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Human Reproduction Development and Ageing - Week 11 Guest Lecture Notes

Topic = Assistive Reprocutive Technology

Concept of Infertility

  • Establishment: 1982

  • Speaker: Dr. Hamish Barblett

Overview of Infertility

  • Defining ‘Infertility’:

    • Infertility is a disease of the male or female reproductive system.

    • Specifically defined as the failure to achieve a pregnancy after 12 months or more of regular unprotected sexual intercourse.

  • Prevalence:

    • Globally, approximately 48.5 million couples experience infertility.

    • In Australia, about 1 in 6 couples of reproductive age will face infertility issues.

Global Fertility Trends

  • Decline in Total Fertility Rate:

    • The global total fertility rate has more than halved over the last 70 years.

    • Particularly prevalent in developed countries, though it affects all countries worldwide.

  • Contributing Factors:

    • Majorly attributed to social and economic factors, primarily the age of females.

    • Significant associations with endocrine-disrupting chemicals and environmental pollutants, including:

      • Bisphenols

      • BPAs (Bisphenol A)

      • Phthalates

      • Pesticides

      • Herbicides

      • Insecticides

      • Heavy Metals

      • Parabens

      • PFAS

    • These pollutants affect oocyte and sperm quality and are linked with declining fertility and fecundity (the ability to conceive).

Causes of Infertility

  • Distribution of Causes:

    • Female Factor: 30%

    • Male Factor: 30%

    • Mixed Causes: 20%

    • Unexplained: 20%

Female Factor Contributing to Infertility

  • Key Aspects:

    • Age: Born with a finite ovarian reserve (1-2 million eggs at birth, 400,000 at puberty, approximately 0 at menopause).

    • Lifestyle Factors: Includes smoking, alcohol consumption, diet, and exercise.

    • Environmental Factors: Exposure to various toxins and pollutants.

    • Medical Conditions: Presence of certain health issues that may affect fertility.

    • Unexplained Causes: Some cases remain without a clear diagnosis.

Diagnostic Tests for Female Factor Infertility

  • Components of Diagnosis:

    • Patient History: Comprehensive medical and reproductive history.

    • Blood Tests: Hormonal assessments and other relevant indicators.

    • Tracking Cycle: Monitoring menstrual cycles and ovulation.

    • Ultrasound: Imaging to check for follicular development and other abnormalities.

    • Hysterosalpingogram (HyCoSy): Examination of uterine cavity and fallopian tubes via radiographic imaging.

    • Laparoscopy: Minimally invasive surgical procedure to visualize internal organs.

    • Hysteroscopy: Direct visualization of the interior of the uterus.

Ovulation Cycle & Disorders

  • Factors Affecting Ovulation:

    • Psychological or Physical Stress: Can disrupt hormonal balance.

    • Weight: Both underweight and obesity can impact fertility.

    • Exercise: Excessive or intense physical activities may lead to ovulatory dysfunction.

    • Diet & Nutrition: Poor dietary choices and nutritional deficiencies can affect fertility.

    • Medical Conditions: E.g., endometriosis or chronic illnesses that can interfere with normal ovulation.

    • Hormonal Imbalances: Conditions such as Polycystic Ovary Syndrome (PCOS).

Polycystic Ovarian Syndrome (PCOS)

  • Prevalence: Affects up to 25% of women of reproductive age.

  • Symptoms: Menstrual cycle irregularities and ovulation difficulties.

  • Diagnosis Criteria: A woman must exhibit two of the following three characteristics to be diagnosed with PCOS:

    • Irregular or absent periods.

    • High levels of male hormones (androgens).

    • Polycystic ovaries visible on ultrasound.

Treatment Options for Female Factors

  • Medications:

    • Drugs used include:

      • GnRH agonists

      • Progestogens

      • Androgenic steroids

      • Oral contraceptive pills (OCP)

  • Surgical Options:

    • Procedures such as Laparoscopy or Laparotomy for endometriosis or other physical abnormalities.

  • In Vitro Fertilisation (IVF):

    • A method used for treating infertility rather than addressing the condition directly.

Male Factor in Infertility

  • Common Causes:

    • Age: Older males may face decreased fertility.

    • Lifestyle: Includes factors such as smoking and alcohol.

    • Medical History: Includes previous testicular trauma or vasectomy.

    • Disorders: Hormonal imbalances or genetic abnormalities.

    • Environmental Factors: Exposure to toxins or pollutants.

    • Varicocele: A condition involving swollen veins in the scrotum.

    • STIs: Sexually transmitted infections that can affect fertility.

  • Semen Analysis Parameters:

    • Volume

    • Motility: The ability of sperm to move.

    • Concentration: The number of sperm per milliliter.

    • DNA Fragmentation: Integrity of the sperm genetic material.

    • Morphology: Shape and structure of the sperm.

    • Vitality: Measure of living sperm in a sample.

Treatment Options for Male Infertility

  • Cycle Tracking and Timed Intercourse: Adjusting the timing of intercourse to the woman’s ovulation cycle.

  • Ovulation Induction: Pharmacological assistance for ovulation.

  • Intrauterine Insemination (IUI): A less invasive method involving the placement of washed sperm into the uterus.

Semen Preparation for IUI

  • Process:

    • Washing of seminal plasma to eliminate non-viable sperm.

    • Selection of normal, progressively motile sperm via:

      • Sperm density gradient centrifugation

      • Swim-up technique.

    • Approximately 20 million motile sperm are then inseminated directly into the uterus.

    • Commonly used as a first-line treatment for single women and same-sex female couples.

In-Vitro Fertilisation (IVF)

  • Indications:

    • Blocked or damaged fallopian tubes.

    • Minor issues with sperm quality.

    • Female reproductive factors such as problems with ovulation or endometriosis.

    • Unexplained infertility.

Risks Associated with IVF

  • Common Risks:

    • Bleeding

    • Reactions to fertility drugs or anesthetics

    • Ovarian Hyperstimulation Syndrome (OHSS) which can lead to complications

    • Poor outcomes including:

      • Cycle cancellations

      • Failed egg retrieval or fertilization

      • Absence of viable embryos after Preimplantation Genetic Testing (PGT).

Intracytoplasmic Sperm Injection (ICSI)

  • Procedure: A single sperm is injected directly into an egg, used primarily in cases of male factor infertility or previous unsuccessful IVF attempts.

Cryostorage and Fertility Preservation

  • Importance: Storing gametes (eggs or sperm), embryos, or tissues for potential future use.

  • Purposes:

    • Medical: Often for cancer patients (oncofertility).

    • Social: For individuals wanting to preserve fertility for future family planning.

Preimplantation Genetic Testing (PGT)

  • Types:

    • PGT-A: Chromosomal abnormalities screening.

    • PGT-SR: Structural rearrangements including inversions, translocations.

    • PGT-M: Testing for single-gene disorders.

Surrogacy and Donor Considerations

  • Options:

    • Surrogacy as a means of achieving pregnancy.

    • Use of donor gametes or embryos.

Additional Treatment Options

  • Innovative Treatments:

    • Supplements, Platelet Rich Plasma (PRP), Endometrial Scratch, Assisted Hatching, Endometrial Receptivity Assay, Non-Invasive PGT (NiPGT).

Success Rates in IVF and ART

  • Key Resource: "Your IVF Success Estimator" - a tool providing insights into success rates across Australia.

  • Funded by the Australian Government, focusing on realistic expectations of IVF success based on multiple factors.

Access and Barriers to Reproductive Technology

  • Financial, social/cultural, and legislative barriers affect accessibility to reproductive technologies.

  • Costs as a percentage of disposable income vary by country:

    • USA, Canada, Scandinavia, Japan, United Kingdom, and Australia detailed as % of annual disposable income.

Emerging Technologies in ART

  • Artificial Intelligence:

    • Utilization in embryo selection models to improve chances of successful implantation, reportedly better than human evaluations.

  • Uterine Transplants:

    • Success cases in Australia leading to births.

Careers in Assisted Reproductive Technology (ART)

  • Professions include:

    • Fertility Nurse

    • Fertility Doctor

    • Counsellor

    • Genetic Counsellor

    • Embryologist

    • Industry Representatives (Sales or Scientific/Medical Advisory)

    • General Management roles in ART organizations.