Fertilization-Infertility: Detti

Question 1

Definition of Infertility

Answer 1

• One year of unprotected intercourse without conception
• After 35 yrs of age: 6mo of unprotected intercourse without
  conception
  *Affects 10-15% of couples in the US

Question 2

Describe the following factors in the human reproductive process:

• Male factor
• Cervical factor
• Ovarian factor
• Tubal/Peritoneal factor
• Uterine factor

Answer 2

• Male factor: sperm ascend through cervix, uterus, tubes; acquire the capacity to fertilize the oocyte
• Cervical factor: filters and nurture sperm into uterus and tubes
• Ovarian factor: ovulation of a mature oocyte must occur
• Tubal/peritoneal factor: tubes capture ovulated oocyte and transport sperm and embryo
• Uterine factor: uterus is receptive to embryo implantation and support pregnancy

Question 3

How do the male and female factors contribute (quantitatively) to infertility?

Answer 3

Female factor - 60%
–>mostly tubal/peritoneal issues (30-40%), followed by ovulatory (15%) and cervical/uterine (5-10%)

Male factor - 40%
–>ex low volume, retrograde ejaculation, duct obstruction, hypogonadism, CBAVD

Combined - 20%

Question 4

What tests can be done to evaluate male factor infertility?

Answer 4

• Semen analysis (for volume, concentration, motility, morphology, pH, and round cells)
• FSH, LH, PRL, Testosterone
• Karyotype
• Y chromosome microdeletions

Question 5

What are some causes of cervical factor infertility?

What tests would be done to evaluate?

Answer 5

• anatomical changes (ex: DES exposure)
• infections
• changes in mucus characteristics

Tests: cultures, post-coital test

Question 6

What are some causes of uterine/endometrial factor infertility?
What tests would be done to evaluate?

Answer 6

• Anatomical changes (congenital malformations, fibroids, adhesions)
• Functional abnormalities (endometritis, dec. receptivity, things that cause premature sperm activation)

Tests: TV Ultrasound and Sonohysterography; Hysterosalpingography; Hysteroscopy; Endometrial biopsy

Question 7

What are some causes of tubal/peritoneal factor infertility?

What tests would be done to evaluate?

Answer 7

• Anatomical changes (congenital malformations, bilateral tubal ligation, adhesions, endometriosis)

Tests: Hysterosalpingography; Laparoscopy with chromopertubation; Sonohysterography

Question 8

What are some causes of ovarian/ovulatory factor infertility?
What tests would be done to evaluate?

Answer 8

-Ovulatory dysfunction: Oligo/Anovulation (PCOS); Luteal phase deficiency (def progesterone)

Tests: Menstrual history (in detail!); Basal body temperature (will tell of ovulating at all); Serum progesterone; Urinary LH excretion (ov. predictor kits); Basal FSH/Clomiphene challenge test (will give indication of available oocyte reservoir); Oligo-amenorrhea testing

Question 9

Treatment of male factor infertility

Answer 9

– Endocrine treatment
– intra-uterine sperm injection (IUI), TDI
– assistive reproductive technology (ART)

Question 10

Treatment of female factor infertility

Answer 10

• Correction of anatomical defects
• Treatment of infections
• Restoration of a regular ovulatory pattern; i.e. ovulation induction with Clomiphene Citrate, Aromatase Inhibitors, Gonadotropins

Question 11

At what point is embryo transfer conducted?

What is given for luteal support?

Answer 11

• Embryo transfer 3-6d after oocyte retrieval (2-5d post-fertilization)
• Luteal support = hCG, progesterone; continue until viability is diagnosed (dx by rising hCG ~12d after transfer) and placental progesterone production is established