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Infertility

Dr Angelo Smith MD WHPL. Infertility. Definition. Failure of a couple to conceive after 1 year of regular intercourse without use of contraception Primary infertility – No prior pregnancies Secondary infertility – Prior pregnancy. Prevalence.

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Infertility

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  1. Dr Angelo Smith MD WHPL Infertility

  2. Definition • Failure of a couple to conceive after 1 year of regular intercourse without use of contraception • Primary infertility – No prior pregnancies • Secondary infertility – Prior pregnancy

  3. Prevalence • Infertility affects 10-15% of reproductive-age couples in the world. • Approx. 85% of couples achieve pregnancy within 1 year • Conception rate (fecundability) • 25% conceive within 1 mo. • 60% conceive within 6 mo.’s • 75% conceive within 9 mo.’s • 90% conceive within 18 mo.’s

  4. Etiology Successful conception requires a specific series of events: • Ovulation of competent oocyte • Production of competent sperm • Juxtaposition of sperm and oocyte in a patent reproductive tract • Fertilization • Generation of a viable embryo • Transport of the embryo to the uterine cavity • Implantation of the embryo into the endometrium

  5. Etiology • Major causes of of infertility: • Female factor – 60% • Ovulatory dysfunction • Abnormalities of female reproductive tract • Peritoneal factors • Reproductive aging • Male factor – 20% • Abnormal semen quality • Abnormalities of male reproductive tract • Idiopathic – 15% Infertility in ~ 20-40% of couples has multiple causes

  6. Infertility: History • Female • Duration of infertility and prior evaluation or therapy • Menstrual cycle (length and characteristics) • Symptoms associated with ovulation (e.g. breast tenderness, bloating, mood changes) • Full OBHx and GynHx • Prior pregnancies, surgeries, or STD’s • Sexual history (frequency of intercourse) • Chronic medical illness • Family history (infertility, birth defects, genetic disorders) • Social history (smoking, EtOH, drugs)

  7. Infertility: History • Male • Prior children • Genital tract infections • Genital surgery or trauma • Chronic medical illness • Medications (e.g. Furantoins, CCB) • EtOH, drugs, or smoking • Sexual history (frequency of intercourse)

  8. Infertility: Physical Exam • Female • Height, weight , BMI • Pelvic exam • Masses • Tenderness (Adnexa, Cul-de-sac) • Structural abnormalities (Vagina, Cervix, or Uterus) • Male • Evidence of androgen deficiency • Structural defects (e.g. varicocele, hernia)

  9. Male factor: Evaluation

  10. Male factor: Evaluation • Semen analysis • Following 2-4 day period of abstinence • Repeated x1 for accuracy

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