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The McCoughey Septuplets

Explore the various causes, diagnostic methods, and treatment options for female infertility, including male and tubal factors, ovulation problems, and unexplained cases. Learn about tests like semen analysis, Hysterosalpingogram, IUI, and IVF to help patients on their fertility journey.

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The McCoughey Septuplets

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  1. The McCoughey Septuplets

  2. Infertility 101 Definitions Under 35 yo No conception after one year of unprotected intercourse Over 35 yo No conception after 6 months of unprotected intercourse

  3. Your Infertility Patient. . . 34 yo woman presents to your clinic to discuss her concerns about infertility

  4. Psychosocial Issues • Expectations • Stress on Relationships • Stress on Finances • Alternatives- Adoption or Childless • Counseling, Support Groups

  5. Etiologies • Male Factor 40% • Tubal Factor 40% • Ovulation Problem 10% • Unexplained 10%

  6. Start with History. . .What Clues Can You Find on History? • Male Factor • Tubal Factor • Ovulation

  7. Semen Analysis Normal values: Volume 2-5cc Count >20 million Motility >50% Morphology >50% normal (strict criteria >15%)

  8. Male Factor Infertility Evaluation: Repeat semen analysis Physical exam- varicocele, testicular size Lab testing- testosterone, FSH, LH Genetics for special cases IUI (intrauterine insemination) ICSI (intracytoplasmic sperm injection) Donor sperm

  9. Etiologies • Male Factor 40% • Tubal Factor 40% • Ovulation Problem 10% • Unexplained 10%

  10. Hysterosalpingogram

  11. HSG: Unilateral Blocked Tube

  12. HSG: Tubal Infertility

  13. HSG: Hydrosalpinx

  14. HSG of DES daughter

  15. Etiologies • Male Factor 40% • Tubal Factor 40% • Ovulation Problem 10% • Unexplained 10%

  16. Ovulation Physiology • The LH (lutenizing hormone) surge occurs 34-36 hours prior to follicle rupture • Progesterone is increasingly produced after the LH surge • Secretory changes to the endometrium occur secondary to the increased progesterone levels

  17. Ovulation Predictor Kits

  18. Salivary Estrogen: TCI Ovulation Tester- 92% accurate

  19. Add Saliva Sample

  20. Non-Ovulatory Saliva Pattern

  21. High Estrogen/ Ovulatory Saliva Pattern

  22. Approach to Ovulation Disorders • Evaluate- Hypothyroidism Prolactin Disorder Hyperandrogenism- PCOS Weight loss/ weight gain • Induce Ovulation Clomid (clomiphene citrate)

  23. Traditional Infertility Evaluation • Semen Analysis • Hysterosalpingogram (HSG) • Documentation of Ovulation • Post-coital Exam • Diagnostic Laparoscopy

  24. Current Infertility Evalution • Semen Analysis • Hysterosalpingogram (HSG) • Documentation of Ovulation 4) Ovarian Reserve Testing

  25. Ovarian Reserve Testing Day #3 FSH (<10 mIU/ml) and estradiol (<80 pg/ml) -Correlates with the functional status of the ovaries and the quality of the oocytes - FSH >15 only 5% success with IVF - High estradiol level increases risk of cancelling IVF cycle

  26. Unexplained Infertility • 12-15% of couples • 3% chance of achieving a pregnancy • Treatment: Superovulate with IUI (intrauterine insemination)- Clomid 12% success Pergonal 16% IVF

  27. Infertility?

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