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. Secondary Infertility Subfertility vs. Sterility Fecundity: is the probability of achieving a live birth in 1 menstrual cycle. Fecundability is expressed as the likelihood of conception per month of exposure.
Abnormal spermatogenesis Endocrine disorders Hypothalamic dysfunction (Kallmann's Chromosomal abnormalities syndrome) Mumps orchitis Pituitary failure (tumor, radiation, Cryptorchidism surgery) Chemical or radiation exposure Hyperprolactinemia (drug, tumor) Abnormal motility Exogenous androgens Absent cilia (Kartagener's Thyroid disorders syndrome) Adrenal hyperplasia Varicocele Anatomic disorders Congenital absence of vas deferens Antibody formation Obstruction of vas deferens Sexual dysfunction Congenital abnormalities of Retrograde ejaculation ejaculatory system
Central defects Chronic hyperandrogenemic anovulation Hyperprolactinemia (drug, tumor, empty selia) Hypothalamic insufficiency Pituitary insufficiency (trauma, tumor, congenital)
Peripheral defects Gonadal dysgenesis Premature ovarian failure Ovarian tumor Ovarian resistance Metabolic disease Thyroid disease Liver disease Renal disease Obesity Androgen excess, adrenal or neoplastic
Pelvic Factor Infection Appendicitis Pelvic inflammatory disease Uterine adhesions (Asherman's syndrome) Endometriosis Structural abnormalities Diethylstilbestrol (DES) exposure Failure of normal fusion of the reproductive tract Myoma
Cervical Factor Congenital DES exposure Mllerian duct abnormality Acquired Surgical treatment Infection
Congenital abnormalities Undescended testes Prior paternity Frequency of intercourse Exposure to toxins Previous surgery Previous infections (mumps), treatment Drugs and medications General health (diet, exercise, review of systems) Decreased frequency of shaving Excessive heat exposure (spermicidal)
In utero diethylstilbestrol (DES) exposure History of pubertal development Present menstrual cycle characteristics (length, duration, molimina) Contraceptive history Prior pregnancies, outcomes Previous surgeries, especially pelvic Prior infection History of abnormal Papanicolau (Pap) smear, treatment Drugs and medications General health (diet, weight stability, exercise patterns, review of systems)
Pelvic masses Uterosacral nodularity Abdominopelvic tenderness Uterine enlargement Thyroid exam Uterine mobility Cervical abnormalities
Sperm count/motility
> 20 million sperm/ml Check motility and morphology x >50% motile x >30% structurally normal
Sperm Count
For ovulation
Basal body temperature Ovulation kit (LH surge) Other hormone tests (steroids)
Hysterosalpingogram
Blocked tubes
Hypogonadotrophism
hMG GnRH CC, hCG results poor
Varicocoele
Ligation? (no definitive data yet)
Retrograde ejaculation
Ephedrine, imipramine AIH with recovered sperm
IVF-in vitro fert and embryo transfer GIFT-gamete intrafallopian tube transfer ZIFT-zygote intrafallopian tube transfer Intracytoplasmic sperm injection
Basic Steps in IVF Ovary stimulation Egg retrieval Sperm retrieval-wash sperm Fertilization Embryo transfer Progesterone
IVF Success Rates Stage Women Cycle initiation Ovulation Oocyte retrieval Fertilization Embryo Transfer Pregnancy Birth Number of 100 95 90 85 70 24 18
GIFT
ICSI