Scribd
Upload
23 views

Female Infertility: James N Anasti, M.D. Dept OB/GYN

This document summarizes information about female infertility, including definitions, statistics on birth rates and fertility services over time, and the impact of age on fertility. It discusses how a woman's ovarian reserve declines significantly with age, decreasing her chances of live birth from IVF and increasing her risk of miscarriage. Lifestyle factors like obesity, smoking, and excessive alcohol or caffeine consumption can negatively impact fertility as well. The document outlines how to evaluate potential causes of infertility like ovarian function, tubal patency, uterine factors, cervical issues, and unexplained infertility.

Uploaded by

Nor Aina
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPT, PDF, TXT or read online on Scribd
23 views

Female Infertility: James N Anasti, M.D. Dept OB/GYN

This document summarizes information about female infertility, including definitions, statistics on birth rates and fertility services over time, and the impact of age on fertility. It discusses how a woman's ovarian reserve declines significantly with age, decreasing her chances of live birth from IVF and increasing her risk of miscarriage. Lifestyle factors like obesity, smoking, and excessive alcohol or caffeine consumption can negatively impact fertility as well. The document outlines how to evaluate potential causes of infertility like ovarian function, tubal patency, uterine factors, cervical issues, and unexplained infertility.

Uploaded by

Nor Aina
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPT, PDF, TXT or read online on Scribd
You are on page 1/ 43

Female infertility

James N Anasti, M.D.


Dept OB/GYN
Definition
• Infertility

• Fecundablity

• Fecundity
Just the Facts
1790 Birth rate : 55/1000
2001 Birth rate: 14.7/1000
Fertitlity services 1982: 12% (6.6 mil)
Fertility services 1995: 15% (9.3 mil)

Services used: 53% ovulatory drugs, 1.6% ART


What physical attribute is an
important factor for infertility?
AGE: the Hutterites
• Peaks at age 20-24 (2.6% infertile)
• Age 30-34 decrease by 15-19 % (11% infertile)
• Age 35-39 decrease by 26-46% (33% infertile)
• Age 40-45 decrease by 95% (87% infertile)
• Data confirmed by insemination studies
Age: IVF
• Younger than 35: 42% Live birth per embryo
• Age 35-37: 35.1% Live birth per embryo
• Age 38-40: 25% Live birth per embryo
• Age 41-42: 14.5% Live birth per embryo
• Age 43: 5.9% Live birth per embryo
• Greater than 43: 2.9% Live birth per embryo
Age: Miscarriage
• Recognized
– Age 30: 7-15%
– Age 31-34: 17-21%
– Age 35-39: 17-28%
– Age 40: 40-52%
• Unrecognized: 60%
What is the mechanism of age
that causes infertility?
Physiology of Aging Ovary
Why are older women Infertile?
• They less eggs develop? NO

• They ovulate less? NO

• They produce less steroids? NO


Chromosomes:Aneuploidy
• Young women 10% eggs are aneuploidic
• Age 40: 30% abnormal
• Age 43: 50 % abnormal
• Age 45: 100% abnormal
How does one check for ovarian
reserve?
Checking for Ovarian Reserve
• Success of IVF: the outcome
• Physiology : age related increase of FSH
– Day 3 FSH: >10-15 mIu/mL
– Day 3 Estradiol: >80 pg/mL
• Clomiphene Challenge Test (CCT)
– Day 3 & Day 10 FSH (after clomid 50mg day 5-9)
– IVF success <10%
Who to Screen?
• Age >35
• Family Hx POF
• Ovarian Surgery
• Smoking
• Poor Gonadotropin response
Infertility: Guiding Principles
• Identify the cause
• Provide accurate information
• Emotional Support; RESOLVE group
• Guide treatments
What life style behaviors
decrease infertility?
Basic Info: Life style
• 62% of US have BMI > 25
• 25% female in US smoke: 13% infertile
• Mary Jane factor
• ETOH
• Caffeine??
Normal Reproductive Efficiency
• Fecundity: baboons 80% Human 20%

• 93% of couples pregnant in 2 years

• Egg 12-14 hrs, Sperm 3-5 days


How can we help?
• Assume day before temp spike on BBT
• Peak fertility 2 days prior to ovulation
• LH detection
• But easiest: Intercourse Twice a week
When should a work-up begin?
• Most people need no treatment
• 3 year rule
– 5% decrease per year in age
– 15-25% per year of infertile
• >35 don’t wait
• Obvious reasons
History & Physical Exam
• G’s P’s and complicaion
• LNMP, Sexual Activity
• Surgery’s
• Meds, symptoms
• FmHX menopause, reproductive
Physical Exam:
• BMI
• Thyroid
• Skin
• Breast
• Pelvic
Screening Test
• PAP, STD
• Rh, Cystic Fibrosis,Rubella
• Varicella
What are the main causes of
infertility?
Infertility: Causes
Infertility: KISS it
• Sperm in cervix
• Mature Oocyte
• Cervix must nurture sperm
• Capture the oocyte in tube
• Uterus enviroment
How do we screen for male
infertility?
Male Factor
How do we check for ovulatory
defects?
Infertility: Ovarian Factor
• Menstrual History: 97.7% predictor
• BBT
– Thermogenic potential of progesterone (.4-.8)
– Ovulation when see rise (1-5 days after)
– 12 or more days to menses
• Progesterone 3-4 ng/mL
– 7-8 days post ovulation
– Luteal pahse function
Ovulatory Factor
• LH excretion: Ovulation prediction (24-48 h)
– Start 2-3 days before LH Surge
– Late afternoon testing, Concentrate urine
– Day of surge and next 2
• Ultrasound
How do we check for tubal
factor?
Tubal Factor
• Risk factors
– PID; 12%,24%,75%, Ectopic 6 fold
• HSG
– 2-5 days after menses
– 1-3 % infection rate high risk
– Increase preg rate
– False positive obstruction rate (15-30%)
Hydrosalpinges Myoma

Normal HSG
Tubal Factor: Laparoscopy
• Chromotubation with indigo carmine
– Why not methylene blue?

• Possibility of Treatment

• Tubal surgery: Is it worth it??


Tubal Factor: Chlamydia Antibody
testing
• Pretest: Laparoscope or not

• HSG sooner than latter

• Not yet defined


Uterine Factors
• Hysterosalpingography (HSG)
– HSG v Hysterscope: Sens 98%, Spec 35%
– All polyp vs submucous myomas
• Ultrasound/Sonohysterography
– SIS 75 sens, spec 90%
Bicornate Polyp

Late Prolif Mid secr


Early Prolif
Endometrial Biopsy

Proliferative

Secretory
Uterine Factors: Bottom Line
Congenital Malformation Yes, Septum only

Leiomyomas Maybe, submucous

Intrauterine Adhesions Yes

Endometrial Polyps Maybe


Cervical Factor
• Postcotial test (Sims-Huhner)
Intercourse (2-12 hrs) for test
Look at: pH, Sperm, Spinnbarkeit, Ferning
Cellularity, Sperm Shaking, sperm Agglutanation
Has seen better days
Unexplained Infertility
• Defined
• 10-30% incidence
• Laparoscope necessary:
– Canadian Study: 17% v 29% (NTT:9)
• Just slower to get pregnant 3 year data
– Spontaneous conception falls 40%
UI:Who should you treat?
No treatment 1.3-4.1%
IUI 3.8%
Clomid 5.6%
Clomid & IUI 8.3%
Gonadotropins 7.7%
Gonadotropins & IUI 17.1%
IVF 20.7%

You might also like