrauterine adhesions fibroid 

  18. Male factors • Semen abnormality Oligospremia, Aspermia, Asthenospermia • Sperm transport abnormality • Endocrine disorders • Sexual dysfunction • Immunological factors

  19. Male and female factors • Psychological factors • Subfertility • Immunological factors

  20. Classification

  21. Investigation and Diagnosis • Male investigation History: general health, medications, lifestyle and reproductive health General examination Specific examination: abnormality of genitals seminal analysis

  22. Normal Seminal analysis(Fourth/Fifthversion) • Volume ≥ 1.5ml • PH 7.2~7.5 • Density ≥ 15×10 /ml • Count ≥ 39×10 /every ejaculation • ≥ 32% sperm progressive motility (grade a+b) Grade a: rapid progressive motility Grade b: slow progressive motility • Morphology ≥ 4% • Survive rate ≥ 50% • WBC ≤ 1×10 • Volume ≥ 2.0ml • PH 7.2~7.5 • Density ≥ 20×10 /ml • Count ≥ 40×10 /every ejaculation • ≥ 50% sperm progressive motility (grade a+b) or ≥ 25% sperm rapid progressive motility (grade a) Grade a: rapid progressive motility Grade b: slow progressive motility • Morphology ≥ 15% • Survive rate ≥ 58% • WBC ≤ 1×10 6 6 6 6 6 6 Fourth version Fifth version

  23. Female Investigation • History • General examination • Specific examination • Others

  24. Specific examination Ovarian examination • Ovulation monitor • Luteal function • Ovarian reserve

  25. Ovarian function Ovulation monitor 1、Basic body temperature 2、Cervical mucus 3、Vaginal cytological test 4、Ultrasound monitor 5、Serum or urinary LH peak 6、Serum E2 and P levels 7、Endometrial biopsy 8、Laparoscopy

  26. Follicular development and ovulation

  27. Biphasic basal body temperature

  28. monophasic basal body temperature

  29. Low estrogen High estrogen

  30. Cervical mucus

  31. Fern crystallization

  32. Proliferative endometrium Secretory endometrium

  33. Luteal function 1、BBT 2、Endometrial biopsy 3、Serum E2 and P levels

  34. Ovarian reserve 1、Age 2、Antral follicle count (AFC) 3、Basic FSH、E2 4、CC stimulating test 5、GnRH-a stimulating test 6、AMH、Inhibin B

  35. Tubal investigation • Hydrotubation • Hysterosalpinography (HSG) • Laparoscopy • Hysterosalpingography by Ultrasound

  36. Hydrotubation

  37. HSG normal figure

  38. Laparoscopy :methylene blue liquid

  39. Postcoital test • Cervical hostility • Hysteroscope • Laparoscopy

  40. Postcoital test

  41. Postcoital test • Cervical hostility • Hysteroscope • Laparoscopy

  42. Cervical hostility

  43. Postcoital test • Cervical hostility • Hysteroscope • Laparoscopy

  44. Endometriosis(Laparoscopy)

  45. Treatment of infertility • 1.Treatment of genitals organic disease • 2.Induction of ovulation • 3.Luteal support • 4. Improvement of cervical mucus • 5.Treatment of tubal inflammation • 6.ART

  46. 1. Genitals organic disease Genital malformations Genital inflammation Uterine Myoma Endometriosis ----Etiology combined treatment: Infection control, Surgery

  47. 2.Tubal infertility • Fallopian tube obstraction: Fallopian tube glue loose solution operation Salpingostomy Tubo-uterine implantation Tubal anastomosis • Fallopian tubes were partial unobstructed: Liquid instillation Physical therapy Traditional Chinese Medicine

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