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IN THE NAME OF GOD

IN THE NAME OF GOD. Female Infertility. Definition. Infertility is one year of unprotected coitus without conception The term "primary infertility" is applied to the couple who has never achieved a pregnancy "secondary infertility" implies that at least one previous conception has taken place.

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IN THE NAME OF GOD

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  1. IN THE NAME OF GOD

  2. Female Infertility

  3. Definition • Infertility is one year of unprotected coitus without conception • The term "primary infertility" is applied to the couple who has never achieved a pregnancy • "secondary infertility" implies that at least one previous conception has taken place

  4. Infertility • In order for a woman to become pregnant: • Egg must be released from one of her ovaries (ovulation) • Egg must go through the fallopian tube toward the uterus • Sperm must join with the egg in the fallopian tube (fertilization) • Fertilized egg must attach to the uterine wall (implantation) • Infertility can result from problems that interfere with any of these steps.

  5. You’re not alone. • About 12% of women (7.3 million) in the United States aged 15-44 had difficulty getting pregnant or carrying a baby to term in 2002. • Ten to 15% of couples in the U.S. are infertile.

  6. When should you go 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. • Women with the following issues should speak to their doctors: • irregular periods or no menstrual periods • very painful periods • Endometriosis • pelvic inflammatory disease • more than one miscarriage

  7. What Increases the Risks? • Age • Stress • Poor diet • Smoking • Alcohol • STDs • Overweight • Underweight • Caffeine intake • Too much exercise

  8. The Age Factor • A woman'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.

  9. The Age Factor • 20% of women in 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

  10. Major Causes

  11. Common Causes of Infertility • Severe endometriosis • Pelvic Inflammatory Disease (PID) • Ovulation disorders • Elevated prolactin • Polycystic ovary syndrome (PCOS) • Early menopause • Benign uterine fibroids • Pelvic adhesions

  12. Physical Obstructions • Endometriosis • Pelvic Inflammatory Disease • Uterine Fibroids • Pelvic Adhesions • Ovarian Failure

  13. First visit • Have both come to all visits!! • Get a complete history • Sexual history!! • Educate!!

  14. Manly Questions • Infertility duration • Prior fertility in relationship(s) • Medical & surgical history • Meds (anabolic steroids, cancer chemotherapy, sulfasalazine, nitrofurantoin) • Alcohol, drugs, pot • Occupational exposures • Sexual dysfunction • Tight fitting underwear/pants • Previous testing

  15. Womanly Questions • Infertility duration • Detailed menstrual history • Prior pregnancies • Fertility in other relationships • IUD’s, OCP’s, Depo • Frequency of intercourse/sexual dysfunction

  16. Womanly Questions • Gynecologic history (PID, endometriosis, fibroids, cervical dysplasia) • DES exposure • Medical and surgical history • Medications • Previous tests and therapy

  17. DRUGS • Cause hyperprolactinemia: • Neuroleptic, antidepressant, and hypotensive drugs and drugs for gastrointestinal symptoms • Recreational drugs such as marijuana and cocaine • Spontaneous galactorrhoea must be ascertained and further investigated for suspected hyperprolactinemia

  18. Endometriosis • Occurs when the uterine 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

  19. PID • Pelvic inflammatory disease (PID) is a spectrum of infections of the female genital tract that includes endometritis, salpingitis, tuboovarian abscess, and peritonitis.

  20. Uterine Fibroids and Pelvic 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.

  21. Ovarian failure • Ovarian failure can 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.

  22. Hormonal Obstructions • Ovulation disorders • Elevated prolactin • Polycystic ovary syndrome • Early menopause

  23. Ovulation disorders • Disruption in the 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.

  24. Elevated prolactin • Also called hyperprolactinemia • Can cause irregular or no ovulation • Irregular periods • May cause galactorrehea, milk production when not pregnant

  25. Polycystic ovary syndrome (PCOS) Produces too much androgen hormone (male hormones) Causes an irregular or no menstrual cycle PCOS

  26. TESTS • Thyroid • Midcycle progesterone level &/or luteal phase progesterone level • FSH/ LH • Cortisol • Hystersalpingogram • Laporoscopy • Postcoital Test

  27. Education • BBT’s/menstrual calendar • Clomiphene • Pergonal • Artificial insemination • IVF

  28. 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.

  29. Complications • Multiple pregnancy • Ovarian hyperstimulation syndrome (OHSS) • Ovaries may enlarge and cause pain and bloating • Higher risk in PCOS women • Bleeding or infection • Low birth weight • Birth defects

  30. Ways to Battle Infertility • Regular exercise • Avoid alcohol, tobacco, and narcotics • Limit caffeine • No more than 250 mg per day • Limit medications • Eat a balanced diet

  31. Coping with Infertility • Consider other options • Adoption, donor sperm or egg • Talk about your feelings • To each other • Support groups • Counseling services

  32. Coping with Infertility • Acupuncture • Practice relaxation • Stay in touch with loved ones

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