Initial assessment ROS

Male

"amily History

Hereditary conditions relevant to re$conce tional lanning 'ssess the emotional im act of infertility on the cou le female

Galactorrhea Hirsutism Changes in weight Devtal defects o Undescended testis Past genital surgery Infections o Mum s orchitis Previous genital trauma o Medications o History of occu ational e! osures Infertility Premature ovarian failure Congenital or develo mental defects Mental retardation Coital fre#uency Dys areunia Se!ual dysfunction Cystic fi%rosis &halassemia &ay$sachs disease &horough hysical e!amination Particular attention given to o Height o (eight o )ody ha%itus o Hair distri%ution o &hyroid gland o Pelvic e!amination

Diagnostic evaluation Semen analysis Confirmation of ovulation Documentation of tu%al atency Male factor

Cause of infertility in *+, of infertile cou les May %e a contri%uting factor in as many as -+$.+, of cases Male fertility ea/s at -0 y1o Male fertility declines shar ly after .0 y1o Increased ris/ of chromosomal trisomies Causes of Semen abnormalities Oligo2oos ermia Genetic disorder 7ndocrino athies 6aricocele1anatomic disorder Maturation arrest Hy os ermatogenesis 7!ogenous factors

Abnormal count '2oos ermia 3linefelter4s syndrome Sertoli cell only syndrome Seminiferous tu%ule or 5eydig cell Hy ogonadotro ic hy ogonadism Ductal o%struction 1 young syndrome 6aricocele 7!ogenous factors Abnormal volume 8o e9aculate Ductal o%struction

 Retrograde e9aculation 79aculatory failure Hy ogonadism 5ow volume 1 High volume O%struction of e9aculatory ducts '%sence of seminal vesicles and vas deferens Partial retrograde e9aculation Infection Un/nown factors '%normal motility Immunologic factors Infection Defects in s erm structure Meta%olic or anatomic a%normalities of s erm 6aricocele Poor li#uefaction of semen '%normal viscosity 7tiology un/nown '%normal mor hology 6aricocele Stress Infection 7!ogenous factors Un/nown factors 7!traneous cells Infection or inflammation Shedding of immature s erm &reatment &reatment of Male Medical infertility may %e Surgical classified as 'R& &reatment of reversi%le endocrine or infectious causes of su%fertility: such as se!ually transmitted diseases and thyroid disorders: tends to %e efficacious Medical thera ies for other causes of male factor infertility are severely limited Medical thera y Clomi hene citrate 7strogen agonist and ;atrial antagonist Used to treat male infertility of idio athic origin 'cts on the hy othalamic ituitary a!is and: in men: increases serum levels of 5H: "SH and testosterone &reatment with CC yields little im rovement in semen arameters and no im rovements in regnancy rates GnRH Hy ogonadotro hic hy ogonadal males 'ntis erm Condoms anti%odies Glucocorticoids 6aricocele Involves interru tion of the internal s ermatic vein 5a arosco y O en surgery In9ection of 7m%oli2ing agents &hera eutic %enefits <controversial= &reatment 'rtificial Placement of whole semen or rocessed s erm into the female re roductive insemination tract

Intrauterine insemination Intracervical insemination

Infertility I DFE

Permits s erm ovum interaction in the a%sence of intercourse Intravaginal insemination erformed in cases of severe coital dysfunction Placement of a%out +>- to +>0 ml of washed rocessed and concentrated s erm into the intrauterine cavity %y &ranscervical catheteri2ation May %e erformed either with unwashed or with rocessed s ecimens

Infertility 1 (causes up to cervical factor) ??> &his defines as ? year of un rotected intercourse without regnancy@ infertility ?*> &he ro%a%ility of achieving live %irth within a single cycle@ fecundity ?-> Male fertility declines shar ly after@ 45 y o ?.> ' normal s ecial retains its fertili2ing a%ility u toAAA that is why it is refera%le to have a s erm in the oviduct rior to the arrival of the oocyte> !" #rs ?0> &he male artner should %e advised to a%stain from e9aculation for AAA %efore collection of semen sam le: %ecause infre#uent e9aculation lowers seminal volume and occasionally the s erm count in other individuals> "$% days ?B> S erm motility %egins to decline AAAA after e9aculation: and it is %est to e!amine the s ecimen within this time eriod> " #rs ?C> Method to lace the s erm in the female re roductive tract %y means other than se!ual intercourse> If the s erm is from the hus%and: the techni#ue is called@ insemination ?D> '%sence of s erm in the semen@ a&oospermia ?E> '%normal dilation of veins within the s ermatic cord@ varicocele *+> &otal s erm num%er er e9aculate@ 4'( ml Infertility 1$ DFE Post test ?> Define Infertility $ ? year of un rotected intercourse without regnancy *> Fecundability$ defined as a ro%a%ility of achieving regnancy within a single menstrual cycle <*+$*0,= -> Semen analysis <- %asic investigation done %efore infertility= .> Documentation of ovulation 0> Documentation of tu%al regnancy B> )ormo&oospermia$ semen arameters normal C> "$% days$ d of a%stinence %efore s erm collection D> " #ours$ degree of motility decreases how many hours after e9aculation E> *i+uefaction$ rocess of thinning out of s erm which occurs *+$-+ minutes after e9aculation ?+> ,aricocele$ '%n> Dilatation of veins within the s inal cord ??> Infertility$defines as ? year of uno osed intercourse w1o regnancy ?*> 45 years$ male fertility declines shar ly after ?-> " #ours$ s erm motility decline AAAafter e9aculation ?.> A-..S/E0(IA$ ')S78C7 of s erm in semen ?0> "$% days$ normal s erm retains its fertili2ing a%ility for u toAAAA /retest DFE ?> Define fecundity F probability of ac#ievin1 a live birt# 2it#in a sin1le cycle *> (hat is secondary infertility F presence of previous pre1nancy -> what are the - %asic investigations %efore starting infertility treatment G Semen analysis G Confirmation of ovulation G documentation of tubal patency B> the normal li#uefaction time F "'$%' mins C> what is the normal total s erm count F 34' million e4aculate D> all s erm are non via%le 1 non motile F necro&oospermia E> treatment for varicocele F sur1ery ?+> motility is e! ected to decrease how many hours after e9aculation 5 " #ours