Infertility Boyarsky C MD Ph D Infertility is

Infertility Boyarsky C. , MD, Ph. D

Infertility is the inability to conceive after a year of unprotected intercourse.

Infertility and Subfertility • Infertility – in a case than a pregnancy is impossible (for example, after two salpingoectomies or stable azoospermia) • Subfertility – the probability of pregnancy is significantly reduced, but it is possible (endometriosis, PCOS etc. )

Infertility • Primary infertility – Couples with primary infertility have never been able to conceive • secondary infertility is difficulty conceiving after already having conceived

Age of women • Infertility is impaired in 10 -15% of married couples • In 20 years only 6% firstly married women can have infertility • In 30 years 10 -15% firstly married women can have infertility • In 40 years up to 50% firstly married women can have infertility

Infertility • Male causes • Female causes

Infertility • • • Male infertility Ovulatory dysfunction Tubal disease Endometriosis Immunological infertility Idiopathic infertility

Male infertility • The main method of male infertility investigation is semen analysis, twice during one month • Normal values by WHO

Normal values by WHO, 1999 and 2010 1999 2010 Volume, ml >1, 5 Concentration, mln. /ml Motility, A+B Morphology 20 15 50% 40% 14% 4%

Semen analysis • Aspermia - complete lack of semen • Azoospermia - absence of sperm cells in semen • Oligospermia or ** Oligozoospermia - decreased number of spermatozoa in semen • Asthenozoospermia - reduced sperm motility • Teratospermia - increase in sperm with abnormal morphology • Oligoasthenoteratozoospermia – complex abnormalities

Aspermia • One of the causes of aspermia is retrograde ejaculation • Diabetes mellitus type 1 • Multiple sclerosis • Spinal cord injury

Azoospermia • Obstructive • Unobstructive

Obstructive azoospermia • Unborn causes, CTFR mutations, a gene of cystic fibrosis • After vasectomy for male contraception purpose • After serious inflammatory disease of male ejaculatory tract

Unobstructive azoospermia • Mutation in long arm of Y-chromosome • AZF gene – locus a, b, c • Mutation in locus c can be associated with sperms during testicular biopsy • Klinefelter's syndrome – 47, XXY • Sertoli cell only syndrome

Testicular biopsy • During biopsy vital sperm can be received

Oligoasthenoteratozoospermia – complex abnormalities • AIH – artificial insemination by husband sperm • IVF-ET – in vitro fertilization and embyo transfer • ICSI – intracytoplasmatic sperm injection

Ovulation is the process in a female's menstrual cycle by which a mature ovarian follicle ruptures and discharges an ovum an oocyte.

An anovulatory cycle is a menstrual cycle during which the ovaries fail to release an oocyte. WHO classification of anovulation. • WHO I type – low gonadotrophin level (Kallmann syndrome – hypogonadism + inosmia) • WHO II type – normal gonadotrophin level (PCOS) • WHO III type – high gonadotrophin level (POF – POI)

WHO I type • Kallmann syndrome – hypogonadism, anosmia (an inability to perceive odors), low GNRH secretion, Low FSH and LH • Anorexia nervosa is an eating disorder characterized by refusal to maintain a healthy body weight

WHO II type, PCOS (2003 a consensus workshop sponsored by ESHRE/ASRM in Rotterdam) • Anovulation (Oligomenorrhea, amenorrhea — irregular, few, or absent menstrual periods). • Hyperandrogenism - is a medical condition characterized by excessive production and/or secretion of androgens. Hirsutism — excessive mild symptoms of hyperandrogenism. Biochemical hyperandrogenism – high level of testosterone. • Ultrasound signs – multifollicular ovaries (more than 12 follicles by one view)