Infertility - Sveučilište u Zagrebu Medicinski fakultet

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Infertility
Ana Dimitrović
Mentor: A. Žmegač Horvat
Definition
• Not being able to get pregnant despite
having frequent unprotected sex for at
least a year
Symptoms
• Inability for a couple to get pregnant
• Woman: abnormal menstrual periods
• Man: hormonal problems (changes in hair
growth or sexual function)
When to see a doctor
• You plan to conceive and
you are a woman older
than 30 or haven‘t
menstruated in six months
• You are a woman who has
a history of irregular or
painful menstrual cycles,
pelvic pain,
endometriosis…
• You are a man with a low
sperm count or a history of
testicular, prostate or
sexual problems
Causes of male infertility
Impaired production or function of
sperm
• Impaired shape or movement of
sperm
• Low sperm concentration
• Varicocele
• Undescended testicle
• Testosterone deficiency (male
hypogonadism)
• Genetic defects
• Infections
Causes of male infertility
Impaired delivery of sperm
• Sexual issues
• Retrograde ejaculation
• Blockage of epididymis or ejaculatory ducts
• No semen (ejaculate)
• Hypospadia
• Anti – sperm antibodies
• Cystic fibrosis
Causes of male infertility
General health and
lifestyle
• Emotional stress
• Malnutrition
• Obesity
• Cancer and its
treatment
• Alcohol and drugs
• Age
• Other medical
conditions
Causes of male infertility
Environmental exposure
• Pesticides and other chemicals
• Overheating the testicles
• Substance abuse
• Tobacco smoking
Causes of female infertility
• Fallopian tube
damage or
blockage
• Endometriosis
• Ovulation disorders
• Hyperprolactinemia
• Polycystic ovary
syndrome (PCOS)
• Early menopause
• Uterine fibroids
• Pelvic adhesions
Causes of female infertility
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Medications
Thyroid problems
Cancer and its treatment
Caffeine intake
Other medical conditions
Risk factors
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Age
Tobacco smoking
Alcohol use
Being overweight
Too much exercise
Caffeine intake
Tests and diagnosis
Tests for men
• General physical
examination
• Semen analysis
• Hormone testing
• Transrectal and
scrotal ultrasound
Tests for women
• Ovulation testing
• Hysterosalpingography
• Laparoscopy
• Hormone testing
• Ovarian reserve testing
• Genetic testing
• Pelvic ultrasound
Medical treatments
Drugs
• Clomiphene
• Human menopausal gonadotropin, hMG
• FSH
• Human chorionic gonadotropin, hCG
• Gonadotropin – releasing hormone (Gn-RH)
analogs
• Aromatase inhibitors
• Metformin
• Bromocriptine
Medical treatments
Fertility drugs and the risk of multiple
pregnancies
• Injectable fertility drugs increase the
chance of multiple births
• Careful monitoring: blood tests, hormone
tests, ultrasound measurement of ovarian
follicle size
• Multifetal pregnancy reduction
Medical treatments
Surgery
• Laparoscopic techniques
• Blockages, varicocele
Medical treatments
Assisted reproductive technology (ART)
• In vitro fertilization (IVF)
Medical treatments
• Electric or vibratory stimulation to achieve
ejaculation
• Surgical sperm ejaculation
• Intracytoplasmic sperm injection (ICSI)
• Assisted hatching
Complications of treatment
• Multiple pregnancy
• Ovarian hyperstimulation syndrome
(OHSS)
• Bleeding or infection
• Low birth weight
• Birth defects
Complementary and alternative
treatments
• Group psychological intervention
• Acupuncture
• Manual physical therapy
• Fertility tourism (legal regulation, lower
prices, sought procedure)
Prevention
Male:
• Avoid alcohol,
tobacco and street
drugs
• Avoid hot tubs and
steam baths
Female:
• Avoid alcohol,
tobacco and street
drugs
• Exercise moderately
• Avoid weight
extremes
• Limit caffeine
• Limit medications
The end

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