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 the processes of conception, as well as sensitivity to the emotional stress that can result from the inability to conceive.
OBJECTIVES Definition of primary and secondary infertility Causes of male and female infertility Evaluation of couple To approach the exams
DEFINITION Primary Couple has never conceived No conception during first year without contraception for woman younger than 35, or after, 6 months for woman >35 year. Secondary - couple has had at least one prior conception
Etiology of infertility 20-40% of couples will have multiple causes TUBAL AND PELVIC PATHOLOGY 35% OVULATORY 15%20% AZOOSPERMIA FEMALE 60% MALE 35-40% CERVICAL 5% OTHER 10%-15% SPEROFF, et al.,2011 COMPROMISED ESPERMATOGENESIS
EVALUATION SEXUAL HABITS MALE AND FEMALE HISTORY REPRODUCTIVE HISTORY SEXUAL TRANSMITTED INFECTIONS LIFE STYLES OCUPACION MEDICINES USE AND SURGICAL
PHYSICAL EXAMINATION MALE Obesity Hypothalamic or pituitary failure Abnormalities of the penis, include location of urethral meatus Palpation of testes and measurement of size. Presence of vas deferens Degrees of varicocele Secondary sexual characteristics
PHYSICAL EXAMINATION FEMALE Vaginal /Cervical structural abnormalities Uterine enlargement ( leiomyoma, endometriosis, pelvic adhesive disease) Weight. Alter the production of sex steroid hormone Breast secretion and their character Signs of androgen excess
FEMALE MALE Hormonal assessments GONADOTROPIN LEVELS (FSH,LH,ESTRADIOL) FSH,LH,TESTOSTERONA PROLACTIN THYROID HORMONE Progesterone THYROID HORMONE ANDROGEN LEVELS(TESTOSTERO NE,DHEA,ANDROSTE NEDIONE ESTRADIOL LEVELS ANTIMULLERIAN HORMONE OVARIAN RESERVE
THE INITIAL CONSULTATION OF THE INFERTILITY COUPLE SEMEN ANALYSIS HYSTEROSCOPY INITIAL CONSULTATTION USG TV LAPAROSCOPY EVALUATION OF PELVIC ANATOMY HYSTEROSALPINGOGRAPHY
SONOGRAPHY Female. Useful tool for evaluating adequate follicle development and ovulation, endometrial assessment. Male. Scrotal ultrasonography to diagnose varicocele
Standard to look for tubal occlusion. HYSTEROSALPINGOGRAPHY
HYSTEROSCOPY Evaluation of abnormalities of the endometrial cavity and also offers the opportunity for treatment in case of fibroids and polyps.
LAPAROSCOPY Indicated in women with endometriosis or pelvic adhesive disease
Semen analysis According to the American Association for Clinical Chemistry (AACC), the tests should be conducted at least seven days apart and over the course of two to three months. MACROSCOPIC CARACTERISTICS 1-VOLUME 2-COLOR 3-PH 4-LIQUEFACTION 5-VISCOSITY AGARWAL,et al.,2016
SEMEN ANALYSIS MICROSCOPIC CARACTERISTIC AGLUTINATION: SUGGEST IMMUNOLOGICAL CAUSE PERCENT MOTILITY COUNT MOTILE SPERM TOTAL NUMBER OF SPERM UNDIFFERENTIATED ROUND CELLS IMMATURE GERM CELLS WHITE BLOOD CELLS CONCENTRATION COUNT TOTAL SPERM AGARWAL,et al.,2016
ENDTZ TEST WHEN ROUND CELL CONCENTRATTION > 1.0*10ˆ6/ML. ROUND CELLS :DIFFERENTIATE -LEUKOCYTES -IMMATURE GERM CELLS CAUSES: SEXUAL TRANSMITTED DESEASE VASECTOMY VARICOCELE SPIND CORD INJURY AGARWAL,et al.,2016
EOSIN-NIGROSIN Sperm viability Done on all specimens having a motility <25% It is important to know whether immotile spermatozoa are alive or dead. AGARWAL,et al.,2016
SPERM MORPHOLOGY Sperm morphology is an important parameter of semen evaluation
GENETIC TESTING MEN WITH AZOOSPERMIA OR SEVERE OLIGOZOOSPERMIA -Klinefelter s syndrome is the most frequent genetic causes of human infertility, occurring in 11% of azoospermic men and 4% of infertile men. In this case the has an extra chromosome xxy -Y chromosome microdeletion is diagnosed when portions of the Y chromosome DNA are missing specifically. Cystic fibrosis gene mutation: Congenital bilateral absence of vas difference, can occur without other symptoms of cystic fibrosis
ADVANCED SPERM TESTS UNEXPLAINED INFERTILITY ONE OR MORE ABNORMAL PARAMETERS RECURRENT PREGNANCY LOSS FERTILIZATION FAILURE 1-MENSUREMENT OF OXYGEN SPECIES (ROS) 2- DNA FRAGMENTACION 3-OXIDATION-REDUCUCTION- POTETIAL (ORP)
CONCLUSIONS From the beginning, the evaluation of infertility should focus on the couple an not on one or the other partner. Clinicians caring for infertility couples, should keep basic goals in mind: 1. To identify and to correct specific causes of infertility 2. To provide accurate information. 3. To provide emotional support during a trying time.
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