module 5- fertility concepts Flashcards
Fertility
The natural capability to produce offspring. A related term, fecundity, is the potential output of reproduction by an organism, as measured by number of gametes, seeds, etc.
Fertility Rate
Total fertility rate (T F R) in simple terms refers to total number of children born or likely to be born
to a woman in her lifetime if she were subject to the prevailing rate of age-specific fertility in the population.
Birth Rate
The total number of live births per 1,000 in a population in a year or period.
how many people suffer from infertility
More than 186 million people worldwide, with 8-12% of couples of
reproductive age worldwide affected by infertility
infertility for both males and females
Roughly 1/3 of infertility cases
2/3 of cases of infertility
are attributed to both male and female or have no known cause.
where is infertility more prevalent
in developing countries
Age-related fertility decline
affects both men and women, but begins earlier in women
- Above age 37, female fertility rates decline steeply, while sperm count decreases significantly around age 40
- lifestyle and environmental factors are believed to play an increasingly
significant role with age.
study of fertility
- is key factor in informing national and even global policies, which influence a variety of
Examples of these topics fertility
reproductive research, healthcare, family planning, child development, and social support for the aging population.
A correct understanding of population dynamics
vital for making decisions in health policy and resource allocation.
fertility rates and developing countries
tend to be higher due to the lack of access to contraceptive, poor maternity care, and generally lower levels of female education
fertility rates in developed countries
tend to have lower fertility rates due to lifestyle choices associated with economic affluence where mortality rates are low, birth control is easily accessible, and children often can be seen as economic drain cause by housing, education, and other costs involved
over the past 50 years
- there has been an overall decline in fertility rates across the world
the global fertililty rate
is now 2.5 children per women
- however this rate masks the underlying regional variations
where has the lowest fertility rate
europe: at 1.6 children per women
where has the highest fertility rate
africa with 4.7 children per women
why a decline in global fertility
has been attributed mainly to modernization
Canada and decline in fertility
over the past 150 years there has been a decrease as women are having fewer children overall and at increasing maternal ages
the total fertility rate in canada
has been below the replacement level-fertility for ove4r 40 years
replacement level-fertility
the total fertility rate at which a population exactly replaces itself from one generation to the next, without migration
why do fertility issues often go undected and undiganosed
- because people don’t really try conceiving until they talk about having a baby later in life
Fertility
Fertility is defined as the capacity to establish a clinical pregnancy within 12 months of regular and
unprotected sexual intercourse.
Subfertility
term used to describe any form of reduced fertility with a prolonged time to achieve conception in a couple.
Infertility
is the incapacity to establish a clinical pregnancy after 12 months of regular and unprotected sexual intercourse, often due to potentially treatable causes.
Sterility
often used interchangeably with infertility, but refers to a complete incapacity to conceive naturally. For example, due to the absence of gonads regardless of cause (congenital, injury, etc.)
what are the 2 types of infertility
primary infertility and secondary infertility.
Primary Infertility
refers to couples who have not become pregnant after a minimum of 1 year of sexual intercourse without using birth control methods.
Secondary Infertility
refers to couples who have previously carried a pregnancy to term, but are now are unable to conceive.
what is the most common type of infertility for female
secondary infertility
- most common in regions of the world with high rate of unsafe abortion and poor maternity are due to the high rate of post-abortive and postpartum infections
what can examine infertility
- tests will examine the hormones gametes, gonads, reproductive ducts and external genitalia
diagnostic tests and fertility interventions
are based on our knowledge of the factors and mechansims behind impaired reproductive function
hormones ; infertility
Circulating levels of the regulatory hormones of the reproductive system.
Gametes; infertility
Quantity and quality of oocytes in females, and sperm in males.
Gonads ; infertility
Anatomy and function of ovaries or testes.
Reproductive ducts; infertility
Anatomy and function of the reproductive ducts in male and female.
External genitalia; infertility
Anatomy and function of the external genitalia.
the process of diagnosing infertility
If a couple has not achieved a pregnancy after 12 months of regular unprotected intercourse, a
diagnostic exam is recommended.
1. medical history
2. physical exam
Medical History
- allows doctors to identify
previous factors that may have caused the patient’s current fertility issues, as well as current factors
Physical Exam
- evaluates more specific anatomical and physiological factors
- the presence of structural abnormalities in the external genitalia and reproductive tract and the appearance of secondary sex characteristics. Performing blood analyses and additional tests allows
doctors to detect hormonal imbalances and other potential metabolic abnormalities.
what factors are considered during a medical history check
- Previous physical injuries that may have compromised the integrity of the reproductive tract
- Previous infections such as sexually transmitted infections (S T Is), urinary tract infections, and
others - Current systemic diseases such as hypertension, diabetes, and autoimmune conditions
- Current hormonal conditions, such as hypogonadism and polycystic ovary syndrome (P C O S)
- Current lifestyle factors, such as nutrition, physical activity, medication use, smoking habit, or
drug use - Other serious conditions that may impair reproductive capacity, such as cancer (ovarian,
prostate), or uterine fibroids, among others
specific diagnostic tests for males
- semen analysis
- testicular biopsy
- imaging
Semen Analysis
Used to detect sperm abnormalities such as azoospermia.
Testicular Biopsy:
Used as a diagnostic tool to determine unexplained male infertility as well as
azoospermia.
Imaging: males
A pelvic and scrotal ultrasound or MRI.
specific diagnostic tests for females
Imaging
Imaging females
Generally a hysterosalpingography to check for uterine or tubal abnormalities, or pelvic
ultrasound to visualize the ovaries and follicles.
specific diagnostic tests for both
Physical Exam:
Hormonal Tests
Genetic Testing:
Physical Exam:
An examination of testes and penis or an examination of breasts, genitals, and pelvis.
Hormonal Tests:
Mainly F S H and either testosterone or progesterone.
Genetic Testing:
To diagnose certain genetic disorders affecting fertility
idiopathic infertility.
Despite the available tests, sometimes clinicians are still unable to identify the cause of infertility.
A diagnosis of idiopathic infertility
does not preclude the possibility for treatment. Depending on the
health status of the person, clinicians will sometimes proceed through treatment, and a successful
pregnancy might be achieved.
what are the type of factors that can cause infertility
- congenital disorders
- the aging process
- physical injury
- disease
- lifestyle factors
congenital disorders and fertility
- Klinefelter syndrome
- Turner’s Syndrome
- anorchia
- cryptorchidism
usually detected at early age and become a part of an indivduals medical history
Anorchia:
A condition in which a genetic male is born without testes.
Cryptorchidism:
A condition in which one or both of the testes fail to descend from the abdomen into the scrotum during prenatal development.
what is the most common cause of gonadal dysgenesis.
Turner’s Syndrome
Turner’s Syndrome
condition in which a female is partially or completely missing one of her X chromosomes (45, X0)
about Turner’s Syndrome
In addition to under-developed ovaries and altered secondary sexual characteristics, classical Turner’s
features include short stature, webbing of the neck, widely spaced nipples, cardiac and renal
abnormalities, and often hormonal imbalances among many other health issues.
Gonadal Dysgenesis:
Any congenital developmental disorder in which there is abnormal development of the gonads in males or females.
Klinefelter syndrome
genetic disorder in which boys are born with an extra X chromosome (47,X X Y).
about Klinefelter syndrome
- causes hypogonadism in males, causing reduced sperm count, and is one of the common genetic causes of infertility in men.
diagnosis of Klinefelter syndrome
diagnosed by evaluating the outward symptoms (e.g. small testes,
tall/slender build, and low testosterone), and confirmed by chromosome analysis, also known as
karyotyping
can females get pregnant who have turners syndrome
- most are infertile
- only 2% of women have natural pregnancies
- these are at higher risk of miscarriages, stillbirths and malformed babies
fertility and the aging process
- aging is considered the most important natural factor associated with fertility decline in both males and females
aging
is a intrinsic process that involves the progressive deteriotion and decline in normal function of all bodily system
- affected by diet, exercise, drug use…
female reproductive aging
- involves a decline in reproductive potential, mainly due to a decline in ovarian function
decline in ovarian function; aging
- decrease in the quantity and quality of oocyte/follicles and alternations in hormonal signaling that eventually lead to the cessation of ovarian follicular activity and the cycle
the cessation of the cycle is
menopause
Final menstrual period = Menopause
Defined as one year of spontaneous missed periods without any abnormality or drugs that can alter
menstrual cycles.
Premenopause
Years from puberty to menopause, also referred to as the reproductive life of a female.
Postmenopause
stage which begins with the last menstrual period and continues for the rest of a
woman’s life.
Perimenopause
starts before menopause and continues 12 months after it. In this stage the body
begins to undergo several physical and hormonal changes.
Spontaneous cessation of menses before age 40
premature menopause, or premature
ovarian failure
premature menopause, or premature
ovarian failure.
Certain interventions such a radiation therapy or oophorectomy (surgical removal of ovaries) can result in permanent cessation of ovarian function and, thus, induce an artificial
menopause.
when can a slight decline in fertility be detected
as early as 25 years of age, but clinically significant decline starts more around 30
females have approximately how many primordial follicles at beginning of puterty
400,000
how many follicles reach maturity
About 300 to 400 follicles
follicular pool and increasing age
follicular pool declines progressively with increasing age, as does the ovarian reserve
- The ovarian reserve depends on both the follicular pool, and the health and quality of the oocytes contained in the pool.
- decline is accelerated in the last 10-15 years before menopause due to hormonal dysregulation.
hormonal changes that are observed in menopause
Increased sensitivity to G n R H
Less suppression of F S H secretion
Increased sensitivity to G n R H
- With the continual loss of the remaining follicles, there is a decrease in the production of gonadotropin surge inhibiting factor (G n S I F)
what does decrease in the production of gonadotropin surge inhibiting factor (G n S I F) result in
higher sensitivity of the pituitary to
gonadotropin releasing hormone and a subsequent rise in luteinizing hormone (L H).
Less suppression of F S H secretion
The earliest hormonal change is a rise in follicle stimulating hormone (F S H), which is attributed to a decreased production of inhibin B and antimullerian hormone (A M H).
- Increasing F S H levels accelerate the processes of selection and recruitment of the dominant follicles, which speeds up the loss of the remaining follicles
what does these hormones result in overall
decrease in number and quality of the
remaining follicles, and thus a decrease in the ovarian production of estrogen and progesterone.
oocyte quality and age
- it decreases significantly with age likely due to accompanying increases in oxidative stress
oxidative stress
- physiological imbalance in the production of reactive oxygen species (ROS).
ROS
are natural byproducts of metabolism which, due to their high chemical reactivity cause cellular damage by oxidizing and thus, altering cellular DNA, fatty acids, and proteins
- as the system that fix the damage become less efficient over time, the damage can expand to become a condition or disease
lifestyle factors; oxidative stress
- oxidative stress can be worsened by lifestyle choices such as unhealthy diet, sedentarism, smoking, alcohol intake, drug use
fertility and oxidative stress
- can be a big factor in infertility
- known to play an important role in the development of aging-related diseases, such as atherosclerosis, hypertension, diabetes mellitus, ischemic diseases and neurodegeneration
when can decrease in oocyte quality be detected
around age 35 as measured by the presence of chromosomal abnormalities
does male fertility decline with age?
yes.
fertility with age and males
decline starts to become evident around 40, much later than females
why is older age declining mens reproductive capacity
declining testosterone levels
what is the progressive hormone decline in males known as
andropause or late-onset hypogondaism
symptoms of andropause
- Low sex drive
- Lack of energy
- Difficulty getting erections and/or weaker erections
- Loss of muscles mass or strength
- Increased body fat
- Depression and/or mood swings
- Hot flashes
what is the earliest and most common symptom of male fertility decline is
decrease in erectile function
erectile dysfunction
affects 10% of men at age 40 and 80% over the age of 70
common cause of erectile dysfunction in men over 50
related to atherosclerotic disease which impacts circulation
- other cause can be psychological, neurological, hormonal, pharmacological, and anatomical
HPG axis and age for men
- serum testosterone levels are known to decline with age particularly due to the decrease in the number of leydig cells, deterioration of testicular perfusion, and disturbances to GnRH and chorionic gonadotrophin secretion
how much does testerone levels decline with aging
1% per year and this decline is more pronounced in free testosterone levels because of alternation in sex hormone binding gloubin (SHBG)
Sex Hormone Binding Globulin (S H B G):
A hormone that binds to testosterone in the blood, reducing the amount of available testosterone.
primary hypogonadism
Testosterone deficiency due to a testicular defect
secondary hypogonadism
When testosterone deficiency is caused by a problem with the pituitary gland or hypothalamus (such as reduced signaling with gonadotropin secretion)
what else can affect HPG axis with age
body weight, lifestyle, and acute and chronic diseases
the impact of aging on the testes
- men grow older the testicular function and metabolism deteriorate as the testes undergo age-related morpholical changes
testciular change
- decrease # of germ cells, leydig, and sertoli cells
- narrowing of the seminiferour tubules
primary testicular failure
- a decline in testosterone secretion caused by a deficiency or absence of leydig cell function
benign prostatic hyperplasia (BPH)
one of the most common age-related diseases in men
- enlargement of prostate
men after the age 45; ducts and glands
- semen volume decreases due to decline in functional accessory glands
- daily sperm production also decline
- men over 50 experiencing decreases greater than 30%
sperm morphology
- is affected with aging
- with the percentage of sperm with normal morphology decreasing after the age of 40
- likely because of an increase in replication errors causing DNA mutations and freagmentation in sperm cells
sperm and aging
- volume
- motility
- morphology
all decrease with aging
children born from older parents
are at greater risk for genetic abnormalities’, such as down syndrome
fertility and lifestyle factors
- include any individual factors that are modifiable and can affect health (components of an individuals medical history)
nutrition and fertility
- body needs macronutrients (protein, lipids) to produce energy while micronutrients (vitamins and minerals) are required only in small quantities but as essential
examples of lifestyle factors
- nutrition
- physical activity
- alcohol and drugs
- smoking
malnutrition
refers to all deviations from adequate and optimal nutritional status, including undernutrition and overnutrition. In states of undernutrition, the body lacks the nutrients it requires to produce energy or to maintain its cellular processes, and pathology ensues.
When energy is scarce
the mechanisms that distribute energy throughout the body favour the processes that ensure survival over processes that promote growth and reproduction.
Conditions of energy deficit,
are associated with decreased fecundity and infertility, mainly via the disruption of hormones of the H P G
axis.
Food deprivation
has been shown to disrupt the G n R H pulse
Inhibition of G n R H secretion
leads to a cascade of inhibitory effects, including decreased gonadotropin secretion, inhibited synthesis of gonadal steroids, and impaired gametogenesis
overnutrition
- considered a form of malnutrition
- nutrient intake is oversupplied such
that the body’s metabolic capacity to assimilate them is surpassed.
Overnutrition can induce
maladaptive responses
maladaptive responses
hyperlipidemia (excess circulating levels of fat), hyperglycemia (high blood sugar), hyperinsulinemia (high insulin levels), among others
hyperinsulinemia can
potentiate gonadotropin-stimulated ovarian androgen synthesis, increasing androgen secretion, impacting fertility.
Overnutrition and energy homeostasis
negative impact on energy homeostasis
- by forcing the body to
compensate for excess nutritional intake; for example, abnormal glucose homeostasis,
Abnormal glucose homeostasis ; females
insulin resistance (I R) is strongly associated with polycystic ovarian syndrome (P C O S), a hormonal reproductive disorder characterized by abnormal gonadotropin secretion and ovarian androgen production. Insulin resistance is considered to be a precursor to the development of type II diabetes.
Abnormal glucose homeostasis ; males
- negatively affect sperm cell metabolism.
- Sperm cells need energy to acquire and maintain motion competence after epididymal maturation.
Sperm mainly utilize sugars as an energy fuel and require membrane proteins to act as glucose
transporters (GLUTs) to transport glucose across the cell membrane - abnormal environment like diabetes can cause dysfunction in nutrient transport, thus leading to the
decreased fertility and adverse fetal outcomes
direct injury
the integrity of the reproductive structures is compromised, potentially resulting in permanent impairment of function depending on the severity of the injury
example of direct injury
Genital injuries
who are more common to get direct injuries
males
injury to the testis
can destroy the structure of the seminferous tubules, eliminating the capacity for sperm production
- testosterone replacement might be needed
direct injury for female
vaginal or uterine prolapse after birth
- pelvic floor muscles and ligaments weaken to the point of losing the ability to support these organs in place
Indirect Injury
would involve an injury to a non-reproductive structure that ends up interfering with normal reproductive function.
- can occur suddenly, such as those that occur in an accident, but they can also appear progressively, due to degeneration caused by a disease or
condition.
The impact of an indirect injury
can be less obvious, but equally or more severe
example of indirect injury
spinal cord injury (SCI)
- involves any damage to the spinal cord that results in functional changes below the injury
Spinal cord injuries (SCI) ; fertility
can significantly impair sexual and reproductive function
- can affect variety of systems in the body depending on the severity and location if injury (which can affect nerves)
sexual function can be affected by an injury as low as
last vertebra (S5)
SCI and males
- if penis and its normal erectile function are impaired it become impossible for a male to conceive without medical assistance
penile innervation
is derived from the autonomic nervous system, using both sympathetic and parasympathetic nerves for involuntary control and from somatic innervation to supply sensory and motor inputs
Parasympathetic innervation males
Parasympathetic nerves from S 2-4 nerve roots primarily control erectile function by controlling arterial
dilation in the corpora cavernosa.
Sympathetic innervation males
The sympathetic nerves from T 11-L2 control detumescence and contribute to ejaculation and emission by controlling gland secretions and the release of sperm.
Detumescence:
The subsidence of a swelling, especially the return of a swollen organ, such as the
penis, to the flaccid state.
males with SCI; nerves
- vascular and anatomic functions mediating the erection are generally intact; however nerve damage lead to impaired reflexogenic erections, psychogenic erections or both
Reflexogenic Erections:
An erection which is initiated by direct stimulation of the genital region
Psychogenic Erections
initiated by thoughts and erotic stimuli, independent of direct genital
stimulation.
men with SCI and sperm production
and quality can decrease as well due to a variety of factors such as increased temperature due to prolonged sitting, decreased physical activity, and less frequent sperm discharge.
SCI and females fertility
- usually less serve than males since female sexual function is not tightly llinked to their fertility
parasympathtic nerves female
from s2-4 nerve roots control clitoral erection as well as relaxation of uterine smooth muscles
sympathetic innveration females
nerves from T11-L2 control the contraction of the uterus
somatic innervation females
somatic innervation of the uterus is derived from both T12-L2 and S2-S4 and provides pain perception
what do many women experience after a traumatic injury
transient amenorrhea, but gets it back a few month after
amenorrhea
absence of menstruation
what do women with SCI often experience
changes to their sexual response, such as decreased lubrication
- sexual function in females is independent from reproductive function
- many women with PCI can get pregnant
pregnancy issues a women would have with SCI
- preterm labour
- thrombosis or autonomic dysreflexia (uncontrolled hypertension, bradycardia, excessive, sweating, and headache)
what diseases can disrupted fertility
communicable (infections) or noncommunicable (chronic) diseases acquired later in life
sexually transmitted diseases
- have direct impact on reproductive function
- can cause permanent damage to the reproductive tract
chlamydia
is the most commonly reported STI in both canada and the US
- causes by the bacterium chlamydia trachomatis
symptoms of chlamydia
difficult to detect
- more than 50% of infected males and 70% of infected females are asymptomatic and uninformed of their infection status
chlamydia and infertility
- if left untreated, chlamydia can become a chronic recurring condition, leading to more serious complication and long-term effect
chlamydia and females; what is it the leading cause of
pelvic inflammatory disease (PID)
what is pelvic inflammatory disease (PID)?
- complication of STIs where infection spreads to the upper reprodutive tract
what can pelvic inflammatory disease (PID) cause
- the inflammatory response caused of a pathogen result in injury and scarring of the affected tissue
- thus most commone consequences of chlamydia include long-term pelvic pain and damage and scarring of the fallopian tubes resulting in tubal factor infertility
tubal factor infertility
any kind of obstruction that impedes the descent of any fertilized or unfertilized ovum into the uterus through the fallopian tubes and prevents a normal pregnancy
chlamydia and males
- post infection complications are less common in males
- infection in urethra and epididymis
- associated with sperm damage via DNA fragmentation
what is human papillomarvirus (HPV)
the most common viral infection of the reproductive tract
- group of more than 200 related viruses , 40 of which can spread through direct sexual contact via skin and mucous mebranes
what can HPV result in
- asymptomatic
- gential warts
- progression into cancer
most high-risk HPV infections
- occur without any symptoms and go away within 1 to 2 years. some infections can persist for years
persistent infections with high-risk HPV types
can lead to cell changes that may progress to cancer if untreated, it can cuasing approx 5% of cancerss
what are the types of cancer HPV can cause
- cervical
- anal
- oropharyngral
- rarer
cervical cancer
neraly all cases of cervical cancer are caused by HPV, with 2 HPV types (16-18), responsible for about 70% of all cases
anal cancer
about 95% of anal cancer are caused by HPV, most of which are caused by HPV type 16
oropharyngeal cancer
about 70% of orophrayngeal cancr are caused by HPV type 16
rarer cancers
HPV causes about 65% of vaginal cancer, 50% of vulvar cancers and 35% of penile cancers. most of these are caused by HPV type 16
cancer therapies and how they impact fertility
- surgery
- radiation therapy
- chemotherapy
- hormone therapy
cancer surgery on fertility
- best approach to excise the cancerous tissue (tumor)
- can harm reproductive tissues and cause scarring, which can affect fertility
radiation therapy treatment for cancer
- involves the use of high-energy radiation from x-rays, gamma rays, neutrons, protons, and other sources to kill cancerous cells and shrink tumors
- radiation is non-specific it can equally damage normal cells
- ovarian shielding or oophoropexy can protect organs from radiation
chemotherapy; cancer treatment on fertility
- involves the use of drugs to stop the growth of cancerous cells, either by killing the cells or preventing them from dividing
- non-specific, meaning it is also toxic to normal cells
- highly toxic drugs can impair or obliterate the function of gonads
hormone therapy for cancer on fertility
hormones used to treat cancer can disrupt the menstrucal cycle and the HPG axis, which may then affect fertility
Is there medical treatment for persistent HPV infections?
no. can only treat the symptoms caused by HPV. It is preventable though.
vaccines to prevent H P V infection:
Gardasil®, Gardasil®9, and Cervarix®.
HPV vaccines
- provide significant protection against acquiring an H P V infection.
- not effective for treating established H P V infections or disease caused by H P V.
Chronic conditions
- often develop later in life, the causes of which are usually not easily defined.
- depends on individual susceptibility factors that are often hereditary
what can result in the development of chronic conditions?
lifestyle factors
what are examples of chronic conditions that are related to fertility issues and what are they commonly called
- hypertension, type II diabetes, and cardiovascular disease
- aging-associated conditions
what is Type 2 Diabetes
a chronic disease caused by the body’s inability to respond properly to the action of insulin produced by the pancreas, known as insulin resistance. Both male and female fertility is
impacted by abnormal insulin activity.
Type 2 Diabetes and Effects in Females
- associated to alterations in the length of the menstrual cycle, and the age of onset of menopause
- Insulin, through its own
receptor, has been demonstrated to have a direct effect on steroidogenesis in the ovaries
normal conditions and insulin actions
acts as a co-gonadotropin in theca cells.
insulin in type 2 diatbetes in females
hyperinsulinemia can potentiate gonadotropin-stimulated ovarian androgen synthesis.
Insulin resistance and polycystic ovarian syndrome (P C O S),
often characterized by some aberrations in the secretion of gonadotropins and, in particular, with high levels of L H (luteinizing hormone).
Type 2 Diabetes and effects on males fertility
associated with erectile dysfunction and ejaculatory dysfunction. This
is thought to be caused by diabetes-induced autonomic neuropathy and vascular disease, which is a
major cause of erectile dysfunction.
sperm and men with diabetes
- higher percentage of sperm with nuclear and mitochondrial D N A
fragmentation, with the damage being oxidative in nature
sperm DNA damage associated with?
decreased embryo quality, the lower implantation rates, and, possibly, the early onset of some childhood diseases.
Hyperinsulinemia
A condition in which there are excess levels of insulin circulating in the blood
relative to the level of glucose
Autonomic neuropathy:
a group of symptoms that occur when there is damage to the nerves that
manage every day body functions.
assisted reproductive technologies.
The process of treating subfertility infertility encompasses a variety of methods
list assisted reproductive technologies.
Intrauterine Insemination (I U I)
In Vitro fertilization (I V F)
Third Party-Assisted A R T
Intrauterine Insemination (I U I)
insemination is achieved by using a catheter to deposit sperm directly into the uterine cavity as close to the fallopian tube as possible.
In Vitro fertilization (I V F)
eggs and sperm are incubated in a laboratory to produce a viable embryo. The embryo is then transferred to the woman’s uterus.
Third Party-Assisted A R T
Any procedure where someone other than the parents, aids in reproduction. This includes procedures such as: surrogacy, egg/sperm donation
intrauterine insemination most commonly used when
to treat male factor infertility issues (low sperm count, low motility, erectile dysfunction), or certain female issues (presence of anti-sperm antibodies in cervical mucus, dyspareunia).
- help same-sex couples achieve pregnancy with either a
donor sperm or a surrogate.
what can I U I be combined with?
controlled ovarian hyperstimulation (C O H)
controlled ovarian hyperstimulation (C O H),- IUI process
where a hormone injection is used to promote maturation of additional follicles, to increase the odds of a successful pregnancy.
what is used to see when IUI should be used?- IUI process
Ultrasound and blood tests are used to monitor follicle maturation and determine which ovary is
producing the mature follicle.
trigger injection of H C G - IUI process
used to control the timing of ovulation and insemination, to ensure the sperm is deposited in the fallopian tube before ovulation.
before insemination- IUI process
- a sperm wash is performed to remove sperm with abnormal morphology and retain the normal sperm.
If U I U is not successful the first time,
recommended to be repeated
several times before attempting more invasive procedures.
I V F can fail for some women, what is the causes?
inadequate quality of the embryo. Age of the eggs, diseases and lifestyle factors are some other possible factors that could be responsible for I V F failure.
steps during in vitro fertilization
- Ovarian Stimulation
- Egg Retrieval
- Sperm Retrieval
- Fertilization
- Embryo Transfer
Ovarian Stimulation
superovulation, injected hormones are used to promote the maturation of more than one follicle. This hyperstimulation increases the success rate of pregnancy
EGG RETRIEVAL
- Eggs are collected from the ovaries by inserting a hollow needle through the vaginal wall to access the
ovary. - An ultrasound is used to guide the needle through the process.
SPERM RETRIEVAL
- The male provides a semen sample that will be used in the laboratory to combine with the egg.
- The sperm are centrifuged to concentrate it and reduce the volume of semen.
FERTILIZATION
- The concentrated semen is placed in a petri dish with the egg and incubated overnight to fertilize
what if the sperm cannot fertilize the egg on their own- step of vitro fertilization
fertilization is then performed via
intracytoplasmic sperm injection (I C S I).
EMBRYO TRANSFER
I V F embryos are transferred to the uterus 1-6 days after fertilization, by using a long tube to inject it
directly into the uterus.
types of Third Party A R T
Sperm Donation
Embryo Donation
Gestational Surrogacy
Egg Donation
Traditional Surrogacy
Sperm Donation
In cases of male sterility or in the case of a genetic disease, donated sperm can be used to perform I U I
or I V F.
Embryo Donation
- used in cases when both partners are infertile or when all other A R
T approaches have failed. - allows a recipient mother to experience pregnancy and
give birth to the adoptive child. - embryos can be frozen and made available for adoption via an embryo
donation agency.
Gestational Surrogacy
carrier is implanted with an embryo that is not biologically related to her. This can be used when the woman does produce healthy eggs but is unable to carry the pregnancy to term
Egg Donation
An egg donor will undergo ovarian
hyperstimulation and egg retrieval, and the donated eggs will be fertilized with I V F. The resulting embryo can then be placed into the woman’s uterus, after hormonal treatments to make the uterus receptive.
Traditional Surrogacy
woman is unable to carry a pregnancy to term, a couple may choose to select a surrogate. A surrogate is inseminated with sperm from the male partner, which will produce a child that is related to the male partner and the surrogate.
Intrauterine Insemination (I U I) ; Method of Choice when:
- Natural conception is failing for unknown reasons
- Male infertility factors
- Difficulty with sexual performance
- Cervical problems
In Vitro Fertilization (I V F) ; Method of Choice when:
- I U I has failed multiple times
- Fallopian tube abnormalities
- Chronic reproductive disease
- Low sperm count in male
Third Party-assisted A R T; Method of Choice when:
Pregnancy is not achieved using I U I or I V F
what are the 2 types of gestational carriers?
- no genetic link to the couple
- the have genetic link: such as using a family member (so the baby has some of the genetics for families)
