infertility assignment

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"Success isn't about how much money you make. It's about
the difference you make in people's lives." —Michelle Obama
INFERTILITY
Specific Learning Objectives
• List causes of infertility
• Document the psychosocial effects of infertility
• State the necessary investigations
• Describe the various modes of treatment
• Enumerate options to the couple

Definitions
Infertility – Inability of a couple to achieve conception in 1year (sub-fertility)
Sterility – Intrinsic inability to achieve pregnancy
Fecundity – Probability of achieving a life birth in one menstrual cycle.
1

Fecundability – likely- hood of conception per month of exposure

Epidemiology
• Prevalence 13% (range between 7- 28%)
• Normal fertile couples with frequent intercourse; fecundability (20 – 25%)
• Approximately 90% of couples with unprotected sex will have a pregnancy within 1 year.
• Sterility affects 1 – 2% of couples

Aetiology
• In 80% of cases cause found
• In 15 – 20 of cases cause not found


Male factor alone causes about 25%.

Causes of Infertility
2

Male
Endocrine disorders
• Hypothalamic dysfunction
▪ Testosterone synthesis and sperm production interfered with
• Hyperprolactinaemia (drug, tumour)
▪ Reduces sperm production, reduces libido and may cause impotence
• Pituitary failure (tumour, radiation, surgery)
▪ Testosterone and sperm production interfered with
• Exogenous androgens
▪ Low sperm count, an increased number of immature sperm cells, and low
sperm cell motility
• Thyroid disorders
▪ Low levels can cause poor semen quality, poor testicular function and may
disturb libido
• Adrenal hyperplasia
3

▪ Low sperm count, an increased number of immature sperm cells, and low
sperm cell motility
Anatomic disorders
• Congenital absence of vas deferens
• Congenital abnormalities of ejaculatory system
• Obstruction of vas deferens
Abnormal spermatogenesis
• Chromosomal abnormalities
• Mumps orchitis
• Cryptorchidism
• Chemical or radiation exposure
Abnormal motility
• Absent cilia
• Antibody formation
• Varicocoele
4

Sexual dysfunction
• Retrograde ejaculation
• Decreased libido
• Impotence
• Premature ejaculation
• Penile abnormalities e.g. hypospadias or phimosis



Some lifestyle choices that negatively impact male fertility--it is not all-inclusive:
· Smoking--significantly decreases both sperm count and sperm cell motility
· Prolonged use of marijuana and other recreational drugs.
· Chronic alcohol abuse.
· Anabolic steroid use--causes testicular shrinkage and infertility.
· Overly intense exercise--produces high levels of adrenal steroid hormones which cause
a testosterone deficiency resulting in infertility.
· Inadequate vitamin C and Zinc in the diet.
5

· Tight underwear--increases scrotal temperature (results in decreased sperm production)
· Exposure to environmental hazards and toxins such as pesticides, lead, paint, radiation,
radioactive substances, mercury, benzene, boron, and heavy metals
· Malnutrition and anemia.
· Excessive stress!

Female
A.Ovulatory Factor
Central defects
• Chronic hyperandrogeneamic anovulation
• Hyperprolactinemia (drug, tumor, empty sella turcica)
• Hypothalamic insufficiency
• Pituitary insufficiency (trauma, tumor, congenital)

6

Peripheral defects
• Gonadal dysgenesis
• Premature Ovarian failure
• Ovarian tumor
• Ovarian resistance – Savage’s syndrome
• Thyroid disease
• Androgen excess, (adrenal or neoplastic)
▪ CAH include
o Inadequate vaginal introitus and therefore unsatisfactory intercourse
o Poor adrenal suppression
o A high prevalence of polycystic ovaries leading to ovulatory
dysfunction
o Elevated follicular phase progesterone levels causing failure of
implantation (thin endometrium)
7

o Biological and psych...


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