2. SEYED MORTEZA MAHMOODI

3.  Definition
 Fertility
 Fecundity
 Fecundability
 Incidence
 Prevalance

5. FEMALE
MALE
COMBINED
UNKNOWN

7.  Cervical factor infertility
 Uterine factor infertility
 Ovarian factor infertility
 Tubal factors
 Peritoneal factors
 Advanced Age

8.  5%-10%
 Stenosis , chronic cervicitis
 Abnormalities of the mucus-sperm
interaction
 Surgical procedures, infections,
hypoestrogenism, and radiation therapy

11.  PCT, Sims-Huhner
 Speculum examination, 1-2 mm probe
 IUI

12.  2%-5%
 Congenital
 Acquired

40.  Environmental and occupational
 Toxins
 Exercise
 Inadequate diet

42.  previous pregnancies and their outcomes
 frequency of intercourse, use of lubricants (eg, K-Y gel) that could be
spermicidal, use of vaginal douches after intercourse, and the presence of
any sexual dysfunction such as anorgasmia or dyspareunia.
 menstrual history, frequency, and patterns since menarche. A history of
weight changes, hirsutism, frontal balding, and acne should also be
addressed.
 Ask male patients about previous semen analysis results, history of
impotence, premature ejaculation, change in libido, history of testicular
trauma, previous relationships, history of any previous pregnancy, and the
existence of offspring from previous partners.
 history of sexually transmitted diseases (STDs); surgical contraception
lifestyle; consumption of alcohol, tobacco, and recreational occupation;
and physical activities.
 Ask the couple whether they are currently under medical treatment, the
reason, and whether they have a history of allergies.
 A complete review of systems may be helpful to identify any
endocrinological or immunological problem that may be associated with
infertility.

44.  Vitals
 height and weight to calculate the body mass
index,
 Perform an eye examination
 The presence of epicanthus, lower implantation
of the ears and hairline, and webbed neck
 gland enlargement or thyroid nodules
 Perform a breast examination galactorrhea.
menstrual cycles.
 Abnormal masses

45.  A thorough gynecologic examination should include an
evaluation of hair distribution, clitoris size, Bartholin
glands, labia majora and minora, and any condylomata
acuminatum or other lesions that could indicate the
existence of venereal disease.
 Bimanual examination should be performed to establish
the direction of the cervix and the size and position of the
uterus to exclude the presence of uterine fibroids, adnexal
masses, tenderness, or pelvic nodules indicative of infection
or endometriosis.
 The examination of the extremities is important to rule out
malformation, such as shortness of the fourth finger or
cubitus valgus, which can be associated with chromosomal
abnormalities and other congenital defects. Examine the
skin to establish the presence of acne, hypertrichosis, and
hirsutism.

46.  Postcoital test (PCT), Sims-Huhner test
 speculum examination
 HSG
 US
 Saline infusion sonography
 MRI
 Hysteroscopy
 Endometrial biopsy

47.  Laparoscopy
 Ovulation
 Progesterone greater than 4 ng/mL
 Sonographic confirmation of follicle rupture with
serial ultrasonography can also be performed.
 Basal body temperature charts prefer to use
urinary ovulation predictor kits as they are more
accurate and easier to administer
 Ovarian reserve

49. Single line
Late menstrual endometrium
Thick proliferative
endometrium
Thick secretory
endometrium
Posterior enhancement
The uterine lining changes throughout the normal menstrual cycle

51.  Semen analysis
 Volume - 2-5 mL
 pH level - 7.2-7.8
 Sperm concentration - 20 million or greater
 Motility - 50%, forward progression
 Morphology - Normal sperm (>4%)
 White blood cells - Fewer than 1 million cells/µL
 Sperm function test
 the acrosome reaction test
 computer assessment of the sperm head,
 computer motility assessment
 hamster penetration test
 human sperm-zona penetration assay

52.  Ovulation predictors
 Conception cap
 Semen collectors
 Collection condoms are sterile and made
from silicone or polyurethane, as latex is
somewhat harmful to sperm. Semen can also
be collected by masturbation into a sterile
container, such as a specimen cup.

56. In vitro fertilisation (IVF)
&
Embryo transfer(ET)
Involves:-
1. Retrieval of pre-ovulatory oocytes from the woman.
2. In vitro fertilization by sperm.
3. Culture to 8 or 16 cell stage.
4. Transfer to the uterus.

57. 1. Ovarian follicles stimulated
2. Mature oocytes aspirated at laproscopy
3. Oocytes placed in a petri dish to culture with
capacitated sperms.
4. Cleavage monitored in fertilized egg till 6-8 cell
stage
5. Embryo transferred into vagina and cervical canal

58. •In vivo fertilization occur within 12 hours
after ovulation
•In vitro fertilization is not possible after
24 hours.
•Most human sperms do not survive for
more than 48 hours in the female genital
tract

59. Complications
•Increased risk of multiple gestations,
•Spontaneous abortions
•High incidence of chromosomal and cellular
abnormalities
Advantages
Long periods of preservation of blastocysts and
embryos

60. Procedure
Prior to any GIFT, IVF, or ICSI procedure, the woman
receives hormones to stimulate development of the
ovarian follicles.
The fluid containing the ova is placed in a laboratory
dish and observed under a microscope.
The ovum is located and its stage of maturity noted.
It is then carefully cultured in a special nutrient.

61. Approximately three hours before the procedure, a semen sample from the
husband is obtained.
The sperm is washed and prepared for loading into the same catheter into which
several of the wife's ova will be placed.
The ova are obtained by transvaginal needle aspiration (no surgical incision) via
an ultrasound guide.

62. Sperm and ova are sequentially loaded into the catheter, which is then introduced
into the patient's fallopian tube through a tiny incision in her abdomen.
GAMETE INTRAFALLOPIANTRANSFER

63. 2 cell stage 4 cell stage
6-8 cell stage
Morula

64. Just prior to beginning the hatching process on an 8-cell embryo
Assisted Hatching

65. Hatching a high quality 8-cell embryo
A small opening is being made in the embryo's shell (zona pellucida)

66. The needle has been further advanced through the embryo's shell
A gap in the shell is developing

67. A gap in the zona has been created
The oolemma (egg membrane) is bulging and about to "pop"

68. A blastocyst starting to hatch from its shell - lower right of photo
After hatching, the embryo can implant in the uterine lining
Photo taken a few minutes prior to EmbryoTransfer

69. Intracytoplasmic sperm injection (ICSI)
The injection of the sperm into the oocyte
Process of supplementation of sperm fertilization potential by
the direct transport of the sperm into the oocyte is termed
ICSI
Indications:
Non satisfactory sperm motility
Loss of acrosome
Sperm immaturity
Presence of antisperm antibodies in the woman.

70. Procedure:
The sperm will be injected into the oocyte cytoplasm using
apparatus called micromanipulator
Under microscope control the oocyte will be moderately
vacuum held and using an injection pipette of the diameter
of 5 micrometers, the direct transport of the sperm into the
oocyte is performed.
1. Oocyte holder
2. Spermatozoon expulsed
from the capillary
3. Mature oocyte with the
polar body
4. Injection capilary

71. About to inject the egg with a sperm
Holding pipette on left
ICSI needle on right
Sperm head visible in needle at far right, just below X
Polar body of egg at 7 o'clock

72. Needle is advanced to the left
Shell of embryo has already been penetrated by needle
Membrane of egg (oolemma) is stretching and is about to break
Sperm head is visible at tip of needle

73. ICSI needle has penetrated the egg membrane
A single sperm is being injected into the cytoplasm of the egg