INFERTILITY

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INFERTILITY
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INFERTILITY

• Definitions
• Under 35 yo No conception after one year of
  unprotected intercourse
• Over 35 yo No conception after 6 months of
  unprotected intercourse

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Psychosocial Issues

• Expectations
• Stress on Relationships
• Stress on Finances
• Alternatives- Adoption or Childless
• Counseling, Support Groups

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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,
  WBCs, SPA, SCSA, ultrasound, genetics

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HISTORY

• TOXINS, DRUGS, SMOKING, ALCOHOL
• PRIOR SURGERY
• INFECTIONS

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

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Semen Analysis

• Normal values
• Volume 2-5cc
• Count gt20 million
• Motility gt50
• Morphology gt50 normal
• (strict criteria gt15)

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COMMON DIAGNOSIS Varicocele
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• Treatment Surgical
• Varicocele Ligation

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Vasal Obstruction
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• Treatment Surgical
• Ejaculatory duct resection

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

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• Treatment Surgical
• Vasal reconstruction

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IN-VITRO FERTILIZATION
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• Treatment Surgical
• Sperm retrieval,
• Intracytoplasmicsperm injection

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Unexplained Infertility

• 12-15 of couples
• 3 chance of achieving a pregnancy
• Treatment
• Superovulate with IUI
• (intrauterine insemination)-
• Clomid 12 success
• Pergonal 16
• IVF