1. Chapter 25 Infertility and Assisted Reproduction Michael Frietsch HE 210 8/10/14

2. What is Infertility? Physicians define infertility as the inability to get pregnant after a year or more of will-timed, unprotected vaginal intercourse or sperm insemination. The average experiences peak fertility in her twenties with a 20-30% chance of conceiving each menstrual cycle. 3. Myths About Infertility Although infertility is usually considered a woman's problem, both men and women should be evaluated. During an infertility evaluation in 2011, female factors contributed to nearly 50 percent of cases, while male factors were involved in 34 percent of cases. Often many think that birth control pills kill women's eggs or cause infertility. 4. Concerns About Infertility For many women, the internet has become a major source of health information and advice regarding informing themselves about infertility. Finding a physician who specializes in infertility can be crucial to understanding the next steps you and your partner need to take. 5. Causes of Infertility Fertility is based on several physiological events and their timing. For pregnancy to occur there must be a sufficient amount of healthy sperm and the presence of a mature egg. Sperm is deposited into the vagina and move upward through cervical mucus and the fluids of the uterus to meet the ovum while it is still in the oviduct. 6. Causes of a Man's Infertility Problems of production and maturation of the sperm -Can be caused by previous infections such as mumps, undescended testicles, chemical and environmental factors such as drugs, and sports injuries. Problems with the movement of the sperm -Can be caused by chronic prostatitis (inflammation of the prostate gland) and abnormally this seminal fluid. Also, drugs used to treat depression, emotional stress, stomach ulcers, and hypertension can effect sperm production and motility. 7. Causes of Infertility (Continued) Problems of transport resulting from scar tissue -Occurs in delicate passageways through which sperm travel. Can be caused my infections or untreated STI's; intentional blockage is created by vasectomy. Sometimes men are missing their vas deferens. Inability to deposit the sperm into the cervix -This may be the result of sexual dysfunction, such as impotence or premature ejaculation, as well as structural problems in the penis. Spinal cord injuries and various neurological diseased can also interfere with erection and ejaculation. Other factors can be poor health and nutrition. Various chemicals such as alcohol, marijuana, tobacco, and anabolic steroids. 8. Causes of Infertility for Women Mechanical barriers preventing the union of the sperm and ovum - caused by scarring in the tubes or around the ovaries. Can result from pelvic inflammatory disease or pelvic surgery. Infections from IUD's; incorrectly performed abortions, and untreated STI's Endometriosis -Causes scarring, tubal blockage, and possibly immune responses 9. Causes of Infertility for Women Endocrine Problems -Malfunctions of the ovaries, pituitary, hypothalamus, thryoid, or adrenal glands may lead to failure to ovulate regularly or to irregular menstrual periods. Irregular menstrual cycles can decrease the chances of conception Structural problems in the uterus or cervix due to congential problems or DES exposure in utero 10. Causes of Infertility for Women Polycysitic ovarian syndrome -A complex set of poorly understood symptoms usually characterized by ovaries with multiple cysts, irregular menstrual cycles and ovulations, and excess production of both estrogen and androgens (male hormones). Cervical mucus that is too thick or acidic -Due to vaginal infections. This acts as a barrier to unnormal movement of sperm up into the uterus. Mucus can be too thick under the influence of progesterone, or if estrogen levels are too low. 11. Causes of Infertility for Women Immunological response -Your or your partner or donor may have sperm antibodies that tend to destroy the sperms actions by immobilizing sperm or causing them to clump. Women with certain autoimmune disorders may have higher miscarraige rates. Age related factors - Around the age of 30, most women experience a gradual decline in the number and function of the eggs in the uterus. Other factors are extreme weight loss/gain, poor nutrition, 12. Changing Diagnoses and Treatments The field of infertility diagnosis and treatment is evolving rapidly. Infertility workups -Tests all the links in the chain of events from ovulation to an established pregnancy in an orderly way. They are expensive and can be invasive, painful, and emotionally exhausting. Needs for this are a general and medical history of you and your partner, a gynecologic exam, monitoring ovulation, hormonal profile, ovarian reserve, and semen analysis 13. Treatments for Women Infertility Drugs -Drugs used to induce ovulation Can be dangerous, costly, and stressful Surgery - Microsurgery and Laser surgery Other treatments -Acupuncture, herbal medicine, relaxation techniques 14. Treatment for Men Infertility Antibotics if it is caused by an infection A varicoele (a varicose vein in the scrotum) can be corrected surgically. 15. Donor Insemination Used when trying to conceive using the sperm of a man who is not your partner. Can be done with a syringe injected into vagina. ICI inseminations, Intracervical inseminations the sperm is injected through a tiny, strawlike tube into the opening of the cervix Intracytoplasmic sperm injection- procedure where a single sperm is injected into an egg to achieve fertilization outside the body. Expensive procedure. 16. Discussion Question Do you think insurance companies should help women having difficulty with infertility such as costs on expensive conceiving measures like Intracytoplasmic sperm injection?