DR KS KUPOLATI MB,BS (IB.); (F.MAS) OB-GYN India PGDip. IVF/ICSI/IUI/ANDROLOGY (UP-IND) Cert. in Advanced Clinical Sonography (Nig. & India) Cert. in Upper & Lower GI Endoscopy (New Delhi) Fellow, Institute of Industrial Administration of Nig. FIIA Life Member, European Society for Human Reproduction & Embryology (ESHRE) Life Member, European Association for Endoscopic surgery (E.A.E.S) Life Member, World Association of Laparoscopic Surgeons. Infertility Specialist & Laparoscopic Surgeon Director, Iye IVF unit.

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INFERTILITY

Definitions

Fecundity= PHYSIOLOGICAL CAPACITY TO CONCEIVE

Infecundity(sterility) = INABILITY OF A WOMAN TO CONCEIVE-Primary sterility = NEVER ABLE TO CONCEIVE-Secondary sterility= INABILITY TO CONCEIVE, HAVING CONCEIVED IN THE PAST

INFERTILITY :Definitions

Infertility: FAILURE TO ACHIEVE CONCEPTION OVER A 12-MONTH PERIOD OF UNPROTECTED INTERCOURSEPrimary infertility: NEVER HAVING HAD A LIVE BIRTHSecondary infertility: FAILURE TO ACHIEVE A LIVE BIRTH AFTER HAVING HAD A LIVE BIRTH PREVIOUSLY

TYPES OF INFERTILITY

PRIMARY INFERTILITY SECONDARY

INFERTILITY

Male Reproductive System

Normal Female Reproductive System

EFFECT ON OUR EMOTIONS

SADNESS

Number of infertile couples globally - >100 million. Associated with : - Female factor - 40% - Male factor-30-40% - Common to both partners 15-20% . - Unexplained 5-10%

Infertility: facts

INFERTILITY: HEALTH IMPORTANCE

AFFECTS WOMEN STATUS: THE SOCIAL STIGMA OF INFERTILITY WEIGHS ESPECIALLY HEAVILY ON WOMEN, AND MANY WOMEN FACE DIVORCE AS A RESULT

BURDEN ON LIMITED HEALTH CARE RESOURCES AS INFERTILE COUPLES REPEATEDLY SEEK HELP OUTSIDE NORMAL HEALTH FACILITIES

Cultural Interpretation of InfertilityPUNISHMENT BY GODS OR THE ANCESTORS

PUNISHMENT FOR ADULTERY

CONCEPTIONS TAKE PLACE ALMOST AUTOMATICALLY AS SOULS SEEK REINCARNATION

WITCHCRAFT/WICKEDNESS BY EVIL MEN

CAUSES OF INFERTILITYVAGINAL CERVICAL UTERINEPELVICOVARIANOTHER CAUSES UNEXPLAINED

Coital difficulty a) VAGINISMUSb) VAGINAL

OBSTRUCTIONc) IMPERFORATE HYMENd) ABSENCE OF THE

VAGINAe) VAGINAL SEPTUMf) GYNETRESIAg) POOR ERECTIONh) IMPOTENCEi) PREMATURE

EJACULATION

VAGINAL CAUSES:

CERVICAL INFERTILITY: IT INVOLVES INABILITY OF THE

SPERM TO PASS THROUGH THE MOUTH OF THE UTERUS DUE TO DAMAGE OF THE CERVIX.

CAUSES INCLUDE THE FOLLOWING:

A) INADEQUATE OR INHOSPITABLE CERVICAL MUCOUS

B) CERVICAL NARROWING OR "STENOSIS"

C) INFECTIONS OF THE CERVIX WITH COMMON SEXUALLY TRANSMITTED DISEASES (CHLAMYDIA, GONORRHOEA, OR TRICHOMONAS, AS WELL AS MYCOPLASMA HOMINIS AND UREAPLASMA UREALYTICUM)

D)IMMUNE ATTACK OF SPERM OR "SPERM ALLERGY" (ANTISPERM ANTIBODIES)

CERVICAL CAUSES:

ANATOMIC

PROBLEMS (POLYPS, UTERINE FIBROIDS, ABNORMAL SHAPE OF THE UTERUS, SEPTUM OR "DIVIDING WALL" WITHIN THE UTERUS)

THIN OR ABNORMAL UTERINE LINING

ASHERMAN’S SYNDROME

UTERINE CAUSES:

MULTIPLE FIBROIDS

PELVIC CAUSES: INCLUDE ANY DISRUPTION OF THE NORMAL PELVIC ANATOMY:

SCAR TISSUE OR "ADHESIONS"

ENDOMETRIOSIS BLOCKED,

SCARRED, OR DISTORTED FALLOPIAN TUBES, DYSFUNCTIONAL FT.

PELVIC CAUSES

Pelvic inflammatory disease (PID) and infertility

PID: INFECTION OF THE PELVIC ORGANS THAT CAUSE SEVERE ILLNESS AND MAY LEAD TO TUBAL BLOCKAGE AND PELVIC ADHESIONS LEADING TO INFERTILITY

A COMMON SEQUEL TO STDS, POST-PARTUM AND POST-ABORTAL INFECTIONS AND SOME SYSTEMATIC INFECTIONS E.G. TUBERCULOSIS, SCHISTOSOMIASIS

Percent of women with tubal factor infertility following PID, by number of episodes

PID EPISODES

PERCENT

0 1%1 8%2 22%3+ 41%

THE RISK OF TUBAL FACTOR INFERTILITY INCREASES WITH EACH SUCCESSIVE EPISODE OF PID

OVARIAN FAILURE PCOS ANOVULATION POOR OVARIAN

RESERVE PREMATURE

MENOPAUSE LUTEAL DYSFUNCTION GONADAL

DYSGENESIS OVARIAN CANCER

Ovarian Causes of Infertility

AGE: AFTER 35YRS, MOST WOMEN MAY EXPERIENCE A DECLINE IN THE ABILITY TO OVULATE EFFECTIVELY.

MENOPAUSE: 49 – 56YRSABNORMALITIES OF THE THYROID

GLAND OVERPRODUCTION OF PROLACTIN (A

HORMONE LEADING TO BREAST MILK PRODUCTION)

PHYSICAL STRESS, PSYCHOLOGICAL STRESS AND EXTREME LIFESTYLE CHANGES

EXCESSIVE MALE HORMONE (ANDROGENS)

OTHER CAUSES OF INFERTILITY

Cultural and social factorsFEMALE GENITAL MUTILATION

EARLY AGE AT MARRIAGE OR SEXUAL INTERCOURSE

MULTIPLE SEXUAL PARTNERS

RISK OF GENITAL INFECTION

Preventable causes

INFECTIONS–STI:CHLAMYDIA, GONORRHOEA, SYPHILIS ETC.

INFECTIOUS AND PARASITIC DISEASES:TUBERCULOSIS,SCHISTOSOMIASIS, SICKLE CELL DISEASE.

Preventable causes

HEALTH CARE PRACTICES AND POLICIESUNHYGIENIC OBSTETRIC PRACTICESSEPTIC ABORTION AND THEIR COMPLICATIONSPOSTPARTUM AND POSTABORTAL COMPLICATIONS

EXPOSURE TO POTENTIALLY TOXIC SUBSTANCES IN: ENVIRONMENT: ARSENIC, AFLATOXINS, PESTICIDESDIET: CAFFEINE, TOBACCO, ALCOHOL ELECTRO-MAGNETIC RADIATION GAMMA, X-RAYS ETC

APPROXIMATELY 10% OF INFERTILE WOMEN SUFFER FROM UNEXPLAINED INFERTILITY. THIS SIMPLY MEANS THAT THE COMMONLY PERFORMED TESTS TO DIAGNOSE THE CAUSE OF INFERTILTY ARE ALL NORMAL AND DO NOT DEFINE THE REASON FOR INFERTILITY. HOWEVER, WE PERFORM A MORE THOROUGH SEARCH FOR A CAUSE, SINCE MANY SUBTLE ABNORMALITIES MAY BE DISCOVERED TO EXPLAIN THE INFERTILITY. USUALLY SUCH PROBLEMS ARE DUE TO:

DIFFICULTY IN PICKING UP THE EGG BY FALLOPIAN TUBE

FAILURE OF IMPLANTATION OF THE EMBRYO INTO THE UTERUS

FAILURE OF THE SPERM TO FERTILIZE THE EGG WHEN IN CONTACT WITH EACH OTHER

UNEXPLAINED INFERTILITYWhy me syndrome ?

Low sperm counts Abnormal sperm

morphology (shape)

A low sperm motility are usually asymptomatic conditions to most males. Most cases of low sperm counts are "idiopathic" or unexplained.

Some cases are associated with a swollen varicose vein in the scrotum, called a varicocele.

MALE CAUSES• Stress• Heat to the genitals (e.g.. tight clothing, saunas or hot tubs)• Harmful lifestyle habits ( tobacco, alcohol, or drugs such as marijuana).• Short term illnesses, significant stressful periods,• Medications may temporarily affect sperm counts.

Exposure to hazardous toxins, chemicals, or radiation

Infections such as mumps, or venereal diseases

Testicular injury (sports or work injury)

Childhood illness (failure of a testicle to descend properly)

Blockage of one of the ducts allowing flow of sperm from the testicle Injury, infection or prior

vasectomy Genetic absence of these

ducts (cystic fibrosis) Immune reaction against

sperm (antisperm antibodies)

Testicular failure and other hormonal problems

Chronic medical illness (thyroid disease, diabetes, and hypertension)

Spinal cord injuries and paralysis

Varicocele

MALE CAUSES

INVESTIGATIONS

SEMEN QUALITATIVE ANALYSIS (SQA)

BASAL TEMP. CHARTS

TUBAL PATENCY TESTS

HORMONAL TESTS ULTRASONOGRAPHY LAPAROSCOPY HYSTEROSCOPY

Reducing the burden of infertility

CONTROLLING REPRODUCTIVE TRACT INFECTIONS: –EDUCATING PEOPLE ABOUT LINKS BETWEEN RTI AND INFERTILITY–PROMOTING USE OF CONDOM–COUNSELLING HIGH RISK INDIVIDUALS–PROMPTLY TREATING INFECTED INDIVIDUALS AND PARTNER NOTIFICATION–INCREASING ACCESS TO RTI SERVICES

Reducing the burden of infertility(cont.)

PREVENTING POSTPARTUM AND POST-ABORTION INFECTIONS–SAFER BIRTH PRACTICES–PROMOTE FAMILY PLANNING–ACCESS TO SAFE ABORTION SERVICESCONTROLLING ENDEMIC DISEASES-MALARIA, SCHISTOSOMIAISIS, TUBERCULOSIS

Treating infertility

INSIST MEN BE EVALUATED AS WELL AS WOMENSENSITIVE COUNSELLING TO AVOID INAPPROPRIATE TREATMENT AND TO DISCOURAGE FROM SEEKING HELP AT MULTIPLE CLINICS

Treating infertility

ADVISING ABOUT TIMING OF INTERCOURSE AND OTHER BEHAVIOURS -SMOKING AND ALCOHOLHELPING COUPLES TO COPE WITH SOCIAL AND PSYCHOLOGICAL BURDENS OF INFERTILITYHELPING COUPLES TO CONSIDER NON-MEDICAL OPTIONS SUCH AS ADOPTION

Treating infertility: Other options

SURGICAL TECHNIQUES: REPAIRING TUBAL SCARRING, CORRECTING OTHER ABNORMALITIES OF REPRODUCTIVE ORGANSARTIFICIAL INSEMINATION: USING HUSBAND’S OR DONOR’S SEMENIN VITRO FERTILIZATION TECHNIQUES: RECOVERING MATURE OVA, FERTILIZING THEM IN LAB, AND THEN REIMPLANTING IN THE UTERUS .ADVANCED TECHNIQUES: ICSI, TESA, TESE PESA ETC.

IYE HOSP. REPRODUCTIVE CORRECTION CENTER (LAP./HYST. THEATRE)

FRIENDLY SOLUTION CENTER

LAPAROSCOPY TUBAL CANNULATION

IVF/ICSI UNIT

Infertility and Role Of FP Clinics

REASSURING CLIENTS THAT FP METHODS DO NOT CAUSE INFERTILITYDISPELLING LOCAL BELIEFS BLAMING INFERTILITY SOLELY ON WOMENPERSUADING INDIVIDUALS TO SEEK EARLY TREATMENT OF STDSOFFERING BASIC INFERTILITY EVALUATIONS AND TREATMENT

INFERTILITY A MERE TEST OF

OUR RESILIENCE We do not play God We do not create

life We only help it’s expression.GOD IS ALWAYS THE

ANSWERTHROUGH OUR LORD

&SAVIOUR.

YOU WILL SURELY CARRY YOUR OWN BABIES VERY SOON IN JESUS NAME

THANK YOU & REMAIN BLESSED