Fertility Facts
Definition:unprotected sex for one year, not pregnant
Frequency: 1 out of 6 couples in the US
Responsibility: 35% female infertility
35% male
20% both
10% unknown
Maternal Age USA
20-24
25-29
4.1%
5.5%
30-34
35-39
85% treated successfully
9.4%
19.7%
Increase 1970-now-Why?
What can cause infertility?
Unexplained-18%
Female
Male
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Ovulation disorders
Tube/uterus blockage
Cervix
Endometriosis
Other
• Sperm count and
defects
• Erectile or ejaculation
deficiency
Intrinsic vs. Extrinsic, Environmental
More detail on female infertility
• Ovulatory failure-polycystic ovarian syndrome (high
androgen/estrogenlevels), resistant ovarian syndrome,
gonadal dysgenesis
• Impaired gamete/zygote transport-pelvic inflammatory
disease, endometriosis
• Implantation defects-progesterone low
• Spontaneous abortion-chromosome abnormality
More detail on male infertility
• Cryptorchidism-Why?
• Chromosome disorders-gonadal dysgenesis
• Obstructions
• Gonadotropin deficiency
Result in:Low sperm count, sperm of poor
quality
Female Infertility Tests
• For ovulation
• Basal body temperature
• Ovulation kit (LH surge)
• Other hormone tests (steroids)
• Post ovulatory block
•Laparoscopy-fiber optic look
•Hysterosalpingogram-dye
•Post-coital /cervical mucous and sperm
•Sperm antibodies
•Endometrial biopsy
Sperm good for 2-3 days, egg for 2
Can find adhesions, structural abnormality, etc
Hysterosalpingogram
Blocked tubes
Male Infertility Tests
• Sperm count/motility
– > 20 million sperm/ml
– Check motility and morphology
• >50% motile
• >30% structurally normal
• If low check LH and androgen levels
•Testicular biopsy
Sperm Count
Older, low tech treatments
• Drug treatment for ovulation block
• Intrauterine insemination
• Tubal surgery
High tech Assisted Reproduction Technologies
• IVF-in vitro fert and embryo transfer
•GIFT-gamete intrafallopian tube transfer
•ZIFT-zygote intrafallopian tube transfer
•Intracytoplasmic sperm injection
frozen eggs/ ovary transplant; cloned human embryo
First test-tube
baby
Assisted Reproductive Technology
• Estimate 1/100 births now
• Around 40,000/year
• Costs between $7,000 to 15,000 per attempt
IVF
In Vitro Fertilization and Embryo
Transfer
Basic Steps in IVF
•Ovary stimulation
•Egg retrieval
•Sperm retrieval-wash sperm
•Fertilization
•Embryo transfer
•Progesterone
Start with more than 1 egg
Drugs used for ovary stimulation
•Clomiphene (clomid)-anti-estrogen
•hMG (pergonal)-menopausal gonadotropin (FSH and LH)
•FSH-(metrodin)
•GnRH
•GnRH agonists (lupron)-FSH/LH first promoted, then inhibited
•hCG-acts like LH
In a single cycle, could take clomid, pergonal, hCG
shot, then progesterone
Why transfer more than one
embryo?
• Increase the pregnancy rate
• Leads to increased risk of multiple
pregnancies
• In future- Test embryos before transfer
sHLA-G measure of embryo health
Egg retrieval, vaginal, with ultrasound
Modifications if tube not blocked
Gametes mixed for GIFT
GIFT
If fertilization needs help-transfer zygote
ZIFT
Intracytoplasmic sperm injection
ICSI
Additional twists
• Surrogacy
– Gestational
– Egg donor plus gestational
– Egg donor plus sperm donor plus gestational
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Frozen embryos
Egg donors
Frozen eggs
Cloning
From CDC
IVF Success Rates
Stage
Number of Women
Cycle initiation
100
Ovulation
95
Oocyte retrieval
90
Fertilization
85
Embryo Transfer
70
Pregnancy
24
Birth
18
From The Baby Business by Debora Spar
Risks of ART?
• To woman
– Overstimulation of ovary syndrome
– Multiple pregnancies
– Risk of ovarian cancer (clomid, pergonal)
• To baby
– ICSI associated with problems (XYY)
Discussion questions-what treatment(s)
would you select given the following:
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Male with low sperm count
30 year-old female not ovulating
40 year-old female not ovulating
Undiagnosed infertility