1 / 41

Investigations to evaluate Infertility

Investigations to evaluate Infertility. Dr Atin Singhai Assistant Professor Department of Pathology KGMU, Lucknow. Background. Definition: 1 yr unprotected coitus without conception 10-15% couples affected Etiology Couples: 35% Tubal and pelvic pathology 35 % Male problems

kisha
Download Presentation

Investigations to evaluate Infertility

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Investigations to evaluate Infertility Dr Atin Singhai Assistant Professor Department of Pathology KGMU, Lucknow

  2. Background • Definition: • 1 yr unprotected coitus without conception • 10-15% couples affected • Etiology • Couples: • 35% Tubal and pelvic pathology • 35 % Male problems • 15% Ovulatory dysfunction • 10% Unexplained • 5% unusual causes

  3. Background • Etiology • Women: • 40% Tubal and pelvic pathology • 40% Ovulatory dysfunction • 10% Unexplained Infertility • 10% Unusual causes • Normal couple: • 25-30% chance of pregnancy per ovulatory cycle • Fertility decreases with age

  4. Infertility Time of Exposure% Pregnant 3 months 60% 6 months 70% 1 year 85% 18 months 90%

  5. Approach to Infertility • DDX • Tests/Inv • Dx • Rx

  6. Approach to Infertility • Production • Storage • Delivery

  7. Male Infertility 1. Production: • Hypothalamus • Anterior Pituitary • Testes

  8. Hypothalamic-Pituitary-Gonadal Axis

  9. Male Infertility • 1. Production • Hypothalamus • Congenital abnormalities of hypothalamus • e.g. Kallman’s syndrome • Starvation, stress or severe illness • Tumors (craniopharyngioma, metastatic tumor) • Head injury • Inflammation (sarcoidosis) • Infection (tuberculosis) • Drugs: marijuana

  10. Male Infertility • 1. Production: • Pituitary • Endocrine: thyroid, prolactin • Tumors • Inflammation: sarcoidosis, meningitis • Infiltration • Infarction • Trauma/XRT • Drugs: anabolic steroids

  11. Male Infertility • Production: • Testes: • Congenital: Klinefelters (XYY), developmental disorders • Disorders of gonadal steroidgenesis • Infection: chlamydia, prostatitis, mumps orchitis • Autoimmune • Cryptorchidism • Tumors; chemo/XRT • Drugs / alcohol • Vascular: testicular torsion

  12. Male Infertility • 2. Storage: • Temperature • Rise in scrotal temperature • Occupation • Varicocoele

  13. Male Infertility • 3. Delivery: • Impotence/Ejaculation • Neurogenic: medications (α-blockers, methyldopa) • Endocrine: diabetes • Congenital: absence vas deferens (CF) • Genetic: cystic fibrosis • Primary ciliary dyskinesia: Kartagener syndrome • Hypospadia • Vasectomy

  14. Male Infertility • History: • Previous children • Infections: prostatitis, STD, mumps orchitis • Trauma to head or testicles • Surgery to testicles or hernia • Occupation (sitting, bio hazards) • Chemo or Radio therapy • Ethanol or Smoking • Medication • Medical history (DM, HTN) • Previous investigations

  15. Male Infertility • Physical • Anatomy (meatus) • Testicular size • Varicocele (valsalva) • Rectal exam (protatitis, discharge)

  16. Male Infertility • Investigations: • semen analysis • Abstain 2-4 days prior • At least 2 samples over different period of time • If abnormal: • Blood work: FSH, LH, TSH, testosterone, PRL • Testicular U/S • Chromosomal analysis

  17. Male Infertility • Semen analysis: • WHO (1992) • Volume > 2.0 mL • Sperm > 20 million/mL • Motility > 50% forward progression or > 25% rapid progression within 60 min • Morphology > 30% normal forms • WBC < 1 million/mL

  18. Male Infertility • Tx / Interventions: • Treat underlying causes • Intrauterine Insemination (IUI) • Intracytoplasmic Sperm Injection (ICSI)

  19. Female Infertility • Fecundability: probability of achieving a pregnancy within 1 menstrual cycle (25%) • Fecundity: ability to achieve a live birth within 1 menstrual cycle (6%)

  20. Female Infertility • Production • Storage • Delivery

  21. Female Fertility • Production: • Hypothalamus • Pituitary • Ovary

  22. Hypothalamic-Pituitary-Gonadal Axis

  23. Female Infertility • Hypothalamus: • Stress • Exercise • Eating disorders • Psychogenic • Congenital/genetic: Kallman’s syndrome (hyposmia & hypoplasia olfactory lobes of brain) • Starvation/stress or severe illness • Tumors (craniopharyngioma, metastatic tumor) • Head injury • Inflammation (sarcoidosis) • Infection (tuberculosis) • XRT • Drugs

  24. Female Infertility • Pituitary: • Sheehan syndrome • Tumors: Pituitary adenoma, metastatic • Empty sella syndrome • Inappropriate gonadal steroid feedback: • estrogen excess: obesity/ tumors • estrogen deficiency: aromatase deficiency/ ER gene mutation • androgen excess: adrenal or ovarian • PCOS • Testicular feminization (46 XY) - absenceandrogen receptors

  25. Female Infertility • Ovary • Gonadal dysgenesis - Turner’s Syndrome 45XO or mosaics 46 XX/45 XO • Testicular feminization • XRT / Chemo for childhood malignancies • Premature ovarian failure

  26. Female Infertility • Storage (R.P.L. unless severe) • Uterine abnormalities • Mullerian Agenesis: Mayer-Rokitansky-Kuster-Hauser syndrome • Leiomyoma • Luteal phase deficiency

  27. Female Infertility • Delivery: • Uterine abnormalities • Vaginal septum • Tubal Disease • Infections/ STD/PID • Ruptured appendix • Septic abortion • Endometriosis

  28. Female Infertility • History: • Age • GTPAL • Regulatory of period • Prolactin S/S • Thyroid S/S • Infections, Surgeries • Medication, Smoking, Ethanol • Medical history • Previous investigations

  29. Female Infertility • Examination: • Thyroid • Breast (milk) • Abdomen (masses, scars) • Vaginal (abnormalities) • Bimanual (Uterus, masses)

  30. Investigations • Blood work: • TSH • PRL • D3 FSH • D3 LH • Luteal phase Progesterone • Imaging: • Pelvic Ultrasound • HSG • Diagnostic • Laparoscopy (later)

  31. Treatment • Treat the underlying cause • Medical • Surgical

  32. Treatment • Anovulation: • Clomiphene induction  IUI • Gonadotropin  IUI • IVF • Bilateral tubal disease • Unexplained infertility after Gonadotropin + IUI failure. • Failure of the above • ICSI • Male factor • Unexplained infertility

  33. Take Home Points • DDx – Hx – Px – Inv - Rx • Age is important factor for female • Hypothalamic-Pituitary-Gonadal axis central in working up both male and female infertility • Investigations: • Male: Sperms • Female: Tubes (HSG) + Ovaries (FSH, LH, PRL, TSH)

  34. Multiple Choice Questions

  35. Infertility is defined as unprotected coitus for ___ months, without conception : • 3 • 6 • 9 • 12

  36. Spermatogenesis and sperm maturation is regulated by : • Leydig Cells • Sertoli Cells • Vas Deferens • Intermediate Cells

  37. Cause/s of male infertility is / are : • Kallaman’s syndrome • Craniopharyngioma • Marijuana abuse • All of the above

  38. Normal semen count is ___ million / ml • ≥ 15 • ≥ 20 • ≥ 25 • ≥ 30

  39. Indication/s for semen analysis is / are : • Investigation for infertility • to check effectiveness of vasectomy • for selection of donor for artificial insemination • All of the above

  40. Thank you

More Related