2. Outline Definition Signs and symptoms Process of conception Types of infertility Causes of infertility Diagnostic studies ComplicationTreatmentPreventionSummaryReferences

3. Definition In vitro fertilization (IVF) is a procedure in which eggs (ova) from a woman's ovary are removed, they are fertilized with sperm in a laboratory procedure, and then the fertilized egg (embryo) is returned to the woman's uterus.

4. Signs and symptoms Most men with fertility problems have no signs or symptoms. Most men with fertility problems have no signs or symptoms. Some men with hormonal problems may note a change in their voice Some men with hormonal problems may note a change in their voice or pattern of hair growth, enlargement of their breasts, or difficulty or pattern of hair growth, enlargement of their breasts, or difficulty with sexual function with sexual function Infertility in women may be signed by irregular menstrual periods Infertility in women may be signed by irregular menstrual periods or associated with conditions that cause pain during menstruation or associated with conditions that cause pain during menstruation or intercourse. or intercourse.

5. Process of conception * Every month the pituitary gland in a woman's brain sends a signal to her ovaries to prepare an egg for ovulation. The pituitary hormones — follicle-stimulating hormone (FSH) and luteinizing hormone (LH) — are involved in stimulating the ovaries to bring an egg to ovulation. * A large boost in LH carries a message to the ovarian follicle to release its egg (ovulate). A woman is most fertile at the time of ovulation — around day 14 of her menstrual cycle — although the exact time of ovulation varies among women due to different lengths of menstrual cycles.

6. * * The egg is then captured by a fallopian tube and is viable for about 24 hours, but its best chance of being fertilized is within the first 12 hours following ovulation. For pregnancy to occur, a sperm must unite with the egg in the fallopian tube during this time. * * Sperm are capable of fertilizing the egg for up to 72 hours and must be present in the fallopian tube at the same time as the egg for conception to occur. If fertilized, the egg moves into the uterus two to four days later. There it attaches to the uterine lining and begins a nine-month process of growth.

12. Types of infertility Infertility was divided into two types: Type I: never achieving a recognized pregnancy, Type II: conception but no live birth. Infertility is broken down into male factor, female factor.

13. Type of infertility common in lesbians? A new study suggests that lesbians may be more likely to suffer from a common cause of infertility

14. DIAGNOSTIC STUDIES 1. Hormonal Studies (Estradiol, FSH, LH,...) 2. Endometrial Biopsy 3. Ultrasound Testing 4. Laparoscopy 5. Semen Analysis 6. The Postcoital Test (PCT) 7. Hysterosalpingogram (HSG)

15. Female infertility Causes of infertility

16. OOvulation problems Annovulation : lack of ovulation Oligoovulation : infrequent ovulation Luteal phase defects TTubal problems affect their ability to pick up the egg  Infection Sexually transmitted diseases, Previous pelvic infection, infection from internal organs

17.  Surgery  Previous ectopic pregnancy EEndometriosis

19.  Uterine problems Fibroids Uterine Polyps

21. Male infertility

22. no sperm in the ejaculate poor sperm quantity or quality Age Age Emotional stress Emotional stress smoking smoking

23. TREATMENT OF INFERTILITY

24. Ovulation induction: 1.Clomid (Clomiphene)/ Tamoxifen: Clomid blocks the estrogen receptors on the hypothalamus causing them to “think” there is estrogen deficiency 2.Bromocriptine / Cabergoline / Quinagolide: reduce prolactin secretion 3.hMG (pergonal, menogon) : hMG contains both FSH and LH hormones 4. FSH (metrodin) : stimulates the ovaries to produce multiple follicles. 5.LH (luteinizing hormone) : Gonal F and Puregon 6.hCG (profasi and pregnyl ): 7.pulsatile GnRh (Fertiral )

25. C CC Complication → Complications of being infertile often involve strong emotions and may trigger negative feelings between you and your partner. These may include:  Depression  Guilt  Anger  Stress  Disappointment  Fear of losing partner because of infertility  Diminished confidence and self-esteem

26. Prevention FFFFor male: Most types of male infertility aren't preventable. However, avoid drug and tobacco use and excessive alcohol consumption, which may contribute to male infertility. Also, high temperatures can affect sperm production and motility FFFFor female: A woman can increase her chances of becoming pregnant in a number of ways: Exercise moderately Avoid weight extremes Avoid alcohol, tobacco and street drugs

29. العقم في المرأه

33. References  www.ansewr.com www.ansewr.com  Boggs, William M., and Rosella D. Smith. The Journey to Fertility: A Couple's Guide to In Vitro Fertilization. Timonium, MD: Wilrose Books, 2001 http://www.emedicin.com/emerg/topic507.htm http://www.emedicin.com/emerg/topic507.htm  http://www.emedicin.com/emerg/topic507.htmhttp://www.emedicin.com/emerg/topic507.htm  http://www.umm.edu/ency/article/001600.htm http://www.umm.edu/ency/article/001600.htm  Burroughs.A,etal.(2001)8th maternity nursing, an introductory text. W.B. Saunders company. Philadelphia London new York st. Louis