Infertility – B. Pharma 2nd Semester Pathophysiology notes pdf

Infertility

Content

  • Infertility      
  • Definition
  • Causes
  • Evaluation
    of the Infertile couple
  • Abnormalities
    of Spermatogenesis
  • Evaluation
    of Ovulation
  • Diagnosis

Objectives

At the
end of this PDF Notes, students will be able to –

       Define primary and secondary
infertility

       Describe the causes of infertility

Infertility

       The
inability to conceive following unprotected 
sexual intercourse

      1
year (age < 35) or 6 months (age >35)

      Affects
15% of reproductive couples

       6.1
million couples

      Men
and women equally affected

       Reproductive
age for women

      Generally
15-44 years of age

      Fertility
is approximately halved between 37th and 45th year due to
alterations in ovulation

      20%
of women have their first child after age 30

      1/3
of couples over 35 have fertility problems

       Ovulation
decreases

       Health
of the egg declines

Primary
infertility

      a
couple that has never conceived

Secondary
infertility

      infertility
that occurs after previous pregnancy regardless of outcome

Requirements
for Conception 

       Production
of healthy egg and sperm

       Unblocked
tubes that allow sperm to reach the egg

       The
sperms ability to penetrate and fertilize the egg

       Implantation
of the embryo into the uterus

       Finally
a healthy pregnancy

Causes for infertility

       Male

      ETOH

      Drugs

      Tobacco

      Health
problems

      Radiation/Chemotherapy

      Age

      Enviromental
factors

       Pesticides

       Lead

       Female

      Age

      Stress

      Poor
diet

      Athletic
training

      Over/underweight

      Tobacco

      ETOH

      STD’s

      Health
problems

Causes
of Infertility

       Anovulation
(10-20%)

       Anatomic
defects of the female genital tract (30%)

       Abnormal
spermatogenesis (40%)

       Unexplained
(10%-20%)

Evaluation
of the Infertile couple

       History
and Physical exam

       Semen
analysis

       Thyroid
and prolactin evaluation

       Determination
of ovulation

      Basal
body temperature record

      Serum
progesterone

      Ovarian
reserve testing

       Hysterosalpingogram

Abnormalities of Spermatogenesis

Male Factor

       40%
of the cause for infertility

       Sperm
is constantly produced by the germinal epithelium of the testicle

      Sperm
generation time 73 days

      Sperm
production is thermoregulated

      
F less than body temperature

       Both
men and women can produce anti-sperm antibodies which interfere with the
penetration of the cervical mucus

Semen
Analysis (SA)

       Obtained
by masturbation

       Provides
immediate information

      Quantity

      Quality

      Density
of the sperm

       Abstain
from coitus 2 to 3 days

       Collect
all the ejaculate

       Analyze
within 1 hour

       A
normal semen analysis excludes male factor 90% of the time

Normal Values for SA

Volume – 2.0 ml
or more

Sperm Concentration
– 20 million/ml or more

Motility – 50%
forward progression

                 25%
rapid progression

Viscosity – Liquification
in 30-60 min

Morphology – 30%
or more normal forms

pH – 7.2-7.8

WBC – Fewer than
1 million/ml

Causes
for male infertility

       42%
varicocele

      repair
if there is a low count or decreased motility

       22%
idiopathic

       14%
obstruction

       20%
other (genetic abnormalities)

Abnormal Semen Analysis

       Azospermia

      Klinefelter’s
(1 in 500)

      Hypogonadotropic-hypogonadism

      Ductal
obstruction (absence of the Vas deferens)

       Oligospermia

      Anatomic
defects

      Endocrinopathies

      Genetic
factors

      Exogenous
(e.g. heat)

       Abnormal
volume

      Retrograde
ejaculation

      Infection

      Ejaculatory
failure

Evaluation of Ovulation

Menstruation

       Ovulation
occurs 13-14 times per year

       Menstrual
cycles on average are Q 28 days with ovulation around day 14

       Luteal
phase

      dominated
by the secretion of progesterone

      released
by the corpus luteum

       Progesterone
causes

      Thickening
of the endocervical mucus

      Increases
the basal body temperature (0.6° F)

       Involution
of the corpus luteum causes a fall in progesterone and the onset of menses

Ovulation

       A
history of regular menstruation suggests regular ovulation

       The
majority of ovulatory women experience

      fullness
of the breasts

      decreased
vaginal secretions

      abdominal
bloating

      mild
peripheral edema

       slight weight gain

       depression

       Absence
of PMS symptoms may suggest anovulation

Anovulation

Symptoms

       Irregular
menstrual cycles

       Amenorrhea

       Hirsuitism

       Acne

       Galactorrhea

       Increased
vaginal secretions

Evaluation*         

       Follicle
stimulating hormone

       Lutenizing
hormone

       Thyroid
stimulating hormone

       Prolactin

       Androstenedione

       Total
testosterone

       DHEAS

*Order the appropriate
tests based on the clinical indications

Anatomic
Disorders of the Female Genital Tract
Sperm
Transport, Fertilization, & Implantation

       The
female genital tract is not just a conduit

      facilitates
sperm transport

      cervical
mucus traps the coagulated ejaculate

      the
fallopian tube picks up the egg

       Fertilization
must occur in the proximal portion of the tube

      the
fertilized oocyte cleaves and forms a zygote              

      enters
the endometrial cavity at 3 to 5 days

       Implants
into the secretory endometrium for growth and development

Congenital Anatomic Abnormalities























Unexplained infertility

       10%
of infertile couples will have a completely normal workup

       Pregnancy
rates in unexplained infertility

      no
treatment 1.3-4.1%

      clomid
and intrauterine insemination 8.3%

      gonadotropins
and intrauterine insemination 17.1%

Summary

       Infertility
is the inability to conceive following unprotected  sexual intercourse

       Infertility
should be evaluated after one year of unprotected intercourse

       Primary
infertility – a couple that has never conceived

       Secondary
infertility – infertility that occurs after previous pregnancy regardless of
outcome

       History
and Physical examination usually will help to identify the etiology.

 


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