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INFERTILITY

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INFERTILITY

DefinitionsDefinitions

Under 35 yoUnder 35 yo No conception after one No conception after one year of unprotected intercourseyear of unprotected intercourse

Over 35 yoOver 35 yo No conception after 6 No conception after 6 months of unprotected intercoursemonths of unprotected intercourse

Psychosocial Issues

ExpectationsExpectations Stress on RelationshipsStress on Relationships Stress on FinancesStress on Finances Alternatives- Adoption or ChildlessAlternatives- Adoption or Childless Counseling, Support GroupsCounseling, Support Groups

Male Infertility

•History- reproductive, sexual, medical, surgical, family, infectious,

toxic, pharmacologic, childhood, traumatic

•Exam- weight, height, body hair, thyroid, cardiac, lungs, abdomen,

genitalia, testes, prostate, neurologic

•Testing- Two semen analysis, gonadotropins, ASA, WBC’s, SPA,

SCSA, ultrasound, genetics

HISTORY

TOXINS, DRUGS, SMOKING, TOXINS, DRUGS, SMOKING, ALCOHOL ALCOHOL PRIOR SURGERYPRIOR SURGERYINFECTIONSINFECTIONS

Evaluation:Evaluation:Repeat semen analysisRepeat semen analysisPhysical exam- varicocele, testicular sizePhysical exam- varicocele, testicular sizeLab testing- testosterone, FSH, LHLab testing- testosterone, FSH, LHGenetics for special casesGenetics for special cases

ICSI (intracytoplasmic sperm injection)ICSI (intracytoplasmic sperm injection)Donor spermDonor sperm

Semen Analysis

Normal values:Normal values:

Volume Volume 2-5cc2-5cc

CountCount >20 million>20 million

MotilityMotility >50%>50%

MorphologyMorphology >50% normal >50% normal

(strict criteria (strict criteria >15%)>15%)

COMMON DIAGNOSIS

Varicocele

Treatment: Treatment: SurgicalSurgicalVaricocele Varicocele LigationLigation

Vasal Obstruction

Treatment: Treatment: SurgicalSurgicalEjaculatory Ejaculatory duct duct resectionresection

Other Common Diagnoses

Genetic

•Y Deletions

•Klinefelters

•Translocations

•Cystic Fibrosis

Treatment: Treatment: SurgicalSurgicalVasal Vasal reconstructreconstructionion

IN-VITRO FERTILIZATIONIN-VITRO FERTILIZATION

Treatment: Treatment: SurgicalSurgicalSperm Sperm retrieval,retrieval,

IntracytoplaIntracytoplasmicsperm smicsperm injectioninjection

Unexplained Infertility

12-15% of couples12-15% of couples 3% chance of achieving a pregnancy3% chance of achieving a pregnancy Treatment:Treatment:

Superovulate with IUI Superovulate with IUI (intrauterine insemination)- (intrauterine insemination)-

ClomidClomid 12% success12% successPergonalPergonal 16%16%

IVFIVF