Infertility and IVF Lecture Notes

Introduction

  • Special guest: Professor Shenling Tan
  • Full professor of Obstetrics and Gynecology at McGill University
  • Medical Director at Originale Fertility Clinic and Women’s Health Centers (Montreal & Ottawa)

Importance of Studying Infertility and IVF

  • Current global decline in fertility compared to historical trends (previous famine & birth control issues)
  • Need to understand the causes, treatments, and medicines involved in infertility

Causes of Infertility

Female Infertility

  • Female Factors: (1/3) of infertility cases
    • Lack of eggs, irregularizations, fallopian tube issues
    • Ovulation disorders or endometriosis

Male Infertility

  • Male Factors: (1/3) of infertility cases
    • Low sperm count, poor motility, or abnormal shapes
  • Unexplained infertility is common; emphasis on the couple's involvement in treatments

Understanding Total Fertility Rate

  • Definition: average number of children per couple; replacement rate is 2.1
  • Canada has been below replacement rate since 1966, mainly due to contraception, leading to a reliance on immigration for population increase

Physiological Processes in Conception

  • Basic Reproductive Concepts: Good-quality sperm, eggs, and womb are essentials
  • Journey of sperm from vagina to egg is challenging; aids in producing fertility treatments
  • Men's Sperm Journey: Hundreds of millions of sperm are required for successful fertilization

Treatment Strategies for Infertility

Treatments Available

  1. Artificial Insemination: Places sperm closer to egg
  2. In-Vitro Fertilization (IVF): Direct fertilization in laboratory, increasing chances of success
  3. Medications: Various hormonal medications to stimulate egg growth and ovulation
    • Clomiphene Citrate: For stimulating ovulation but can have side effects
    • Letrozole: Newer alternative for inducing ovulation
    • Injectable Gonadotropins: Used in IVF to stimulate multiple egg production

Medications and Their Mechanisms

  • Explanation of how ovulation induction medications work
  • Understanding the use of hormones to help women release more eggs
  • Risks associated with ovulation-stimulating drugs (twins or triplets)

Polycystic Ovarian Syndrome (PCOS)

  • Most common hormonal disorder in women; defined by specific criteria
  • Metformin is the first line treatment to address insulin resistance in PCOS patients

Menstrual Cycle Overview

  • Three phases: proliferative, ovulatory, and luteal phases
  • Importance of regular menstrual cycle as an indicator of ovulation

Sperm Analysis and Factors Affecting Fertility

  • Importance of accurate sperm testing and guidelines outlined by WHO
  • Low sperm count defined as fewer than 20 million sperm per milliliter
  • Variance in sperm counts over different testing times

Ovarian Reserve Measurement

  • Ovarian Reserve: Determined by factors like age, FSH levels, and AMH levels
  • Ultra-sound measurement of follicles is a crucial diagnostic tool

Factors Affecting Ovarian Reserve

  • Age leads to a natural reduction in egg quality and quantity over time
  • Discussion on conditions like hypogonadotropic hypogonadism and ovarian disorders

IVF Journey

  • Stages of IVF: stimulation, egg retrieval, fertilization, and embryo transfer
  • Genetic testing of embryos before implantation

Egg Freezing Recommendations

  • Advocates for egg freezing as an insurance policy for future fertility
  • Discussion on methods and costs associated with egg freezing

Conclusion

  • Eggs can be frozen and stored for many years, allowing women more flexibility in family planning
  • Recognizes that society's view of family size and timing is changing, impacting fertility decisions
  • Emphasizes the need for egg freezing as a proactive choice for younger women

Email Contact for Questions

  • Professor Tan provided contact information for additional queries regarding the lecture.