Infertility and Assisted Reproductive Technology

What is fertility

The ability to conceive and bear children → Production of offspring

What is fecundity

Physical capability to produce reproductive potential

What is the difference between infertility and sterility

Infertility = lack of fertility; sterility = lack of fecundity

Crude birth rate formula

Number of live births per 1000 people alive

General fertility rate

Number of births in a year divided by number of women aged 15-44 times 1000

How does female fertility change with age

Declines with age and is infertile around 51

How does male fertility change with age

Declines but doesn’t reach zero → Mature sperm still exists but gets less with age

What are the causes of infertility

Male = female; sperm problem, endometriosis, tubal damage, ovulatory failure, idiopathic

After LH is released when does ovulation occur

40 hours after LH surge

What can be female causes of infertility

Ovarian failure, luteinized follicle syndrome, insufficient luteal phase, blocked fallopian tube, cervical factors, uterine malformation, endometrial problem

What is cause of male infertility

Varicocele 37%, idiopathic 25%, remaining is problem with testicle, semen or obstruction, cryptorchidism

What is evaluated in a semen sample

Concentration, motility, vitality and morphology of sperm + leukocyte presence

What is asthenospermia

Poor motility

What is teratozoospermia

Poor morphology

What is oligozoospermia

Low concentration of sperm

What is necrospermia

Many dead sperm cell

What are the indication for IUI

Cervical factor, male factor chronic anovulation, immunologic disorder, endometriosis, idiopathic infertility

How is sperm prepared in IUI and IVF

Sperm liquefaction → Gradient prep → Centrifugation → Collection of top part containing sperm

How is IUI done

Injection of prepared sperm directly into the uterus via a needle

How is ovulation stimulated for IUI

Give clomiphene citrate → grow follicle to 18 mm

Indication for IVF

Partial or complete tubal obliteration, chronic anovulation, male factor, immunologic disorder, endometriosis, idiopathic infertility

What are the indication for ICSI

Sperm count is low and abnormal morphology after prep

What are the indication for MESA

Obstructive azoospermia

What are the indication for TESE

Unobstructive azoospermia

How is IVF done

Collect oocyte → assess → Inseminate oocyte → Fertilization assessment → Embryo culture (4 cell → 8 → blastocyst stage at 120h) → Transfer

How is ICSI done

Collect oocyte → assess → Inject sperm → Fertilization assessment → Embryo culture (4 cell → 8 → blastocyst stage at 120h) → Transfer

What is ovarian hyperstimulation syndrome (OHSS)

High hormones lead to ovarian swelling → can cause clots and serious complication

What is the complication of ART

OHSS, multiple pregnancy, ovarian cancer (in theory), genetic defect transfer

What is IVM

In vitro maturation → Culture ovarian follicle to PREVENT OHSS

What is IVC

In vitro culture → Culture embryo in blastocyst stage to PREVENT multiple pregnancy