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Female and male infertility Causes & Management by Asar Khan
Infertility is defined as the inability of couples to conceive after 12 months of unprotected intercourse, affecting about 10-15% of couples in the U.S. Causes include age, medical conditions like endometriosis and PCOS, lifestyle factors, and male-related issues such as semen deficiencies. Treatment options range from medications and surgical interventions to assisted reproductive technologies, with approximately two-thirds of couples seeking treatment successfully achieving pregnancy.
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Female and male infertility Causes & Management by Asar Khan
- 2. Presenting By AsAr KhAn& sAimA (M.Sc Zoology) AWKUM Buner
- 3. What is infertility? Couplesthat have been unable to conceive a child after 12 months of regular sexual intercourse without birth control. Women who have repeated miscarriages are also said to be infertile.
- 4. In order fora woman to become pregnant: Egg must be released from one of her ovaries Egg must go through the fallopian tube toward the uterus
- 5. Sperm must joinwith the egg in the fallopian tube (fertilization) Fertilized egg must attach to the uterine wall (implantation)
- 6. You’re not alone About12% of women (7.3 million) in the United States aged 15-44 had difficulty getting pregnant or carrying a baby to term in 2002. 10 to 15% of couples in the U.S. are infertile.
- 8. When should yougo see a doctor? Women in their 30s who've been trying to become pregnant for six months should speak to their doctors as soon as possible.
- 9. Women with thefollowing issues should speak to their doctors: irregular periods or no menstrual periods very painful periods Endometriosis pelvic inflammatory disease more than one miscarriage
- 10. What Increases theRisks? Age Stress Poor diet Smoking Alcohol Overweight Underweight Caffeine intake Too much exercise
- 11. The Age Factor Awoman's fertility naturally starts to decline in her late 20's. After age 35 a woman's fertility decreases rapidly. A woman is born with all the eggs she'll have, and with time, the supply diminishes. The remaining eggs also age along with the rest of the body.
- 12. 20% of womenin the United States have their first child after age 35. About one third of couples over age 35 have fertility problems. Age decreases the woman’s ability to conceive by: Ability of a woman’s ovaries to release eggs Increased miscarriages
- 13. Common Causes ofInfertility Severe endometriosis Pelvic Inflammatory Disease (PID) Ovulation disorders Elevated prolactin Polycystic ovary syndrome (PCOS) Early menopause Benign uterine fibroids Pelvic adhesions
- 14. Physical Obstructions Endometriosis Pelvic InflammatoryDisease Uterine Fibroids Pelvic Adhesions Ovarian Failure
- 15. Endometriosis Occurs when theuterine tissue implants and grows outside of the uterus, affecting the function of the ovaries, uterus and fallopian tubes. Scar tissue can block the fallopian tubes and prevent the egg from entering the uterus. There is a 25-35% rate of infertility in moderate to severe cases of Endometriosis
- 16. PID (Pelvic inflammatorydisease ) (PID) is a spectrum of infections of the female genital tract that includes endometritis, salpingitis, tuboovarian abscess, and peritonitis.
- 17. Uterine Fibroids andPelvic Adhesions Fibroids are benign tumors in the wall of the uterus May cause infertility by blocking the fallopian tubes Pelvic adhesions are bands of scar tissue that bind organs after pelvic infection, appendicitis, or abdominal or pelvic surgery This scar tissue formation may impair fertility.
- 18. Ovarian failure Ovarian failurecan be a consequence of medical treatments, or the complete failure of the ovaries to develop or contain eggs in the first place (Turner's Syndrome). Ovarian failure can also occur as a result of treatments such as chemotherapy and pelvic radiotherapy for cancers in other body areas. These therapies destroy eggs in the ovary.
- 19. Hormonal Obstructions Ovulation disorders Elevatedprolactin Polycystic ovary syndrome Early menopause
- 20. Ovulation disorders Disruption inthe part of the brain that regulates ovulation can cause low levels of luteinizing hormone (LH) and follicle-stimulating hormone (FSH). Even slight irregularities in the hormone system can affect ovulation.
- 21. Elevated prolactin Also calledhyperprolactinemia Can cause irregular or no ovulation Irregular periods May cause galactorrehea, milk production when not pregnant
- 22. PCOS (Polycystic ovarysyndrome ) Produces too much androgen hormone (male hormones) Causes an irregular or no menstrual cycle
- 23. Early menopause Absence ofmenstruation Early depletion of ovarian follicles before age 35 Although the cause is unknown, certain conditions are associated with early menopause, including immune system diseases, radiation or chemotherapy treatment, and smoking etc.
- 24. Other Causes Medications Thyroid problems Cancerand treatment Other medical conditions conditions associated with delayed puberty or amenorrhea HIV/AIDS, kidney disease and diabetes
- 25. Fertilization Problems (1) =Anti-sperm antibodies (ASA) (2) = Oocyte membrane proteins
- 26. Immune Infertility The developingembryo may be miscarried due to the mother’s immune system recognizing it as a “foreign body” and attacking it. Also, the woman may produce anti-sperm antibodies (ASA) to her partner’s sperm.
- 27. ASA neutralize spermby clumping them together and destroying their membranes. They also coat over receptors involved in sperm-egg binding and fertilization. An estimated 12 to 15 percent of unexplained infertility in women is linked to ASA.
- 28. Oocyte Membrane Proteins Reception,an oocyte membrane protein, is responsible for binding sperm with the egg. If this protein is not receptive or present, fertilization cannot occur.
- 29. Development Problems Hard Egg Ifegg is too 'hard', then the embryo cannot hatch out of the zona pellucida and it dies. To fix this problem, scientists can make a tiny hole in the egg to give it a head start.
- 31. Teratogens Damage from externalsources, including viral infections, x-rays and other radiation, and poor nutrition
- 32. Treatment Infertility can betreated with medicine, surgery, artificial insemination or assisted reproductive technology. Stimulate ovulation with fertility drugs About two-thirds of couples who are treated for infertility are able to have a baby. In most cases, infertility is treated with drugs or surgery.
- 33. Assisted reproductive technology(ART) In vitro fertilization (IVF) Most effective Recommended when both fallopian tubes are blocked ART works best when the woman has a healthy uterus, responds well to fertility drugs, and ovulates naturally or uses donor eggs.
- 34. Complications Multiple pregnancy Ovarian hyperstimulationsyndrome (OHSS) Ovaries may enlarge and cause pain and bloating Higher risk in PCOS women Bleeding or infection Low birth weight Birth defects
- 35. Medicine used are.. . Clomid: cause ovulation , by acting on PG Mostly used in PCOS syndrome It is taken by mouth. Repronex , Pergonal: used for non-ovulating women who do not ovulate with their PG. Gonal-F , Follistim: it cause the ovaries to begin the process of ovulation , these are injected. And many more . . .
- 36. Ways to BattleInfertility Regular exercise Avoid alcohol, tobacco, and narcotics Limit caffeine No more than 250 mg per day Limit medications Eat a balanced diet
- 37. Coping with Infertility Considerother options Adoption, donor sperm or egg Talk about your feelings To each other Support groups Counseling services Stay in touch with loved ones
- 38. THANK YOU VERYMUCH
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- 42. Male infertility it refersto the inability of a male to achieve a pregnancy in a fertile female. 15% of couples, 30%: male , 30% female & both , 25% unexplained & 5% others.
- 44. Male infertility iscommonly due to deficiencies in the semen, and semen quality is used as a surrogate measure of male fecundity.
- 45. Causes Factors relating tomale infertility are: Pre-testicular causes Tobacco smoking Testicular factors DNA damage Post-testicular causes
- 46. Pre-testicular causes It referto conditions that impede less support of the testes and include situations of poor hormonal support and poor general health including: Drugs, alcohol riding (bicycle riding, horseback riding) Medications, including those that affect spermatogenesis such as chemotherapy, anabolic steroids, cimetidine, spironolactone; those that decrease FSH levels such as phenytoin; those that decrease sperm motility such as sulfasalazine and nitrofurantoin.
- 47. Tobacco smoking Male smokersalso have approximately 30% higher odds of infertility. There is increasing evidence that the harmful products of tobacco smoking kill sperm cells.
- 48. DNA damage Common inheritedvariants in genes that encode enzymes employed in DNA mismatch repair are associated with increased risk of sperm DNA damage and male infertility.
- 49. Testicular factors Testicular factorsrefer to conditions where the testes produce semen of low quantity and/or poor quality despite adequate hormonal support and include: Age Genetic defects on the Y chromosome Abnormal set of chromosomes (Klinefelter syndrome) Neoplasm e.g. seminoma Idiopathic failure Trauma Hydrocele Mumps Malaria Testicular cancer Acrosomal defects affecting egg penetration Idiopathic oligospermia - unexplained sperm deficiencies account for 30% of male infertility.
- 50. Post-testicular causes It decreasemale fertility due to conditions that affect the male genital system after testicular sperm production and include defects of the genital tract as well as problems in ejaculation: Vas deferens obstruction Lack of Vas deferens, often related to genetic markers for Cystic Fibrosis Infection, e.g. prostatitis Retrograde ejaculation Ejaculatory duct obstruction Hypospadias Impotence
- 51. Diagnosis The diagnosis ofinfertility begins with a medical history and physical exam by a physician, preferably a specialist with experience or who specializes in male infertility.
- 52. Medical history The historyshould include prior testicular or penile insults (torsion, cryptorchidism, trauma) infections mumps orchitis, epididymitis Environmental factors excessive heat, radiation, medications, and Drug use anabolic steroids, alcohol, smoking etc
- 53. Physical examination Usually, thepatient disrobes completely and puts on a gown. The physician will perform a continuous examination of the penis, scrotum, testicles, anus and rectum.
- 54. Sperm sample The volumeof the semen sample, approximate number of total sperm cells, sperm motility/forward progression, and % of sperm with normal morphology are measured. This is the most common type of fertility testing.
- 55. Semen deficiencies areoften labeled as follows: Oligospermia or Oligozoospermia - decreased number of spermatozoa in semen Aspermia - complete lack of semen Hypospermia - reduced seminal volume Azoospermia - absence of sperm cells in semen Teratospermia - increase in sperm with abnormal morphology Asthenozoospermia - reduced sperm motility
- 56. Blood sample Common hormonaltest include determination of FSH and testosterone levels. A blood sample can reveal genetic causes of infertility, e.g. Klinefelter syndrome, a Y chromosome microdeletion, or cystic fibrosis.
- 57. Prevention Some strategies suggestedor proposed for avoiding male infertility include the following: 1. Avoiding smoking as it damages sperm DNA 2. Avoiding heavy marijuana and alcohol use.
- 58. 3. Avoiding excessiveheat to the testes. 4. Sperm counts can be depressed by daily coital activity and sperm motility may be depressed by coital activity that takes place too infrequently.
- 59. 5. When participatingin contact sports, wear an Protective Cup (safe guard) and Jockstrap to protect the testicles.
- 60. Sports such asBaseball, Football, Cricket, Hockey, Softball, Motorcross, Wrestling, Karate or other Martial Arts or any sport where a ball, foot, arm, knee or bat can come into contact with the groin.
- 61.
Editor's Notes
- #7 The American Society for Reproductive Medicine estimates there are 6.1 million people dealing with infertility in the United States -- that's roughly 10% of those trying to conceive. Fortunately, there are many tests and procedures that can identify and treat the causes of infertility. Ten percent to 15 percent of couples in the United States are infertile. Infertility is defined as not being able to get pregnant despite having frequent, unprotected sex for at least a year. One in six couples is infertile. In 40 per cent of cases the problem rests with the male, in 40 per cent with the female, ten per cent with both partners, and in a further ten per cent of cases, the cause is unknown. Fertility problems strike one in three women over 35. One in 25 males has a low sperm count and one in 35 is sterile. For healthy couples in their twenties having regular unprotected sex, the chance of becoming pregnant each month is 25 per cent. The chance of conceiving in an IVF cycle is on average around 20 per cent (but varies due to individual circumstances).
- #11 Many of the risk factors for both male and female infertility are the same. They include: Age. After about age 32, a woman's fertility potential gradually declines. Infertility in older women may be due to a higher rate of chromosomal abnormalities that occur in the eggs as they age. Older women are also more likely to have health problems that may interfere with fertility. The risk of miscarriage also increases with a woman's age. A gradual decline in fertility is possible in men older than 35. Tobacco smoking. Men and women who smoke tobacco may reduce their chances of becoming pregnant and reduce the possible benefit of fertility treatment. Miscarriages are more frequent in women who smoke. Alcohol use. For women, there's no safe level of alcohol use during conception or pregnancy. Moderate alcohol use does not appear to decrease male fertility. Being overweight. Among American women, infertility often is due to a sedentary lifestyle and being overweight. Being underweight. Women at risk include those with eating disorders, such as anorexia nervosa or bulimia, and women following a very low-calorie or restrictive diet. Strict vegetarians also may experience infertility problems due to a lack of important nutrients such as vitamin B-12, zinc, iron and folic acid. Too much exercise. In some studies, exercising more than seven hours a week has been associated with ovulation problems. Strenuous exercise may also affect success of in vitro fertilization. On the other hand, not enough exercise can contribute to obesity, which also increases infertility. Caffeine intake. Studies are mixed on whether drinking too much caffeine may be associated with decreased fertility. Some studies have shown a decrease in fertility with increased caffeine use while others have not shown adverse effects. If there are effects, it's likely that caffeine has a greater impact on a woman's fertility than on a man's. High caffeine intake does appear to increase the risk of miscarriage.
- #12 After about age 32, a woman's fertility potential gradually declines. Infertility in older women may be due to a higher rate of chromosomal abnormalities that occur in the eggs as they age. Older women are also more likely to have health problems that may interfere with fertility. The risk of miscarriage also increases with a woman's age. A gradual decline in fertility is possible in men older than 35. The reason is straightforward. A woman is born with all the eggs she'll have. And with time, the supply diminishes. The remaining eggs also age along with the rest of the body.
- #13 , about 20 percent of women in the United States now have their first child after age 35. So age is an increasingly common cause of fertility problems. About one third of couples in which the woman is over 35 have fertility problems. Aging decreases a woman's chances of having a baby in the following ways: The ability of a woman's ovaries to release eggs ready for fertilization declines with age. The health of a woman's eggs declines with age. As a woman ages she is more likely to have health problems that can interfere with fertility. As a women ages, her risk of having a miscarriage increases.
- #16 The normal tissue lining the uterine cavity is called the endometrium. Endometriosis is a condition in which the presence of this endometrial tissue moves outside the uterus. The most common places for implantation are the ovaries, fallopian tubes, bladder and intestines, uterine wall, and the lining of the pelvis. In very rare cases it may be found in the lungs, surgical wounds (cesarean section scars), brain tissue and the vaginal wall. Can Endometriosis cause infertility?Adhesions (scar tissue) can block the fallopian tubes and prevent the egg from entering the uterus. There is a 25-35% rate of infertility in moderate to severe cases of Endometriosis, resulting primarly from damage incurred to the ovaries and fallopian tubes. http://www.alternativesurgery.com/education/endometriosis.php
- #17 Endometritis (Inflammation of the endometrium). , salpingitis ( Inflammation of the uterine tube). , tuboovarian abscess (A large abscess involving a uterine tube and an adherent ovary, resulting from extension of purulent inflammation of the tube.) , and peritonitis( Inflammation of the peritoneum .) infection of the uterus (womb), fallopian tubes (tubes that carry eggs from the ovaries to the uterus) and other reproductive organs. It is a common and serious complication of some sexually transmitted diseases (STDs), especially chlamydia and gonorrhea. PID can damage the fallopian tubes and tissues in and near the uterus and ovaries. Untreated PID can lead to serious consequences including infertility, ectopic pregnancy (a pregnancy in the fallopian tube or elsewhere outside of the womb), abscess formation, and chronic pelvic pain.
- #21 A delicate balance of sex hormones (oestrogen, progesterone, luteinizing hormone, follicle stimulating hormone) is needed for the timely growth and release of the egg from the ovary (ovulation). Hormone imbalances can cause ovulation disorders in women and are the most common cause of infertility in women.
- #22 Hyperprolactinemia (excessive prolactin) can cause irregular or no ovulation, resulting in infertility. Women who have this disorder often have irregular periods, and may also experience galactorrhea (ga-LAK-to-RE-ah) - milk production when not pregnant
- #23 Polycystic Ovarian Syndrome (PCOS) is a health problem that can affect a woman’s menstrual cycle, fertility, hormones, insulin production, heart, blood vessels, and appearance. Women with PCOS have these characteristics: high levels of male hormones, also called androgens an irregular or no menstrual cycle may or may not have many small cysts in their ovaries. Cysts are fluid-filled sacs. PCOS is the most common hormonal reproductive problem in women of childbearing age. An estimated five to ten percent of them have PCOS. In women with PCOS, the ovary doesn't make all of the hormones it needs for any of the eggs to fully mature. They may start to grow and accumulate fluid. But no one egg becomes large enough. Instead, some may remain as cysts. Since no egg matures or is released, ovulation does not occur and the hormone progesterone is not made. Without progesterone, a woman’s menstrual cycle is irregular or absent. Also, the cysts produce male hormones, which continue to prevent ovulation.
- #25 Medications. Temporary infertility may occur with the use of certain medications. In most cases, fertility is restored when the medication is stopped. Thyroid problems. Disorders of the thyroid gland, either too much thyroid hormone (hyperthyroidism) or too little (hypothyroidism), can interrupt the menstrual cycle and cause infertility. Cancer and its treatment. Certain cancers — particularly female reproductive cancers — often severely impair female fertility. Both radiation and chemotherapy may affect a woman's ability to reproduce. Chemotherapy may impair reproductive function and fertility in men and women. Other medical conditions. Medical conditions associated with delayed puberty or amenorrhea, such as Cushing's disease, sickle cell disease, HIV/AIDS, kidney disease and diabetes, can affect a woman's fertility. Caffeine intake. Excessive caffeine consumption reduces fertility in the female.
- #27 In women with anti-sperm antibodies ASA, the antibodies gather sperm together and poke holes in their membranes, rendering them useless for conception. It makes it impossible for the sperm to penetrate correctly into the egg.
- #32 damage from external sources (teratogens) including viral infections such as rubella, x-rays and other radiation, and poor nutrition. In Week 3 we see the formation of the heart, the beginning development of the brain and spinal cord, and the beginning of the gastrointestinal tract. Teratogens introduced during this period may cause severe problems such as the absence of one or more limbs or a heart that is outside of the chest cavity at birth.
- #35 Multiple pregnancy. The most common complication of ART is multiple pregnancy. The number of quality embryos kept and matured to fetuses and birth ultimately is a decision made by the couple. If too many babies are conceived, the removal of one or more fetuses (multifetal pregnancy reduction) is possible to improve survival odds for the other fetuses. Ovarian hyperstimulation syndrome (OHSS). If overstimulated, a woman's ovaries may enlarge and cause pain and bloating. Mild to moderate symptoms often resolve without treatment, although pregnancy may delay recovery. Rarely, fluid accumulates in the abdominal cavity and chest, causing abdominal swelling and shortness of breath. This accumulation of fluid can deplete blood volume and lower blood pressure. Severe cases require emergency treatment. Younger women and those who have polycystic ovary syndrome have a higher risk of developing OHSS than do other women. Bleeding or infection. As with any invasive procedure, there is a risk of bleeding or infection with assisted reproductive technology. Low birth weight. The greatest risk factor for low birth weight is a multiple pregnancy. In single live births, there may be a greater chance of low birth weight associated with ART. Birth defects. There is some concern about the possible relationship between ART and birth defects. More research is necessary to confirm this possible connection. Weigh this factor if you're considering whether to take advantage of this treatment. ART is the most successful fertility-enhancing therapy to date
- #37 Exercise moderately. Regular exercise is important, but if you're exercising so intensely that your periods are infrequent or absent, your fertility may be impaired. Avoid weight extremes. Being overweight or underweight can affect your hormone production and cause infertility. Avoid alcohol, tobacco and street drugs. These substances may impair your ability to conceive and have a healthy pregnancy. Don't drink alcohol or smoke tobacco. Avoid illegal drugs such as marijuana and cocaine. Limit caffeine. Women trying to get pregnant may want to limit caffeine intake to no more than 250 milligrams of caffeine a day (one or two cups of coffee). Limit medications. The use of both prescription and nonprescription drugs can decrease your chance of getting pregnant or keeping a pregnancy. Talk with your doctor about any medications you take regularly.
- #38 Coping with infertility can be difficult. It's an issue of the unknown — you can't predict how long it will last or what the outcome will be. Infertility isn't necessarily solved with hard work. The emotional burden on a couple is considerable, and plans for coping can help. Planning for emotional turmoil Set limits. Decide in advance how many and what kind of procedures are emotionally and financially acceptable for you and your partner and attempt to determine a final limit. Fertility treatments may be expensive and often not covered by insurance companies, and a successful pregnancy often depends on repeated attempts. Some couples become so focused on treatment that they continue with fertility procedures until they are emotionally and financially drained. Consider other options. Determine alternatives — adoption, donor sperm or egg, or even having no children — as early as possible in the fertility process. This can reduce anxiety during treatments and feelings of hopelessness if conception doesn't occur Talk about your feelings. Locate support groups or counseling services for help before and after treatment to help endure the process and ease the grief should treatment fail. Managing emotional stress during treatment Acupuncture. This ancient therapy may benefit some couples who are undergoing fertility treatment. Although it's not clear exactly how acupuncture may improve fertility, it's thought that acupuncture reduces stress. Practice relaxation. Cognitive behavior therapy, which uses methods that include relaxation training and stress management, has been associated with higher pregnancy rates. Express yourself. Reach out to others rather than repressing guilt or anger. Stay in touch with loved ones. Talking to your partner, family and friends can be very beneficial. The best support often comes from loved ones and those closest to you. Managing emotional effects of the outcome Failure. The emotional stress of failure can be devastating even on the most loving and affectionate relationships and for people who've prepared well for the possibility of failure. Don't hesitate to seek professional help if the emotional burdens become too heavy for you or your partner. Success. Some studies have indicated that even if fertility treatment is successful, women experience increased stress and fear of failure during pregnancy. Other research suggests that women who achieved pregnancy using fertility treatments felt increasingly better and had higher self-esteem and less anxiety as the pregnancy progressed than did women whose pregnancies didn't involve medical intervention. Multiple births. A successful pregnancy that results in multiple births introduces new complexities and emotional problems. The risk of depression is higher in women who have multiple births. Parenting. Once a child arrives, parents are more likely to be more anxious and have less confidence and self-esteem. Discuss becoming parents with your partner and plan for the many changes — challenging and rewarding — that a child will bring to your lives.