Infertility

Define infertility

Is a disease of the male or female reproductive system defined by failure to achieve pregnancy after 12 months or more of regular unprotected sexual intercourse

Approximately how many couples globally experience infertility?

48.5 million couples

Approximetely how common is infertility among Australian couples of reproductive age

About 1 in 6 Australian couples of reproductive age experience infertility.

What proportion of infertility is attributed to male / female / /unexplained / both factors

30% - male
30%. female
20% - mixed

20% - unexplained

What major age-related factor contributes to female infertility?

Females are born with a finite ovarian reserve, which declines over time.1-2 million eggs at birth, 400,000 at puberty, and approx 0 at menopause

What other categories of factors can contribute to female infertility?

Smoking, alcohol, diet, and excercise

What factors can disrupt the ovulation cycle?

Psychological and physical stress
Weight (underweight or obesity)
Excessive/intense exercise
Poor diet-nutrition
some medical conditions and medications
hormonal imbalances, such as PCOS

What does PCOS affect

Ovulation and menstrual cycle regularity, affects up to 25% of women.

Endometriosis

A condition where endometrial tissue grows outside of the uterine cavity affects around 10% of women

Treatment options for endometriosis?

Drugs such as GnRH agonists, progestogens, androgenic steroids, and OCPs aas well as surgery such as laparoscopy, or laparotomy.

What investigations can be used to assess female infertility

patient history, blood tests, cycle tracking, ultrasound, laparoscopy, hysteroscopy.
cycle tracking might be used to assess the reproductive cycle and ovulation including through blood tests and ultrasounds

What factors contribute to male infertility

Age, Lifestyle, testicular trauma, previous vasectomy, ejaculatory disorders, hormonal disorders, genetic factors, STI

What is the major investigation listed for male infertility?

Semen analysis, → Volume, motility, concentration, DNA fragmentation

What Assisted reproductive technologies (ART)/ treatment options are available?

Cycle tracking/timed intercourse
Ovulation induction (OI)
Ina uterine insemination (IUI)
In vitro fertilisation (IVF)

Intracytoplasmic sperm injection (ICSI)
Frozen embryo transfer

Gamete cyropreservation
Preimplantation genetic testing (PGT)

What happens during cycle tracking and ovulation induction?

The cycle is tracked using blood tests and ultrasounds, the cycle may be regulated and ovulation induced using hormonal injections, and intercourse is timed around ovulation

What happens during IUI?

Seminal plasma is removed, sperm are selected for normal progressive motility, prepared and the approx 20 million motile washed sperm are inseminated directly into the uterus. Single women and same-sex female couples often use this.

What happens during IVF?

Involves fertilisation as part of an assisted laboratory process, usually used in situations of broken fallopian tubes, minor sperm problems, females factors, unexplained fertility.

What happens during ICSI?

Involves direct injection of sperm into an egg.

What can be stored through cryopreservation?

Gametes (eggs or sperm) embryos or tissue for potential future use. Done because of medical purposes, such as oncofertility and social reasons, such as preserving fertility for the future.

What types of abnormalities can PGT assess according to the lecture?

PGT-M: single-gene/monogenic disorders
PGT-SR: Structural rearrangements such as inversions, translocations, duplications, or deletions.
PGT-A: whole chromosome abnormalities

What are some potential benefits of Assisted Reproductive technology (ART)

provides options for people experiencing infertility and can allow conception where natural conception may be difficult. Different technologies can address different causes or circumstances of infertility.

Potential risks of IVF specifically identified

Bleeding, reactions to fertility drugs or anaesthetics, OHSS (ovarian hyperstimulation syndrome) - possible outcomes include cycle cancellation, failed egg collection, failed/poor fertilisation and/or embryo development or no normal embryos after PGT

One major limitation of ART

Does not guarantee success; cycles can be cancelled, egg collection can fail, fertilisation or embryo development can be unsuccessful, and PGT may identify no normal embryos