Clinical evaluation of infertility

Size: px
Start display at page:

Download "Clinical evaluation of infertility"

Transcription

1 Clinical evaluation of infertility DR. FARIBA KHANIPOUYANI OBSTETRICIAN & GYNECOLOGIST PRENATOLOGIST

2 Definition: inability to achieve conception despite one year of frequent unprotected intercourse.

3 Male factor 23 percent Ovulatory dysfunction 18 percent Tubal damage 14 percent Endometriosis 9 percent Coital problems 5 percent Cervical factor 3 percent Unexplained 28 percent

4 causes of male infertility Primary hypogonadism percent Seminiferous tubule dysfunction 60 to 80 percent including microdeletions of the Y chromosome Post-testicular defects (disorders of sperm transport) 10 to 20 percent Hypothalamic pituitary disease(secondary hypogonadism) -1-2 percent

5 assessment of male factor a specific etiology or treatment can be found in only a few descriptions of observed abnormalities, such as decreased sperm number, movement, or egg penetrating and fusion capabilities Even testicular biopsies have provided little insight; they simply indicated the extent of impaired germ cell maturation. Use of molecular biology techniques has allowed definition of gene deletions and mutations in male infertility

6 components of the evaluation of male infertility history Endocrine tests Physical examination Genetic tests Semen analysis

7 History Developmental history, including testicular descent, pubertal development, loss of body hair, or decrease in shaving frequency Chronic medical illness Infections, such as mumps orchitis, sinopulmonary symptoms, sexually transmitted infections, and genitourinary tract infections including prostatitis Surgical procedures involving the inguinal and scrotal areas such as vasectomy, orchiectomy, and herniorrhaphy Drugs and environmental exposures, including alcohol, radiation therapy, anabolic steroids, cytotoxic chemotherapy, drugs that cause hyperprolactinemia, and exposure to toxic chemicals (eg, pesticides, hormonal disrupters) Sexual history, including libido, frequency of intercourse, and previous fertility assessments of the man and his partner School performance, to determine if he has a history of learning disabilities suggestive of Klinefelter's syndrome

8 PHYSICAL EXAMINATION focus on finding evidence of androgen deficiency depends upon the age of onset early gestation: as ambiguous genitalia late gestation: as micropenisi childhood: as delayed pubertal development adulthood: as decreased sexual function, infertility,and loss of secondary sex charactristics

9 General appearance Eunuchoidal proportions (upper/lower body ratio <1 with an arm span 5 cm >standing height) increased body fat and decreased muscle mass : androgen deficiency. Skin Loss of pubic, axillary, and facial hair, decreased oiliness of the skin, and fine facial wrinkling suggest long-standing androgen deficiency. External genitalia : Incomplete sexual development ( Tanner stage ) Diseases that affect sperm maturation and transport: absence of the vas, epididymal thickening, varicocele, and hernia Decreased volume of the seminiferous tubules : testicular size ( testicular volume below 15 ml and testicular length below 3.6 cm are considered small) Breasts Gynecomastia suggests a decreased androgen to estrogen ratio.

10 STANDARD SEMEN ANALYSIS Measurement of semen volume and ph Microscopy for debris and agglutination Assessment of sperm concentration, motility, and morphology Sperm leukocyte count Search for immature germ cells

11 WHO lower reference limits Volum- 1.5 ml Sperm concentration 15 million spermatozoa / ml Total sperm number 39 million spermatozoa per ejaculate Morphology 4 percent normal forms Vitality 58 percent live Progressive motility 32 percent Total(progressive & nonprogressive motility) -40 percent

12 SPECIALIZED SEMEN ANALYSIS Human zona pellucida binding test Zona-free hamster oocyte penetration test Acrosome reaction Computer-aided sperm analysis Sperm function tests Sperm-cervical mucus interaction Semen culture Semen biochemistry Sperm autoantibodies Sperm biochemistry Sperm chromatin and DNA assay

13 GENETIC TESTS CFTR gene Sex chromosome & somatic mutation Anderogen receptor

14 ENDOCRINE TESTS Serum testosterone Serum LH & FSH Others (prolactin,inhibin B)

15 azoospermia Normal LH OSTRUCTIVE AZOOSPERMIA Normal FSH Normal TESTOSTRONE

16 AZOOSPERMIA NORMAL LH NORMAL FSH OBSTRUCTIVE AZOOSPERMIA: Bilateral congenital absence of the vas NORMAL TESTOSTERONE

17 Evaluation of female infertility

18 infertility evaluation after one year in women under age 35 year after six months in women age 35 years and older sooner in women with irregular menstrual cycles or known risk factors for infertility

19 History and physical examination

20 most important points in the history Duration of infertility and results of previous evaluation and therapy Menstrual history Medical, surgical, and gynecological history Obstetrical history Sexual history Family history Personal and lifestyle history

21 Physical examination as extremes of BMI are associated with reduced fertility and abdominal obesity is associated with insulin resistance. of secondary sexual characteristics is a sign of hypogonadotropic hypogonadism. thyroid gland, galactorrhea, hirsutism, acne, male pattern baldness, virilization Tenderness or masses in the adnexae or posterior cul-de-sac ( chronic pelvic inflammatory disease or endometriosis) Vaginal/cervical structural abnormalities or discharge Uterine enlargement, irregularity, or lack of mobility( uterine anomaly, leiomyoma, endometriosis, or pelvic adhesive disease).

22 Diagnostic tests Semen analysis tests of ovarian reserve ( cycle day 3 FSH or estradiol, clomiphene citrate challenge test, AMH, or antral follicle Documentation of normal ovulatory function rule out tubal occlusion and assess the uterine cavity (HSG, laparoscopy with hysteroscopy Preconception laboratory screening

23 Assessment of the uterine cavity saline infusion sonohysterography HyCoSy three-dimensional sonography hysteroscopy hysterosalpingogr aphy

24 Karyotype male partner if there is severe oligospermia Separate testing for Y chromosome microdeletions may also be offered women with very early premature menopause (prior to age 40) both partners if there have been recurrent pregnancy losses Karyotype may be useful in patients who have failed initial treatment approaches and plan to undergo IVF

EVALUATION OF MALE AND FEMALE INFERTILITY ANDREA BARRUECO AMERICAN CENTER FOR REPRODUCTIVE MEDICINE CLEVELAND CLINIC ART TRAINING 2018

EVALUATION OF MALE AND FEMALE INFERTILITY ANDREA BARRUECO AMERICAN CENTER FOR REPRODUCTIVE MEDICINE CLEVELAND CLINIC ART TRAINING 2018 EVALUATION OF MALE AND FEMALE INFERTILITY ANDREA BARRUECO AMERICAN CENTER FOR REPRODUCTIVE MEDICINE CLEVELAND CLINIC ART TRAINING 2018 The evaluation of an infertile couple requires an understanding of

More information

Male History, Clinical Examination and Testing

Male History, Clinical Examination and Testing Male History, Clinical Examination and Testing Dirk Vanderschueren, MD, PhD Case Jan is 29 years old and consults for 1 year primary subfertility partner 28 years old and normal gynaecological investigation

More information

Infertility: failure to conceive within one year of unprotected regular sexual intercourse. Primary secondary

Infertility: failure to conceive within one year of unprotected regular sexual intercourse. Primary secondary Subfertility Infertility: failure to conceive within one year of unprotected regular sexual intercourse. Primary secondary Infertility affects about 15 % of couples. age of the female. Other factors that

More information

INFERTILITY CAUSES. Basic evaluation of the female

INFERTILITY CAUSES. Basic evaluation of the female INFERTILITY Infertility is the inability to conceive after 12 months of unprotected intercourse. There are multiple causes of infertility and a systematic way to evaluate the condition. Let s look at some

More information

What You Need to Know

What You Need to Know UW MEDICINE PATIENT EDUCATION What You Need to Know Facts about male infertility This handout explains what causes male infertility, how it is diagnosed, and possible treatments. Infertility is defined

More information

Reproductive Testing: Less is More G. Wright Bates, Jr., M.D. Professor and Director Reproductive Endocrinology and Infertility Objectives

Reproductive Testing: Less is More G. Wright Bates, Jr., M.D. Professor and Director Reproductive Endocrinology and Infertility Objectives Reproductive Testing: Less is More G. Wright Bates, Jr., M.D. Professor and Director Reproductive Endocrinology and Infertility Objectives 1. Review definition of infertility and impact of age 2. Stress

More information

Subfertility B Y A L I S O N, B E N A N D J O H N

Subfertility B Y A L I S O N, B E N A N D J O H N Subfertility B Y A L I S O N, B E N A N D J O H N Contents Definition Causes Male Female Hx & Ex Investigations Treatment Definition Failure to conceive after a year of frequent, unprotected communion.

More information

The assessment and investigation of the infertile couple

The assessment and investigation of the infertile couple The assessment and investigation of the infertile couple BIRUTE ZILAITIENE, MD, PHD, PROF., FECSM DEPARTMENT OF ENDOCRINOLOGY AND INSTITUTE OF ENDOCRINOLOGY, LITHUANIAN UNIVERSITY OF HEALTH SCIENCES, KAUNAS,

More information

Infertility for the Primary Care Provider

Infertility for the Primary Care Provider Infertility for the Primary Care Provider David A. Forstein, DO FACOOG Clinical Associate Professor Obstetrics and Gynecology University of South Carolina School of Medicine Greenville Disclosure I have

More information

Infertility DR. RAHUL BEVARA

Infertility DR. RAHUL BEVARA Infertility DR. RAHUL BEVARA Definitions Infertility is defined as the inability to conceive after one year of unprotected coitus. Affects 10-15% of couples Primary Infertility, that is inability to conceive

More information

MALE INFERTILITY & SEMEN ANALYSIS

MALE INFERTILITY & SEMEN ANALYSIS MALE INFERTILITY & SEMEN ANALYSIS DISCLOSURE Relevant relationships with commercial entities none Potential for conflicts of interest within this presentation none Steps taken to review and mitigate potential

More information

Chris Davies & Greg Handley

Chris Davies & Greg Handley Chris Davies & Greg Handley Contents Definition Epidemiology Aetiology Conditions for pregnancy Female Infertility Male Infertility Shared infertility Treatment Definition Failure of a couple to conceive

More information

5/5/2010. Infertility FINANCIAL DISCLOSURE. Infertility Definition. Objectives. Normal Human Fertility. Normal Menstrual Cycle

5/5/2010. Infertility FINANCIAL DISCLOSURE. Infertility Definition. Objectives. Normal Human Fertility. Normal Menstrual Cycle Infertility FINANCIAL DISCLOSURE I HAVE NO FINANCIAL INTEREST IN ANY OF THE PRODUCTS MENTIONED IN MY PRESENTATION Bryan K. Rone, M.D. University of Kentucky Obstetrics and Gynecology I AM RECEIVING COMPENSATION

More information

GPVTS TEACHING APRIL 2016 FERTILITY

GPVTS TEACHING APRIL 2016 FERTILITY GPVTS TEACHING APRIL 2016 FERTILITY Djavid Alleemudder - Consultant Obstetrics & Gynaecology DEFINITIONS What is the definition of infertility? Failure to conceive after 12 months despite regular, unprotected

More information

Infertility. Review and Update Clifford C. Hayslip MD Intrauterine Inseminations

Infertility. Review and Update Clifford C. Hayslip MD Intrauterine Inseminations Infertility Review and Update Clifford C. Hayslip MD Intrauterine Inseminations Beneficial effects of IUI not consistently documented in studies No deleterious effects on fertility 3-4 cycles of IUI should

More information

Test Briefing on Hormonal Disorders and Infertility

Test Briefing on Hormonal Disorders and Infertility Test Briefing on Hormonal Disorders and Infertility Test Briefing on Hormonal Disorders Common Tests FSH LH Progesterone Estradiol Prolactin Testosterone AFP AMH PCOS Panel FSH (Follicle Stimulating Hormone)

More information

Causes of Infertility and Treatment Options

Causes of Infertility and Treatment Options Causes of Infertility and Treatment Options Dr Mrs.Kiran D. Sekhar Former vice President-FOGSI Former Chairperson- Genetics and Foetal medicine-fogsi Founder and Medical Director-Kiran Infertility centre

More information

NEW PATIENT DATA SHEET Please complete as best you can. It is not necessary to have all information before speaking with a doctor. PATIENT INFORMATION

NEW PATIENT DATA SHEET Please complete as best you can. It is not necessary to have all information before speaking with a doctor. PATIENT INFORMATION NEW PATIENT DATA SHEET Please complete as best you can. It is not necessary to have all information before speaking with a doctor. PATIENT INFORMATION PATIENT NAME DOB AGE PARTNER NAME DOB AGE STREET CITY

More information

Infertility. Rhian Allen & David Rogers.

Infertility. Rhian Allen & David Rogers. Infertility Rhian Allen & David Rogers http://www.worldofsurrogacy.com Objectives Definition & Epidemiology Female Gonadal Axis Normal Menstrual Cycle Causes Patient History Patient Examination Investigations

More information

Recent Developments in Infertility Treatment

Recent Developments in Infertility Treatment Recent Developments in Infertility Treatment John T. Queenan Jr., MD Professor, Dept. Of Ob/Gyn University of Rochester Medical Center Rochester, NY Disclosures I don t have financial interest or other

More information

Infertility testing. Global infertility panel. Patient information. Informations for patients

Infertility testing. Global infertility panel. Patient information. Informations for patients Global infertility panel Infertility testing Informations for patients Patient information Each of your body cells contains your genetic information called DNA. DNA carries all the information you need

More information

DEFINITION HX & PH/EX

DEFINITION HX & PH/EX DEFINITION HX & PH/EX Because of the success of the assisted reproductive techniques (ART), the evaluation of the man is often ignored. The physician should not forget the fact that many causes of male

More information

Medical Affairs Policy

Medical Affairs Policy Medical Affairs Policy Service: Infertility and Recurrent Pregnancy Loss Testing and Treatment PUM 250-0018-1706 Medical Policy Committee Approval 06/16/17 Effective Date 10/01/17 Prior Authorization Needed

More information

to ensure the. Sexual reproduction requires the (from the mother) by a (from the father). Fertilization is the fusion of.

to ensure the. Sexual reproduction requires the (from the mother) by a (from the father). Fertilization is the fusion of. The Reproductive System Fill-In Notes Purpose of life: to ensure the. Stages of Human Development Sexual reproduction requires the (from the mother) by a (from the father). Fertilization is the fusion

More information

Infertility INA S. IRABON, MD, FPOGS, FPSRM, FPSGE OBSTETRICS AND GYNECOLOGY REPRODUCTIVE ENDOCRINOLOGY AND INFERTILITY

Infertility INA S. IRABON, MD, FPOGS, FPSRM, FPSGE OBSTETRICS AND GYNECOLOGY REPRODUCTIVE ENDOCRINOLOGY AND INFERTILITY Infertility INA S. IRABON, MD, FPOGS, FPSRM, FPSGE OBSTETRICS AND GYNECOLOGY REPRODUCTIVE ENDOCRINOLOGY AND INFERTILITY To download lecture deck Reference Comprehensive Gynecology 7 th edition, 2017 (Lobo

More information

Infertility. Dafydd Ywain & Kayleigh Hansen

Infertility. Dafydd Ywain & Kayleigh Hansen Infertility Dafydd Ywain & Kayleigh Hansen Terminology Epidemiology Aetiology Male infertility Female infertility Conclusion Content Terminology Fecundability The probability of conceiving during a single

More information

What to do about infertility?

What to do about infertility? What to do about infertility? Dr. M.A. Fischer Section Head, Division of Urology, Department of Surgery Assistant Clinical Professor, Department of Obstetrics and Gynecology Hamilton Health Sciences, Hamilton,

More information

Infertility History Form

Infertility History Form Date form completed: Infertility History Form Patient s name: _ Age: Date of Birth: Occupation: Partner s name: Age: Date of Birth: Occupation: Prior marriage: Yes No # Prior marriage: Yes No # Attempted

More information

TESTOSTERONE DEFINITION

TESTOSTERONE DEFINITION DEFINITION A hormone that is a hydroxyl steroid ketone (C19H28O2) produced especially by the testes or made synthetically and that is responsible for inducing and maintaining male secondary sex characteristics.

More information

Evaluation of the Infertile Couple

Evaluation of the Infertile Couple Overview and Definition Infertility is defined as the inability of a couple to fall pregnant after one year of unprotected intercourse. Infertility is a very common condition as in any given year about

More information

INFERTILITY EVALUATION. Dr. Rahul Bevara

INFERTILITY EVALUATION. Dr. Rahul Bevara INFERTILITY EVALUATION Dr. Rahul Bevara TUBOPERITONEAL FACTOR Causes of tubal factor infertility Distal tubal disease PID Tuberculosis Appendicitis Postabortal or puerperal sepsis Proximal tubal disease

More information

Outline. Male Reproductive System Testes and Sperm Hormonal Regulation

Outline. Male Reproductive System Testes and Sperm Hormonal Regulation Outline Male Reproductive System Testes and Sperm Hormonal Regulation Female Reproductive System Genital Tract Hormonal Levels Uterine Cycle Fertilization and Pregnancy Control of Reproduction Infertility

More information

EVALUATING THE INFERTILE PATIENT-COUPLES. Stephen Thorn, MD

EVALUATING THE INFERTILE PATIENT-COUPLES. Stephen Thorn, MD EVALUATING THE INFERTILE PATIENT-COUPLES Stephen Thorn, MD Overview The field of reproductive medicine continues to evolve rapidly by offering newer diagnostic testing and therapeutic options to improve

More information

16 East 40 th St, 2 nd Fl, New York, NY Ph fax

16 East 40 th St, 2 nd Fl, New York, NY Ph fax Page 1 of 9 16 East 40 th St, 2 nd Fl, New York, NY 10016 Ph 212-679-2289 fax 212-679-2288 Please complete the following: Fertility Evaluation Name: Date of birth: Age: Partner s Name: Date of birth: Age:

More information

FERTILITY & TCM. On line course provided by. Taught by Clara Cohen

FERTILITY & TCM. On line course provided by. Taught by Clara Cohen FERTILITY & TCM On line course provided by Taught by Clara Cohen FERTILITY & TCM FERTILITY AND TCM THE PRACTITIONER S ROLE CAUSES OF INFERTILITY RISK FACTORS OBJECTIVES UNDERSTANDING TESTS Conception in

More information

Patient Past Medical History

Patient Past Medical History Patient Past Medical History A. Identifying Data Date this form when completed Your name Partner's name Age Birth date Height Weight Length of marriage (or relationship) How long have you been trying unsuccessfully

More information

BIOCHEMICAL TESTS FOR THE INVESTIGATION OF COMMON ENDOCRINE PROBLEMS IN THE MALE

BIOCHEMICAL TESTS FOR THE INVESTIGATION OF COMMON ENDOCRINE PROBLEMS IN THE MALE Authoriser: Moya O Doherty Page 1 of 7 BIOCHEMICAL TESTS FOR THE INVESTIGATION OF COMMON ENDOCRINE PROBLEMS IN THE MALE The purpose of this protocol is to describe common tests used for the investigation

More information

Infertility F REQUENTLY A SKED Q UESTIONS. Q: Is infertility a common problem?

Infertility F REQUENTLY A SKED Q UESTIONS. Q: Is infertility a common problem? Infertility (female factors). In another one third of cases, infertility is due to the man (male factors). The remaining cases are caused by a mixture of male and female factors or by unknown factors.

More information

Neil Goodman, MD, FACE

Neil Goodman, MD, FACE Initial Workup of Infertile Couple: Female Neil Goodman, MD, FACE Professor of Medicine Voluntary Faculty University of Miami Miller School of Medicine Scope of Infertility in the United States Affects

More information

Androgens Hormones that are produced by the testes of the male and in small amounts by the ovaries and adrenal glands of the female.

Androgens Hormones that are produced by the testes of the male and in small amounts by the ovaries and adrenal glands of the female. http://www.myfertility.ca/glossary.xhtml (February 27, 2015) Glossary Acrosome This is a membrane-bound cap-like structure found at the head of the sperm. It contains enzymes that are thought to help the

More information

Index. urologic.theclinics.com. Note: Page numbers of article titles are in boldface type.

Index. urologic.theclinics.com. Note: Page numbers of article titles are in boldface type. Note: Page numbers of article titles are in boldface type. A Acquired hypogonadism, prevalence of, 165 167 primary, 165 secondary, 167 Adipose tissue, as an organ, 240 241 Adrenal hyperplasia, congenital,

More information

Male Reproductive Physiology

Male Reproductive Physiology Male Reproductive Physiology Overview Anatomy Function Endocrine and spermatogenesis Testis epididymus,vas deferens,seminal vesicles and prostate Hypothalamic pituitary testicular axis Hormones of the

More information

Male reproduction. Cross section of Human Testis ผศ.ดร.พญ.ส ว ฒณ ค ปต ว ฒ ภาคว ชาสร รว ทยา คณะแพทยศาสตร ศ ร ราชพยาบาล 1. Aims

Male reproduction. Cross section of Human Testis ผศ.ดร.พญ.ส ว ฒณ ค ปต ว ฒ ภาคว ชาสร รว ทยา คณะแพทยศาสตร ศ ร ราชพยาบาล 1. Aims Aims Male reproduction Male reproductive structure Spermatogenesis ส ว ฒณ ค ปต ว ฒ ห อง 216 โทร: 7578 Hypothalamo-pituitary-testicular axis Male sex hormone action Male reproductive structure Male reproductive

More information

Reversible Conditions Organising More Information semen analysis Male Infertility at Melbourne IVF Fertility Preservation

Reversible Conditions Organising More Information semen analysis Male Infertility at Melbourne IVF Fertility Preservation Male Infertility Understanding fertility in men Conceiving a baby depends on a number of factors, including healthy sperm. After a woman s age, this can be the biggest issue. Reproduction, although simple

More information

Infertility. Thomas Lloyd and Samera Dean

Infertility. Thomas Lloyd and Samera Dean Infertility Thomas Lloyd and Samera Dean Infertility Definition Causes Referral criteria Assisted reproductive techniques Complications Ethics What is infertility? Woman Reproductive age Has not conceived

More information

Physiology of Male Reproductive System

Physiology of Male Reproductive System Physiology of Male Reproductive System the anterior pituitary gland serves as the primary control of reproductive function at puberty Ant Pituitary secretes FSH & large amounts of LH (ICSH) FSH & LH cause

More information

Testosterone Therapy-Male Infertility

Testosterone Therapy-Male Infertility Testosterone Therapy-Male Infertility Testosterone Therapy-Male Infertility Many men are prescribed testosterone for a variety of reasons. Low testosterone levels (Low T) with no symptoms, general symptoms

More information

Reproductive System. Testes. Accessory reproductive organs. gametogenesis hormones. Reproductive tract & Glands

Reproductive System. Testes. Accessory reproductive organs. gametogenesis hormones. Reproductive tract & Glands Reproductive System Testes gametogenesis hormones Accessory reproductive organs Reproductive tract & Glands transport gametes provide nourishment for gametes Hormonal regulation in men Hypothalamus - puberty

More information

NICE fertility guidelines. Hemlata Thackare MPhil MSc MRCOG Deputy Medical Director London Women s Clinic

NICE fertility guidelines. Hemlata Thackare MPhil MSc MRCOG Deputy Medical Director London Women s Clinic NICE fertility guidelines Hemlata Thackare MPhil MSc MRCOG Deputy Medical Director London Women s Clinic About the LWC 4 centres around the UK London Cardiff Swansea Darlington The largest sperm bank in

More information

Why Reproduce? In order to ensure the continuation of the species and the continuation of life in general by producing offspring

Why Reproduce? In order to ensure the continuation of the species and the continuation of life in general by producing offspring HUMAN REPRODUCTION Why Reproduce? In order to ensure the continuation of the species and the continuation of life in general by producing offspring Asexual vs Sexual Reproduction Remember: Asexual reproduction:

More information

Animal Reproductive Systems. Chapter 42

Animal Reproductive Systems. Chapter 42 Animal Reproductive Systems Chapter 42 Impacts, Issues Male or Female? Body or Genes? Body and genes don t always match male or female characteristics also depend on hormones mutations can result in intersex

More information

What are the main functions of the male reproductive system? 1. Produce sperm 2. Deposit sperm into the female 3. Provide a pathway for the removal

What are the main functions of the male reproductive system? 1. Produce sperm 2. Deposit sperm into the female 3. Provide a pathway for the removal What are the main functions of the male reproductive system? 1. Produce sperm 2. Deposit sperm into the female 3. Provide a pathway for the removal of urine Where is sperm produced? -In the 2 testes What

More information

Cancer and Fertility Ashley Munchel, MD Assistant Professor of Pediatrics University of Maryland Medical Center

Cancer and Fertility Ashley Munchel, MD Assistant Professor of Pediatrics University of Maryland Medical Center Cancer and Fertility Ashley Munchel, MD Assistant Professor of Pediatrics University of Maryland Medical Center Trends in Pediatric Cancer Incidence Rates by Site, Ages Birth to 19 Years, 1975 to 2010.

More information

FACTSHEET FERTILITY INVESTIGATIONS

FACTSHEET FERTILITY INVESTIGATIONS FACTSHEET FERTILITY INVESTIGATIONS Most people nowadays know enough about contraception to expect a pregnancy to occur reasonably soon after contraceptive precautions are stopped. If your own fertility

More information

Prepare your first visit to Sakthi Fertility

Prepare your first visit to Sakthi Fertility Prepare your first visit to Sakthi Fertility Infertility History Form CONTACT INFORMATION FEMALE: First Name Middle Initial Last Name Date of birth (MM/DD/YY) / / Occupation Health card number Version

More information

Reproductive Endocrinology. Isabel Hwang Department of Physiology Faculty of Medicine University of Hong Kong Hong Kong May2007

Reproductive Endocrinology. Isabel Hwang Department of Physiology Faculty of Medicine University of Hong Kong Hong Kong May2007 Reproductive Endocrinology Isabel Hwang Department of Physiology Faculty of Medicine University of Hong Kong Hong Kong May2007 isabelss@hkucc.hku.hk A 3-hormone chain of command controls reproduction with

More information

Hypogonadism 4/27/2018. Male Hypogonadism -- Definition. Epidemiology. Objectives HYPOGONADISM. Men with Hypogonadism. 95% untreated.

Hypogonadism 4/27/2018. Male Hypogonadism -- Definition. Epidemiology. Objectives HYPOGONADISM. Men with Hypogonadism. 95% untreated. Male Hypogonadism -- Definition - Low T, Low Testosterone Hypogonadism -...a clinical syndrome that results from failure of the testes to produce physiological concentrations of testosterone due to pathology

More information

MedStar Health, Inc. POLICY AND PROCEDURE MANUAL Policy Number: PA.017.MH Last Review Date: 08/04/2016 Effective Date: 01/01/2016

MedStar Health, Inc. POLICY AND PROCEDURE MANUAL Policy Number: PA.017.MH Last Review Date: 08/04/2016 Effective Date: 01/01/2016 MedStar Health, Inc. POLICY AND PROCEDURE MANUAL PA.017.MH Infertility- Diagnosis This policy applies to the following lines of business: MedStar Employee (Select) MedStar MA DSNP CSNP (Not Covered) MedStar

More information

WHY INVESTIGATE FOR INFERTILITY

WHY INVESTIGATE FOR INFERTILITY WHY INVESTIGATE FOR INFERTILITY Intrauterine Insemination 1 About this booklet This series of booklets has been developed and written with the support of leading fertility clinics across Australia, and

More information

Obstetrics and Gynecology. Infertility. Dr. Layla Zaghal. Definition

Obstetrics and Gynecology. Infertility. Dr. Layla Zaghal. Definition Obstetrics and Gynecology Infertility Dr. Layla Zaghal Definition The term infertility is no more used and has been replaced by the term subfertility ; when you tell a couple that they are infertile, it

More information

Hyperandrogenism. Dr Jack Biko. MB. BCh (Wits), MMED O & G (Pret), FCOG (SA), Dip Advanced Endoscopic Surgery(Kiel, Germany)

Hyperandrogenism. Dr Jack Biko. MB. BCh (Wits), MMED O & G (Pret), FCOG (SA), Dip Advanced Endoscopic Surgery(Kiel, Germany) Hyperandrogenism Dr Jack Biko MB. BCh (Wits), MMED O & G (Pret), FCOG (SA), Dip Advanced Endoscopic Surgery(Kiel, Germany) 2012 Hyperandrogenism Excessive production of androgens Adrenal glands main source

More information

Reproductive physiology. About this Chapter. Case introduction. The brain directs reproduction 2010/6/29. The Male Reproductive System

Reproductive physiology. About this Chapter. Case introduction. The brain directs reproduction 2010/6/29. The Male Reproductive System Section Ⅻ Reproductive physiology Ming-jie Wang E-Mail: mjwang@shmu.edu.cn About this Chapter The reproductive organs and how they work the major endocrine functions of sexual glands actions of sex hormones

More information

Dr Manuela Toledo - Procedures in ART -

Dr Manuela Toledo - Procedures in ART - Dr Manuela Toledo - Procedures in ART - Fertility Specialist MBBS FRANZCOG MMed CREI Specialities: IVF & infertility Fertility preservation Consulting Locations East Melbourne Planning a pregnancy - Folic

More information

Ch 20: Reproduction. Keypoints: Human Chromosomes Gametogenesis Fertilization Early development Parturition

Ch 20: Reproduction. Keypoints: Human Chromosomes Gametogenesis Fertilization Early development Parturition Ch 20: Reproduction Keypoints: Human Chromosomes Gametogenesis Fertilization Early development Parturition SLOs Contrast mitosis/meiosis, haploid/diploid, autosomes/sex chromosomes. Outline the hormonal

More information

LABORATORY TESTS IN DIAGNOSIS OF FEMALE INFERTILITY

LABORATORY TESTS IN DIAGNOSIS OF FEMALE INFERTILITY LABORATORY TESTS IN DIAGNOSIS OF FEMALE INFERTILITY Sara Mokhtar M.D. Infertility Fellowship Avicenna Research Institute. Couples wish to know why they have not been able to conceive and,depending on the

More information

Reproductive Endocrinology & Infertility Glossary

Reproductive Endocrinology & Infertility Glossary Reproductive Endocrinology & Infertility Glossary The following is a glossary of terms you may hear during your association with the University of Mississippi Health Care's reproductive endocrinology and

More information

Chapter 14 The Reproductive System

Chapter 14 The Reproductive System Biology 12 Name: Reproductive System Per: Date: Chapter 14 The Reproductive System Complete using BC Biology 12, page 436-467 14. 1 Male Reproductive System pages 440-443 1. Distinguish between gametes

More information

INFERTILITY: DIAGNOSIS, WORKUP AND MANAGEMENT FOR THE COMMUNITY PHYSICIAN

INFERTILITY: DIAGNOSIS, WORKUP AND MANAGEMENT FOR THE COMMUNITY PHYSICIAN INFERTILITY: DIAGNOSIS, WORKUP AND MANAGEMENT FOR THE COMMUNITY PHYSICIAN Caitlin Dunne, MD, FRCSC Clinical Assistant Professor Division of Reproductive Endocrinology and Infertility Department of Obstetrics

More information

Case 1 Dear Dr Re: Joan and John Baldwin, 2 Union Road, Clifton, Bristol. General investigation of infertility. Case 3

Case 1 Dear Dr Re: Joan and John Baldwin, 2 Union Road, Clifton, Bristol. General investigation of infertility. Case 3 General investigation of infertility What is relevant in Primary Care? Case 1 Re: Joan and John Baldwin, 2 Union Road, Clifton, Bristol Would you please see this couple. Mr and Mrs Baldwin present to the

More information

Management of Female infertility Tim Chang

Management of Female infertility Tim Chang Management of Female infertility Tim Chang www.drtchang.com.au Assess and manage as a couple because: 30% infertility male factor related emotional support Role of the physician 1) diagnose and treat the

More information

Assisted Reproduction. By Dr. Afraa Mahjoob Al-Naddawi

Assisted Reproduction. By Dr. Afraa Mahjoob Al-Naddawi Assisted Reproduction By Dr. Afraa Mahjoob Al-Naddawi Learning Objectives: By the end of this lecture, you will be able to: 1) Define assisted reproductive techniques (ART). 2) List indications for various

More information

Testes (male gonads) -Produce sperm -Produce sex hormones -Found in a sac called the scrotum -Suspended outside of the body cavity for temperature

Testes (male gonads) -Produce sperm -Produce sex hormones -Found in a sac called the scrotum -Suspended outside of the body cavity for temperature REPRODUCTION Testes (male gonads) -Produce sperm -Produce sex hormones -Found in a sac called the scrotum -Suspended outside of the body cavity for temperature reduction -Testes wall made of fibrous connective

More information

Aromatase Inhibitors in Male Infertility:

Aromatase Inhibitors in Male Infertility: Aromatase Inhibitors in Male Infertility: The hype of hypogonadism? BEATRIZ UGALDE, PHARM.D. H-E-B/UNIVERSITY OF TEXAS COMMUNITY PHARMACY PGY1 03 NOVEMBER 2017 PHARMACOTHERAPY ROUNDS Disclosures No conflicts

More information

STRUCTURE AND FUNCTION OF THE MALE REPRODUCTIVE SYSTEM

STRUCTURE AND FUNCTION OF THE MALE REPRODUCTIVE SYSTEM Unit 7A STRUCTURE AND FUNCTION OF THE MALE REPRODUCTIVE SYSTEM LEARNING OBJECTIVES 1. Learn the structures of the male reproductive system. 2. Learn the functions of the male reproductive system. 3. Learn

More information

Information Sheet. Male Infertility

Information Sheet. Male Infertility Infertility National Public Awareness Campaign Information Sheet Male Infertility In approximately half of couples complaining of infertility part of the problem lies with the male. Male infertility has

More information

6.7 IN. Continuity through Reproduction. What are the differences between male and female gametes? Discuss their formation and physical attributes.

6.7 IN. Continuity through Reproduction. What are the differences between male and female gametes? Discuss their formation and physical attributes. 6.7 IN What are the differences between male and female gametes? Discuss their formation and physical attributes. Males - 4 sperm per parent cell; Females - 1 ovum per parent cell Sperm - motile (tail);

More information

Bio 12- Ch. 21: Reproductive System

Bio 12- Ch. 21: Reproductive System Bio 12- Ch. 21: Reproductive System 21.1- Male Reproductive System o Male anatomy o Testes and how they relate to sperm production and male sex hormones o Hormone regulation in males 21.2- Female Reproductive

More information

Chapter 22 The Reproductive System (I)

Chapter 22 The Reproductive System (I) Chapter 22 The Reproductive System (I) An Overview of Reproductive Physiology o The Male Reproductive System o The Female Reproductive System 22.1 Reproductive System Overview Reproductive system = all

More information

Evaluation and Treatment of the Subfertile Male. Karen Baker, MD Associate Professor Duke University, Division of Urology

Evaluation and Treatment of the Subfertile Male. Karen Baker, MD Associate Professor Duke University, Division of Urology Evaluation and Treatment of the Subfertile Male Karen Baker, MD Associate Professor Duke University, Division of Urology Disclosures: None Off label uses: There are no oral medications approved by the

More information

Infertility treatment

Infertility treatment In the name of God Infertility treatment Treatment options The optimal treatment is one that provide an acceptable success rate, has minimal risk and is costeffective. The treatment options are: 1- Ovulation

More information

Male Reproductive System Dr. Gary Mumaugh

Male Reproductive System Dr. Gary Mumaugh Male Reproductive System Dr. Gary Mumaugh Reproductive System Basics Primary sex organs (gonads) testes in males, ovaries in females Gonads produce sex cells called gametes (gametes means spouses) and

More information

Testosterone Therapy in Men with Hypogonadism

Testosterone Therapy in Men with Hypogonadism Testosterone Therapy in Men with Hypogonadism (Endocrine Society 2018 Guideline) Ngwe Yin, MD Assistant Clinical Professor of Medicine, UCSF Fresno Medical Education Program Disclosures None Objective

More information

Male Reproduction Organs. 1. Testes 2. Epididymis 3. Vas deferens 4. Urethra 5. Penis 6. Prostate 7. Seminal vesicles 8. Bulbourethral glands

Male Reproduction Organs. 1. Testes 2. Epididymis 3. Vas deferens 4. Urethra 5. Penis 6. Prostate 7. Seminal vesicles 8. Bulbourethral glands Outline Terminology Human Reproduction Biol 105 Lecture Packet 21 Chapter 17 I. Male Reproduction A. Reproductive organs B. Sperm development II. Female Reproduction A. Reproductive organs B. Egg development

More information

Information for Patients. Male infertility. English

Information for Patients. Male infertility. English Information for Patients Male infertility English Table of contents What is male infertility?... 3 Diagnosis... 3 Medical history... 3 Physical examination... 3 Hormone blood tests... 3 Semen analysis...

More information

Hd Hydroxylase. Cholesterol. 17-OH Pregnenolne DHEA Andrstendiol. Pregnenolone. 17-OH Progestrone. Androstendione. Progestrone.

Hd Hydroxylase. Cholesterol. 17-OH Pregnenolne DHEA Andrstendiol. Pregnenolone. 17-OH Progestrone. Androstendione. Progestrone. PATHOPHISIOLOGY OF SEX HORMONES R. Mohammadi Biochemist (Ph.D.) Faculty member of Medical Faculty CHOLESTEROL IS THE PRECURSOR OF STERIOD HORMONES Cholesterol Pregnenolone 17-OH 17βHSD Pregnenolne DHEA

More information

Facts About Folic Acid

Facts About Folic Acid Facts About Folic Acid How much folic acid a woman needs 400 micrograms (mcg) every day. When to start taking folic acid For folic acid to help prevent major birth defects, a woman needs to start taking

More information

Objectives: 1. Review male & female reproductive anatomy 2. Gametogenesis & steroidogenesis 3. Reproductive problems

Objectives: 1. Review male & female reproductive anatomy 2. Gametogenesis & steroidogenesis 3. Reproductive problems CH. 15 - REPRODUCTIVE SYSTEM Objectives: 1. Review male & female reproductive anatomy 2. Gametogenesis & steroidogenesis 3. Reproductive problems 3. Male Reproductive anatomy and physiology. Testes = paired

More information

Fertility in the 21 st Century Dr Leigh Searle

Fertility in the 21 st Century Dr Leigh Searle Fertility in the 21 st Century Dr Leigh Searle Fertility Specialist, Obstetrician, Gynaecologist FRANZCOG, PGDipOMG, MBChB Dr Kate Van Harselaar Fertility Specialist, Obstetrician and Gynaecologist Overview

More information

Optimizing Fertility and Wellness After Cancer. Kat Lin, MD, MSCE

Optimizing Fertility and Wellness After Cancer. Kat Lin, MD, MSCE Optimizing Fertility and Wellness After Cancer Kat Lin, MD, MSCE University Reproductive Care University of Washington Nov. 6, 2010 Optimism in Numbers 5-year survival rate 78% for all childhood cancers

More information

DAX1, testes development role 7, 8 DFFRY, spermatogenesis role 49 DMRT genes, male sex differentiation role 15

DAX1, testes development role 7, 8 DFFRY, spermatogenesis role 49 DMRT genes, male sex differentiation role 15 Subject Index N-Acetylcysteine, sperm quality effects 71 Ambiguous genitalia, origins 1, 2 Anti-Müllerian hormone function 13 receptors 13 Sertoli cell secretion 10, 38 Apoptosis assays in testes 73, 74

More information

New Patient Medical History

New Patient Medical History New Patient Medical History MR #: Initial Appointment Date: / / Name: Birth Date: / / Address: City: State: Zip: Best Phone # to reach you: ( ) Second contact #: ( ) Email Address: Occupation: Marital

More information

Age and Fertility. A Guide for Patients Revised 2012 Copyright 2012 by the American Society for Reproductive Medicine

Age and Fertility. A Guide for Patients Revised 2012 Copyright 2012 by the American Society for Reproductive Medicine 1 Age and Fertility A Guide for Patients Revised 2012 Copyright 2012 by the American Society for Reproductive Medicine INTRODUCTION Fertility changes with age. Both males and females become fertile in

More information

Fertility guide. Everything you need to know before seeking medical advice for infertility treatment

Fertility guide. Everything you need to know before seeking medical advice for infertility treatment Fertility guide Everything you need to know before seeking medical advice for infertility treatment ΙΝ Α FEW WORDS the following text is a valuable guide for those who wish to become parents but are concerned

More information

Chapter 14 Reproduction Review Assignment

Chapter 14 Reproduction Review Assignment Date: Mark: _/45 Chapter 14 Reproduction Review Assignment Multiple Choice Identify the choice that best completes the statement or answers the question. 1. Use the diagram above to answer the next question.

More information

Fertility. Assessment and treatment for people with fertility problems. Issued: February NICE clinical guideline 156. guidance.nice.org.

Fertility. Assessment and treatment for people with fertility problems. Issued: February NICE clinical guideline 156. guidance.nice.org. Fertility Assessment and treatment for people with fertility problems Issued: February 2013 NICE clinical guideline 156 guidance.nice.org.uk/cg156 NICE has accredited the process used by the Centre for

More information

Prof. Dr. Michael Zitzmann Internal Medicine Endocrinology, Diabetology, Andrology University of Muenster, Germany

Prof. Dr. Michael Zitzmann Internal Medicine Endocrinology, Diabetology, Andrology University of Muenster, Germany Induction of fertility in hypogonadal men Prof. Dr. Michael Zitzmann Internal Medicine Endocrinology, Diabetology, Andrology University of Muenster, Germany Induction of fertility in hypogonadal men Prof.

More information

Male Reproductive Structures I. Overview A. Main functions: 1. Produce a haploid male gamete (sperm) 2. Deposit sperm in the female so fertilization

Male Reproductive Structures I. Overview A. Main functions: 1. Produce a haploid male gamete (sperm) 2. Deposit sperm in the female so fertilization Male Reproductive Structures I. Overview A. Main functions: 1. Produce a haploid male gamete (sperm) 2. Deposit sperm in the female so fertilization may occur! A. Scrotum 1. Muscular pouch that holds the

More information

Clinical guideline Published: 20 February 2013 nice.org.uk/guidance/cg156

Clinical guideline Published: 20 February 2013 nice.org.uk/guidance/cg156 Fertility problems: assessment and treatment Clinical guideline Published: 20 February 2013 nice.org.uk/guidance/cg156 NICE 2017. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and-conditions#notice-ofrights).

More information

INFERTILITY GENETIC TESTING. Dr. Ahmad Ebrahimi Molecular Medical Genetics,PhD Yass Medical Genetics Lab. Tehran University of Medical Science

INFERTILITY GENETIC TESTING. Dr. Ahmad Ebrahimi Molecular Medical Genetics,PhD Yass Medical Genetics Lab. Tehran University of Medical Science INFERTILITY GENETIC TESTING Dr. Ahmad Ebrahimi Molecular Medical Genetics,PhD Yass Medical Genetics Lab. Tehran University of Medical Science INFERTILITY GENETIC TESTING It is estimated that genetics are

More information

Chapter 4. Managing Fertility in Childhood Cancer Patients T.K. Woodruff and K.A. Snyder (eds.) Oncofertility. Springer 2007

Chapter 4. Managing Fertility in Childhood Cancer Patients T.K. Woodruff and K.A. Snyder (eds.) Oncofertility. Springer 2007 Chapter 4 Managing Fertility in Childhood Cancer Patients T.K. Woodruff and K.A. Snyder (eds.) Oncofertility. Springer 2007 The original publication of this article is available at www.springerlink.com

More information