Transcript Infertility 101 - University of Nebraska Medical Center

The McCoughey Septuplets
Infertility 101
Definitions
Under 35 yo
Over 35 yo
No conception after one
year of unprotected
intercourse
No conception after 6
months of unprotected
intercourse
Your Infertility Patient. . .
34 yo woman presents to your
clinic to discuss her concerns
about infertility
Psychosocial Issues
Expectations
 Stress on Relationships
 Stress on Finances
 Alternatives- Adoption or Childless
 Counseling, Support Groups

Etiologies
Male Factor
 Tubal Factor
 Ovulation Problem
 Unexplained

40%
40%
10%
10%
Start with History. . .
What Clues Can You Find on History?

Male Factor

Tubal Factor

Ovulation
Semen Analysis
Normal values:
Volume
Count
Motility
Morphology
2-5cc
>20 million
>50%
>50% normal
(strict criteria >15%)
Male Factor Infertility
Evaluation:
Repeat semen analysis
Physical exam- varicocele, testicular size
Lab testing- testosterone, FSH, LH
Genetics for special cases
IUI (intrauterine insemination)
ICSI (intracytoplasmic sperm injection)
Donor sperm
Etiologies

Male Factor
 Tubal
Factor
Ovulation Problem
 Unexplained

40%
40%
10%
10%
Hysterosalpingogram
HSG: Unilateral Blocked Tube
HSG: Tubal Infertility
HSG: Hydrosalpinx
HSG of DES daughter
Etiologies
Male Factor
 Tubal Factor

 Ovulation

Unexplained
40%
40%
Problem 10%
10%
Ovulation Physiology
The LH (lutenizing hormone) surge occurs
34-36 hours prior to follicle rupture
 Progesterone is increasingly produced after
the LH surge
 Secretory changes to the endometrium
occur secondary to the increased
progesterone levels

Ovulation Predictor Kits
Salivary Estrogen: TCI
Ovulation Tester- 92% accurate
Add Saliva Sample
Non-Ovulatory Saliva Pattern
High Estrogen/ Ovulatory
Saliva Pattern
Approach to Ovulation Disorders
Hypothyroidism
Prolactin Disorder
Hyperandrogenism- PCOS
Weight loss/ weight gain
 Induce Ovulation
Clomid (clomiphene citrate)

Evaluate-
Traditional Infertility Evaluation
1)
2)
3)
4)
5)
Semen Analysis
Hysterosalpingogram (HSG)
Documentation of Ovulation
Post-coital Exam
Diagnostic Laparoscopy
Current Infertility Evalution
3)
Semen Analysis
Hysterosalpingogram (HSG)
Documentation of Ovulation
4)
Ovarian Reserve Testing
1)
2)
Ovarian Reserve Testing
Day #3 FSH (<10 mIU/ml) and estradiol (<80 pg/ml)
-Correlates with the functional status of the
ovaries and the quality of the oocytes
- FSH >15 only 5% success with IVF
- High estradiol level increases risk of
cancelling IVF cycle
Unexplained Infertility



12-15% of couples
3% chance of achieving a pregnancy
Treatment:
Superovulate with IUI
(intrauterine insemination)Clomid
12% success
Pergonal
16%
IVF
Infertility?