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INFERTILITY

INFERTILITY. 1. INFERTILITY. Definitions Under 35 yo No conception after one year of unprotected intercourse Over 35 yo No conception after 6 months of unprotected intercourse. Psychosocial Issues. Expectations Stress on Relationships Stress on Finances

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INFERTILITY

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  1. INFERTILITY 1

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

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

  4. Male Infertility • History- reproductive, sexual, medical, surgical, family, infectious, toxic, pharmacologic, childhood, traumatic • Exam- weight, height, body hair, thyroid, cardiac, lungs, abdomen, genitalia, testes, prostate, neurologic • Testing- Two semen analysis, gonadotropins, ASA, WBC’s, SPA, SCSA, ultrasound, genetics

  5. HISTORY • TOXINS, DRUGS, SMOKING, ALCOHOL • PRIOR SURGERY • INFECTIONS

  6. Evaluation: Repeat semen analysis Physical exam- varicocele, testicular size Lab testing- testosterone, FSH, LH Genetics for special cases ICSI (intracytoplasmic sperm injection) Donor sperm

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

  8. COMMON DIAGNOSIS Varicocele

  9. Treatment: Surgical • Varicocele Ligation

  10. Vasal Obstruction

  11. Treatment: Surgical • Ejaculatory duct resection

  12. Other Common Diagnoses • Genetic • Y Deletions • Klinefelters • Translocations • Cystic Fibrosis

  13. Treatment: Surgical • Vasal reconstruction

  14. IN-VITRO FERTILIZATION

  15. Treatment: Surgical • Sperm retrieval, • Intracytoplasmicsperm injection

  16. Unexplained Infertility • 12-15% of couples • 3% chance of achieving a pregnancy • Treatment: Superovulate with IUI (intrauterine insemination)- Clomid12% success Pergonal16% IVF

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