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Infertility Ana Dimitrović Mentor: A. Žmegač Horvat Definition • Not being able to get pregnant despite having frequent unprotected sex for at least a year Symptoms • Inability for a couple to get pregnant • Woman: abnormal menstrual periods • Man: hormonal problems (changes in hair growth or sexual function) When to see a doctor • You plan to conceive and you are a woman older than 30 or haven‘t menstruated in six months • You are a woman who has a history of irregular or painful menstrual cycles, pelvic pain, endometriosis… • You are a man with a low sperm count or a history of testicular, prostate or sexual problems Causes of male infertility Impaired production or function of sperm • Impaired shape or movement of sperm • Low sperm concentration • Varicocele • Undescended testicle • Testosterone deficiency (male hypogonadism) • Genetic defects • Infections Causes of male infertility Impaired delivery of sperm • Sexual issues • Retrograde ejaculation • Blockage of epididymis or ejaculatory ducts • No semen (ejaculate) • Hypospadia • Anti – sperm antibodies • Cystic fibrosis Causes of male infertility General health and lifestyle • Emotional stress • Malnutrition • Obesity • Cancer and its treatment • Alcohol and drugs • Age • Other medical conditions Causes of male infertility Environmental exposure • Pesticides and other chemicals • Overheating the testicles • Substance abuse • Tobacco smoking Causes of female infertility • Fallopian tube damage or blockage • Endometriosis • Ovulation disorders • Hyperprolactinemia • Polycystic ovary syndrome (PCOS) • Early menopause • Uterine fibroids • Pelvic adhesions Causes of female infertility • • • • • Medications Thyroid problems Cancer and its treatment Caffeine intake Other medical conditions Risk factors • • • • • • Age Tobacco smoking Alcohol use Being overweight Too much exercise Caffeine intake Tests and diagnosis Tests for men • General physical examination • Semen analysis • Hormone testing • Transrectal and scrotal ultrasound Tests for women • Ovulation testing • Hysterosalpingography • Laparoscopy • Hormone testing • Ovarian reserve testing • Genetic testing • Pelvic ultrasound Medical treatments Drugs • Clomiphene • Human menopausal gonadotropin, hMG • FSH • Human chorionic gonadotropin, hCG • Gonadotropin – releasing hormone (Gn-RH) analogs • Aromatase inhibitors • Metformin • Bromocriptine Medical treatments Fertility drugs and the risk of multiple pregnancies • Injectable fertility drugs increase the chance of multiple births • Careful monitoring: blood tests, hormone tests, ultrasound measurement of ovarian follicle size • Multifetal pregnancy reduction Medical treatments Surgery • Laparoscopic techniques • Blockages, varicocele Medical treatments Assisted reproductive technology (ART) • In vitro fertilization (IVF) Medical treatments • Electric or vibratory stimulation to achieve ejaculation • Surgical sperm ejaculation • Intracytoplasmic sperm injection (ICSI) • Assisted hatching Complications of treatment • Multiple pregnancy • Ovarian hyperstimulation syndrome (OHSS) • Bleeding or infection • Low birth weight • Birth defects Complementary and alternative treatments • Group psychological intervention • Acupuncture • Manual physical therapy • Fertility tourism (legal regulation, lower prices, sought procedure) Prevention Male: • Avoid alcohol, tobacco and street drugs • Avoid hot tubs and steam baths Female: • Avoid alcohol, tobacco and street drugs • Exercise moderately • Avoid weight extremes • Limit caffeine • Limit medications The end
