1. Infertility Beth McNeill Texas A&M University

2. What is infertility? A condition which impairs the reproductive system from successfully producing offspring. Couples are considered infertile if unable to get pregnant after one year of unprotected intercourse.

3. Facts about Infertility Infertility is NOT an incontinence; it is a disease that inhibits the reproductive system from performing its most basic function—reproduction. Affects about 6.1 million people in U.S (10%) Infertility equally affects men and women 80% to 90% of infertility cases are treatable. In vitro fertilization treatments account for less than 5% of infertility services

4. Conditions for Conception 1.Ovulation-release of the egg from the woman's ovaries 2.Fertilization-the uniting of the woman’s egg and the man’s sperm 3.Implantation-The attaching of the fertilized egg to the lining of the uterus

5. Factors That Causes Infertility Primary Diagnoses for ART Procedures, 1995

6. THE MALE FACTOR Structural Abnormalities Physical damage to reproductive organs Abnormal Functioning Medical conditions

7. THE MALE FACTOR QUALITY & QUANTITY of Sperm QUALITY  Recreational Drug use  Stress  Age QUANTITY  Nutrition  Recreational drug use  Temperature You just never know doc… Any day could be the day. And then, competing with 50 million other guys for just one egg! The stress is killing me!

8. THE MALE FACTOR MYTH OR REALITY? BOXERSVS. BRIEFS ABSTAIN TO GAIN

9. THE FEMALE FACTOR Weight and fertility Number of times risk of infertility is increased

10. THE FEMALE FACTOR Improper hormone level PCOS-Polycystic Ovarian Syndrome Antibody production Medical / Genetic Conditions Recreational drug use

11. THE FEMALE FACTOR Presence of infection -Sexually Transmitted Infections (STI’s) -Pelvic Inflammatory Disease (PID )

12. THE FEMALE FACTOR Structural Abnormalities A.Scarring or tumors of the uterus B.Endometriosis C.Poor quality or lack of cervical mucus D.Adhesions & Fibroids

13. Testing for Infertility Basic work up includes: A semen analysis Proof of ovulation Postcoital test to observe movement of sperm through cervical mucus Evaluation of fallopian tubes

14. Testing for Infertility--MALES Semen Analysis Urologist Evaluation

15. Testing for Infertility-- FEMALES Tests for Ovulation Urine Test- evaluates for luteinizing hormone Basal Body Temperature –looks at body temperatures Progesterone test- measures levels Endometrial Biopsy–looks at uterine lining

16. Testing for Infertility-- FEMALES Structural Abnormalities Postcoital Test (PCT)- evaluates sperm movement Hysterosalpingography (HSG)-X-rays organs Ultrasound- provides pictures of organs using sound Hysteroscope – telescopic examination Laparoscopy- light telescopic examination

17. Individual Treatments MALES  Microsurgery when treating blocked parts of the reproductive tract.  Hormone injections to stimulate production of sperm FEMALES  Fertility drugs to bring on ovulation  Surgery to correct structural abnormalities

18. Treatments to Insure Fertilization Intracytoplasmic sperm injection (ICSI) Procedure injects a single sperm directly into an egg.

19. Treatments for Mobility Problems Intrauterine insemination

20. Treatments for Partners ASSISTED REPRODUCTIVE TECHNOLOGY Treatments or procedures that involve surgically removing eggs from a woman’s ovaries and combining them with sperm to help a woman become pregnant. In Vitro Fertilization (IVF) Gamete Intrafallopian Transfer (GIFT) Zygote Intrafallopian Transfer (ZIFT)

21. Treatments for Partners In Vitro Fertilization (IVF) An ART procedure that uses fertility drugs to mature multiple eggs. Laparoscopy used to remove mature eggs prior to ovulation. Mature egg is fertilized in a dish then placed back in the woman's uterus.

22. Treatments for Partners Gamete Intrafallopian Transfer (GIFT) ART procedure involving removal of eggs from the ovary, combining them with sperm, using laparoscope to place the unfertilized eggs and sperm into the woman's fallopian tube.

23. Treatments for Partners Zygote Intrafallopian Transfer (ZIFT) An ART procedure that is a variation of the IVF and GIFT. A zygote (fertilized egg) is used in the IVF procedure Fertilization occurs outside the body in a dish.

24. Decisions about Infertility Factors to Consider Expense Time-consuming Big commitment Professional counseling may be needed to help sort out issues alternatives

25. For more information www.cdc.gov/reproductive health www.fertility-docs.com www.asrm.org http://cis.nci.nih.gov/fact