Infertility

Zaira, Dulce, Laura, Heidi, Alexa, Melina, Lauren, Rachel,

Sydney
What is infertility?
Primary- Inability to become pregnant

Secondary- Inability to become pregnant after previous

pregnancy
Incidence of Infertility
Decreased in the US from 2006-2010

Little evidence of changes in infertility rates in over 20 years.

1990-2010
Why is there a perception that there has been an
increase in infertility?
Increase in population
Married at older age
Increase awareness on fertility treatments
Infertility VS. Impaired Fecundity
Five Reasons for Male Infertility
1. Sperm production problems
2. Blockage of sperm transport
3. Sexual problems
(erection and ejaculation problems)
4. Hormonal problems
5. Sperm antibodies
Five Reasons for Female Infertility
1. Age (older than 35)
2. Smoking
3. Stress
4. Being overweight or underweight
5. Athletic training
Evaluation of Female Infertility
Laboratory tests include: Imaging tests include:

Basal body temperature Ultrasound

Urine Hysterosalpingography
Progesterone Sonohysterography
Thyroid function Hysteroscopy
Prolactin level Laparoscopy
Ovarian reserve
Evaluation of Male Infertility
Laboratory tests include: Imaging tests include:

Semen analysis (sperm count) Transrectal ultrasonography

Scrotal ultrasonography
 Psychosocial Differences of Infertility
Men vs. Women
Responses depend on a gender-specific diagnosis.

Men experience many of the same emotions as women with the same level of
intensity when they find out infertility is attributable to a male factor.
Common Psychosocial Responses to Infertility
Female Male
1. Distress, stress, tension 1. Distress, stress, tension
2. Depression and sadness 2. Depression and sadness
3. Anxiety 3. Anxiety
4. Failure 4. Failure
5. Guilt 5. Guilt
6. Fear, anger, frustration 6. Fear, anger, frustration
7. Loneliness 7. Loneliness
8. Feelings of defectiveness 8. Feelings of defectiveness
9. Loss of identity 9. Loss of identity
10. Reduced self-control and self- 10. Reduced self-control and self-
esteem esteem
However... Men tend to repress many of their emotions
(i.e. anxiety).
Anxiety, distress, and depression are often
more intense in women
When infertility is not attributable to a male factor.

Women are reminded each month they are infertile

Have a more difficult time adjusting to social

engagement

Often still feel partially responsible for infertility

even if the diagnosis is purely a male factor.

Many of these feelings originate and

manifest from a different place.
Infertility Medications
Medications usage determined by:
A reproductive specialist
The type of infertility

Medications for ovarian stimulation may include:

Clomiphene Citrate (CC)
Synthetic Human Chorionic Gonadatropin (hCG)
Follicle Stimulating Hormone
Bromocriptine and Cabergoline
Gonadotropin-Releasing Hormone (GnRH)
Infertility medications continued
Medications to enhance fertility may include:
Medrol
Doxycycline
Progesterone
Fertility Supplements
Therapeutic Insemination
Artificial placement of sperm in the uterus
Types
Therapeutic Husband Insemination (THI)
Therapeutic Donor Insemination (TDI)
Indications
Male
Ejaculatory dysfunction
Anejaculation
Hypospadias
Female
Anatomic abnormalities
Vaginal Stenosis
Dyspareunia
Insemination Techniques
Intrauterine Insemination (IUI)
Speculum inserted, cervix cleaned
Sperm placed into 1 ml syringe with attached cath
Cath inserted into upper uterus and sperm
inserted
Intravaginal Insemination (IVI)
Rarely used
Can be done at home or in the clinic
Place a syringe into upper third of vagina and
deposit sperm
Intracervical Insemination (ICI)
Rarely used
Placement of a cath in cervical canal, but not
uterus
Sperm sample is delivered to the canal
In Vitro Fertilization (IVF)
Most effective form of Assisted Reproductive Technology (ART)
5-Step Process:
1. Fertility medications stimulate egg production
2. Eggs are retrieved using ultrasound and a hollow needle
3. Male/father produces sperm sample
4. Sperm and eggs are combined in lab (fertilization)
5. Embryos are transferred to uterus using catheter
Able to use eggs, sperm, and embryos from donor
Surrogate mother may carry IVF embryo
One IVF cycle takes about 2 weeks
Benefits and Costs of IVF
Painless for most women and effective
May cause multiple gestation if additional embryos
implanted
Success depends on:
Age and cause of infertility
Costs of IVF:
Time consuming, expensive, and invasive
Typical IVF costs $12,000 before medications
(additional $3,000-$5,000)
In rare cases, Ovarian Hyperstimulation Syndrome
may occur
GIFT (Gamete Intrafallopian Transfer)
Sperm and oocyte are mixed outside of the woman
Inserted via laparoscopy
Fertilized inside fallopian tubes

Indications for GIFT:

History of failed infertility treatment
for anovulation
Unexplained infertility
Low sperm count
ZIFT (Zygote Intrafallopian Transfer)
Laproscopic procedure
Oocyte is retrieved from the woman and IVF is used
1 day later, Zygote is placed into the fallopian tube
Question #1: What are indications for therapeutic
insemination? (Select all that apply)

A. Male ejaculatory problems

B. Vaginal stenosis
C. Failed IVF
D. Hypospadias
Question #2: True or False, Females typically do
not experience emotional turmoil if her significant
other is infertile?

A. True
B. False
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