Infertility For fertile Women

natural period of fertility

Topics
= just efore and during ovulation
-Definition (d-10 to d-18 in a 28 day cycle)
-Fertile Period (Ovulation on approx d-14)
-Primary vs. secondary infertility and women are
-Effects naturally infertile
Psychological impact during the rest of the menstrual cycle
Social impact + during 1st 6 months of Breast Feeding.
-Emotional stress and marital difficulties
-Leave from work MALE FERTILE PERIOD
-Maternal Leave (Puberty to death)
-Paternal leave - peak fertility period - 25 – 40yrs.
-Causes
Sexually transmitted infections Incidence : (in heterosexual couples)
Other Infections -MTB 3-7% of all couples suffer from infertility
Genetic
Other Causes Causes
Nutritional - Vit B12/ Vit D deficiency Many different causes (See Extra Notes).
20-30% - due to male infertility,
Unexplained infertility 20-35% due to female infertility, and
-Medical treatments 25-40% due to combined problems
10-20% - no cause is found.
Fertility Tourism
If conservative medical treatments fail
Infertility is the Assisted reproductive technology (ART)
inability of a person, techniques are used to achieve a pregnancy,
to reproduce by natural means.
1. in vitro fertilization (IVF)
World Health Organization 1a) In-vitro gamete fusion
The WHO defines infertility as follows: 1b) ICSI
Infertility is followed by
“a disease of the reproductive system 1a/b.1) ZIFT
defined by the 1a/b.2) ZIUT
failure to achieve a clinical pregnancy 2. In-vivo Fertilization
(unable to conceive / implant) 2a. GIFT
even after 12 months or more of 2b. Artificial Insemination
regular unprotected sexual co-habitation
Or (if she conceives), 1. In-vitro fertilization (IVF).
unable to carry a pregnancy to full term -most commonly used ART.
(male or female cause)
Principle
Primary infertility Fertilization of the
-infertility in a female/couple who have male and female gametes (sperm and egg)
never had a child before. outside the female body (in-vitro)
(in lab in appropriate medium in a test tube) .
Then,
Secondary infertility
Implant this externally fertilized ovum
-failure to conceive in lady’s reproductive tract
following a previous pregnancy for further development / pregnancy
(had a child before).
Basic IVF Method (Steps)
FEMALE FERTILE PERIOD 1a)
(menarche to menopause) 1. Ovum from Mother
Approx 12 to 45 yrs Transvaginal ovum collection
-peak fertility period - 24 to 30 yrs, -a small (ultrasound guided) needle is
inserted through the back of the vagina
into the ovarian follicles to collect the eggs / ova.
2. Sperms derived from father / Donor to establish a pregnancy.
(50,000 to 100,000 sperms required).
3. Sperms and ovum incubated in culture N.P. :
medium (Test tube) For ZIFT and IUET ,
4. Allowed to fuse /fertilize (IVF) Embryos can be derived by
IVF using both donor ova and sperms
1b) Intracytoplasmic sperm injection followed by development in mother
(ICSI)
Principle / Method OR
-a single sperm (from father/donor) parent ova and sperms
-injected into an egg followed by development in surrogate mother
(using a micro-pipette / needle).
Cytoplasmic transfer
TEST TUBE BABY (TTB) -contents of a fertile egg from a donor are
Defn : injected into the infertile egg of the patient
along with the sperm.
Baby produced by in-vitro fertilization
(in test tube)
& then transferred and 2. In-vivo Fertilization
nourished and developed in uterus
2a) Gamete intra-fallopian transfer (GIFT)
Uses of IVF/TTB Ovum from donor female
1. Maternal Causes of Infertility Transferred to uterus of infertile subject (female)
- inadequate / irregular / no ovulation, who cannot produce ova
- blocked or damaged tubes,
- endometriosis The subject must have normal uterus environment
for implantation & development
,
2. Paternal Causes of Infertility Ovum - derived trans-vaginaly from donor
- poor or low count (father’s sperms used ) lady
- nil count / low motility /abnormal sperms Sperms - from father / donor
(donor sperms used).
Utility
3. Unexplained infertility, Prospective mother who cannot conceive
Eg. Obesity, Vit D/B12 deficiency d/t
-no / abnormal ova or
-very irregular ovulation
After IVF (1a/1b),
product of fertilization / conception (zygote) 2b) Artificial Insemination
is transferred back into uterus / FT Principle
for Implantation and development Healthy ejaculated sperms
by 1 of following 2 (freshly collected/cryo-preserved) from
Healthy father / donor are
Methods of Developing TTB artificially introduced into vagina/uterus
1a/b.1) ZIFT of female subject
1a/b.2) ZIUT
Fertilization happens in-vivo (in female)
followed by In vivo Implantation and development in uterus of
1a/b.1) ZIFT (Zygote intra-fallopian transfer) recepient
after IVF, resulting zygote
(< 4 days / 8 cell / morula stage) N.P. : Also a mixture of sperms and eggs (gametes) can be
is then placed in fallopian tube. placed directly into a woman's fallopian tubes using laparoscopy
g.r.t. natural development of
artificially (in-vitro) fertilized TTB Utility
Impotency (no erections)
1a/b.2) ZIUT /Z IUET Difficult insemination IUI
(Zygote Intra Uterine Embryo transfer) / IUT Low counts IUI
(< 7 days, 32 cell / blastocyst stage) Or
After IVF resulting zygote is allowed to develop to
32 cell stage-Embryo) then placed Abnormal sperms  then Donor sperms
into the uterus of the female
Legal adoption is best method for Managing
Diagnosis
Infertility
Treatment
Drugs used for both women and men
Fertility tourism -clomiphene citrate,
(
= traveling to another country for fertility treatments. (a -human menopausal gonadotropin (hMG),
-follicle-stimulating hormone(FSH),
form of medical tourism). -(GnRH) analogues,
-aromatase inhibitors, and metformin.

Extra Notes Genetic :Robertsonian translocation (in either partner) recurrent

spontaneous abortions or complete infertility
Common Female Causes of Infertility

-irregular / unable to ovulate.

Female Blamed in India
Eg. polycystic ovarian syndrome Infertility Clinics
(with sparse or absent menstrual periods.
-abnormal / partially developed eggs IVF followed by ET embryo transfer
(ovaries do not mature and release eggs).

-structural problems in the

Fallopian tube or uterus or
Eg. - blockage due to malformations,
- previous tubal ligation
EXERCISES
- adhesions d/t infection (TB) 1.What do you think is the significance of reproductive
- fibroids
health in a society?
-endometriosis 2.Suggest the aspects of reproductive health which need to
(growth of endometrial tissue in F tubes be given special attention in the present scenario.
/ extra uterine tissues)) 3.Is sex education necessary in schools? Why?
-Obesity or underweight 4.Do you think that reproductive health in our country has
-Infections improved in the past 50 years? If yes, mention some such
PID (pelvic inflammatory disease)
areas of improvement.
caused by -infections like
tuberculosis, Chlamydia,Gonorrhoea 5. What are the suggested reasons for population explosion?
6. Is the use of contraceptives justified? Give reasons.
-advanced maternal age (>35yrs) 7.Removal of gonads cannot be considered as a contraceptive
option. Why?
-Nutritional - Vit B12/ Vit D deficiency 8. Amniocentesis for sex determination is banned in our
-Dysperunia-painful intercourse (dry vagina)
country. Is this ban necessary? Comment.
Common Male Causes 9.Suggest some methods to assist infertile couples to have
children.
-low semen quality/motility.. 10.What are the measures one has to take to prevent from
-low sperm count contracting STDs?
(d/t primary ciliary dyskinesia, stress, endocrine problems, drugs, radiation, or infection).
-testicular malformations, 11.State True/False with explanation
-blockage of the man's duct system. A) Abortions could happen spontaneously too. (True/False)
-previous vas ligation B) Infertility is defined as the inability to produce a viable
-defect in sperm
offspring and is always due to abnormalities/defects in the
- DNA, centrioles, acrozomal enzymes (not be detected by semen analysis) female partner. (True/False)
C) Complete lactation could help as a natural method of
-folate pathway gene abnormalities contraception. (True/False)
-epigenetic modifications in sperm D) Creating awareness about sex related aspects is an
effective method to improve reproductive health of the
- Nutritional -Vit D / Vit B-12 deficiency
people. (True/False)
General / Common causes
(Male & Female Infertility) Correct the following statements :
A) Surgical methods of contraception prevent gamete
-Diabetes mellitus, formation.
-thyroid disorders (esp autoimmune), B) All sexually transmitted diseases are completely curable.
-Hypo-pituitarism (Abnormal GnRH/Gonadotropin release)
C) Oral pills are very popular contraceptives among the rural
Environmental factors women.
Toxins D) In E. T. techniques, embryos are always transferred into
Tobacco smokers the uterus.
glues, volatile organic solvents or silicones, pesticides.

Factors that can cause

DNA damage in sperms / ova
- smoking,
-radiation or chemotherapy for cancer
-other mutagens (DNA damaging agents)

-Unexplained infertility (no Known cause)

-20% couples have unexplained infertility.
(abnormalities are likely to be present but not detected by current
methods).