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Approach to Infertility, Slides of Pathology

Infertility is defined as a failure to conceive within 1 year of regular unprotected coitus. Male and Female Infertility.

Typology: Slides

2018/2019

Uploaded on 04/10/2019

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APPROACH TO INFERTILITY
Presenter :
Dr. Varughese George
Moderator :
Dr. G.
Mangala
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APPROACH TO INFERTILITY

Presenter :

Dr. Varughese George

Moderator :

Dr. G.

Mangala

Introduction

• Infertility - Failure of a couple to conceive/achieve

a clinical pregnancy after 12 months or more of

regular unprotected coitus.

• Subfertility - Any form of reduced fertility with

prolonged time of unwanted non-conception.

• Fecundability - Probability of achieving a

pregnancy within one menstrual cycle. (In a

healthy young couple, it is 20 percent)

• Fecundity - Probability of achieving a livebirth

within a single cycle.

Factors Essential for

Conception

• Healthy spermatozoa should be deposited high

in the vagina at or near the cervix (male factor).

• Spermatozoa should undergo changes

(capacitation, acrosome reaction) and acquire

motility (cervical factor).

• ™™ Motile spermatozoa should ascend through

the cervix into the uterine cavity and the

fallopian tubes.

• ™™ There should be ovulation (ovarian factor).

Factors Essential for

Conception

• ™™ Fallopian tubes should be patent & oocyte

should be picked up by the fimbriated end of

the tube(tubal factor).

• ™™ Spermatozoa should fertilize oocyte at the

ampulla of the tube.

• Embryo should reach the uterine cavity after 3–

4 days of fertilization.

• ™™ Endometrium should be receptive (by

estrogen, progesterone, IGF-l, cytokines,

integrins) for implantation, and the corpus

luteum should function adequately.

Causes of Infertility

• Male Infertility (30%)

• Female Infertility (30%)

• Both Male & Female Infertility(30%)

• Unexplained (10%)

Causes Of Male Infertility

Pre-testicular Testicular Post-testicular Endocrine

  • Gonadotropin deficiency
  • Obesity
  • Diabetes Mellitus
  • Thyroid dysfunction
  • Hyperprolactinemia Psychosexual –– Erectile dysfunction –– Impotence Drugs –– Antihypertensives –– Antipsychotics Genetic –– 47 XXY (Klinefelter’s Syndrome) –– Y chromosome deletions –– Single gene mutation
    • Immotile cilia (Kartagener) syndrome
    • Cryptorchidism
    • Infection (mumps orchitis)
    • Toxins: Drugs, smoking, Radiation
    • Varicocele
    • Immunologic
    • Sertoli-cell-only syndrome
    • Primary testicular failure
    • Oligoastheno- teratozoospermia Obstruction of efferent duct
      • Congenital –– Absence of Vas deferens (Cystic fibrosis) –– Young’s syndrome
      • Acquired Infection ––Tuberculosis ––Gonorrhea - Surgical –– Herniorrhaphy –– Bladder neck surgery –– Vasectomy - Others –– Ejaculatory failure ––Retrograde ejaculation

Approach to Male

Infertility

History

 Type of lifestyle (heavy smoking,

alcoholism)

 Sexual practices

 Erectile dysfunction and ejaculatory

disorders

 Sexually transmitted diseases

 Surgery in genital area

 Drugs

 Any systemic illness.

Approach to Male

Infertility

Physical examination

 Testicular size

 Undescended testes

 Hypospadias

 Scrotal abnormalities (like varicocele)

 Body hair

 Facial hair

Approach to Male

Infertility

Semen Analysis

  • During transport to laboratory, the specimen should be kept as close to body temperature as possible.
  • Specimen obtained near the testing site in an adjoining room.
  • Condom collection containing spermicidal agent is not recommended.
  • Collection of ejaculate post coitus interruptus is not recommendated.
  • Two semen specimens should be examined that are collected 2-3 weeks apart

Approach to Male

Infertility

Semen Analysis

Test Result Physical examination Time to liquefaction, viscosity, volume, pH, color. Microscopic examination Sperm count, vitality, motility, morphology, and proportion of white cells Immunologic analysis Antisperm antibodies  (^) SpermMAR test  (^) Immunobead test Bacteriologic analysis Detection of infection Sperm function tests Postcoital test, cervical mucus penetration test, Hamster egg penetration assay, hypoosmotic swelling of flagella, and computer- assisted semen analysis

Approach to Male

Infertility

Semen Analysis

Physical Examination

Viscosity :Slightly viscous and easily drawn into a

pipette.

Incompletely liquefied specimens will be

clumped and highly viscous.

Increased viscosity and incomplete

liquefaction will impede sperm motility.

Factors affecting semen viscosity

• Dehydration

• Infections of prostate/seminal vesicles

• Drugs

Approach to Male

Infertility

Semen Analysis

Physical Examination

Volume: N= 1.5-5 ml

Decreased volume frequently associated

with infertility indicates improper functioning

of one of the semen-producing organs.

Low volume ejaculates are caused by 3 disorders :

  • Ejaculatory disorders: Neurological diseases,Diabetes,Prior

surgeries & Medications; can cause retrograde ejaculation,

aspermia or both.

  • Genital tract obstructions : Prostate cysts,inflammatory

disorders,Infections, Scars from prior surgeries.

  • Congenital anomalies : Seminal vesical

aplasia (absence), congenital absence of the vas deferens

Approach to Male

Infertility

Semen Analysis

Microscopic Examination

Sperm Motility

• 1st laboratory assessment of sperm function

• essential for penetration of cervical mucus,

traveling through the fallopian tube, and

penetrating the ovum.

• should be assessed as soon as possible after

liquefaction within 1 hour following ejaculation,

to limit the deleterious effects of dehydration,

pH or changes in temperature on motility

Approach to Male

Infertility

Semen Analysis

Microscopic Examination

Sperm Motility

• A drop of semen is placed on a glass slide,

covered with a coverslip that is then

ringed with petroleum jelly to prevent

dehydration, and examined under 40×

objective.

• At least 200 spermatozoa are counted in

several different microscopic fields.