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Infertility and Assisted
Reproduction
Overview
Introduction
Infertility
Causes of female infertility
Causes of male infertility
In vitrofertilization
1
Female Infertility
Female:
Includes (not an exclusive list):
Blocking of fallopian tubes (oviducts)
Uterine abnormalities
Infertility
Endometriosis,
Polycystic ovary syndrome,
Ovulation failure (absent or infrequent
menstrual cycles), Ectopic pregnancy
Unexplained infertility
Inability to conceive
10-15% of couples fail to conceive within 1 to 2
years of trying
About 1 in 6 couples in US
50 % due to problems in woman
30 % due to problems in male
20 % due to fertility problems in both partners
2
Blocking of Fallopian Tubes and
PID
Fallopian tube blockage often occurs secondary
Pelvic Inflammatory Disease (PID)
One study: 10% with PID had tubular blockage
STD’s: Gonorrhoea, Chlamydia are most common causes
Uterus, fallopian tubes and/or ovaries can be affected
Many women asymptomatic
Can get acute form
Endometriosis
Endometrial cells flourish in areas outside the uterine cavity
Most commonly on the ovaries
5-10% of women
25- 50 % of all infertile women have endometriosis
30 – 40 % of women with endometriosis are infertile
Double normal rate
Tissue may release factors inhibiting normal conception?
Endometriosis may secondary to other problem? Diagnosis-
Laparoscopy, Ultrasound and MRI
Options:
Surgery to remove abnormal tissue/ IVF
3
Ovarian defect in PCOS
Excessive training - athletes
Underactive or overactive thyroid gland
Hormonal irregularities
Polycystic ovarian syndrome
Polycystic Ovarian Syndrome
( PCOS )
Hormonal
Disorder
that
Polycystic Ovarian Syndrome
(PCOS )
Symptoms can include:
Increased facial hair
affects 5-10% of all
Weight gain
women
Acne
Most common cause of infertility
Irregular periods
Most underdiagnosed
Growth of multiple fluid filled cysts on ovaries
Often develops in teenage years but only diagnosed when
woman wishes to conceive
Link between PCOS and overproduction of insulin
Can stim
...
by ovaries
Pelvic pain
Male pattern baldness
If untreated affected women may go on to develop
diabetes type II, high BP, high cholesterol and heart
disease
4
Male Infertility
Potential Causes
Low sperm count
Poor sperm motility
Agglutination
Abnormal sperm
Varicocele
Obstructions
Polycystic Ovarian Syndrome
( PCOS )
Undescended testes
Diseases
Smoking
Sexual and ejaculatory problems
Diet, exercise and medication can often help
Hormonal disturbances
Treatment options include
Contraceptive pill
If you don’t want to conceive (but abnormalities in ovarian function will return
on cessation of pill)
Medications that alter body’s sensitivity to prod
Insulin- diabetes medication- ‘Metformin’ ??
Hormones that stimulate ovulation- Clomiphene (‘Clomid’) +/- hCG
↑ prod of gonadotropins by inhibiting negative feedback on the hypothalamus
In vitrofertilization
V
...
2
...
Menstrual cycle shut down using hormones
Stimulating ovaries with hormones to produce multiple eggs
Collecting matured oocytes from ovaries
Transvaginal ultrasound aspiration
4
...
with sperm
5
...
Placing one or more embryos back into uterus for them to
grow
...
GnRH antagonist- negative feedback suppresses release of
woman’s own GnRH
Long half-life: Supresses woman’s FSH & LH & → Oestradiol
secretion ↓ (DOWN REGULATION)- ovaries inactive & wall of
uterus thin
2
...
Matured cocytes harvested 36 hrs following hCG
Before
IVM
4
...
2% (for
women under 35);
23
...
3% (for women aged 38-39)
10