infertility and modern methods of treatment-joy

8/2/2019 Infertility and Modern Methods of Treatment-joy

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INFERTILITY AND MODERN

METHODS OF TREATMENT



Reproductive Health & Infertility

Reproductive Health (RH)

WHO Definition

– Goals of RH

» Capacity to reproduce

Infertility

– Involuntary childlessness

– Definition



Prevalence

Global 10%

Regional Variations

– Europe 5-10% – Sub-Saharan Africa10-30%

Major RH problem in Africa



Etiology

STD - irreversible tubal damage

Post abortion, post parturm infections

Lack of ovulation Uterine disorders

Male factors

Cancer therapy



Social implications

Children as a basis of marriage

Social stigma

High cultural premium Women affected less than men



Methods of treatment

Prevention

Conventional

ART



Preventive approach

STD’s - Reduce transmissionEducation

Condoms

Screening of common STD’s

Safe abortion

Safe delivery



Modern Methods of Infertility

Treatment - Male Semen Analysis

– Azoospermia» Obstructive

Surgery

Sperm recovery

» Non-obstructive (Testicular failure) Surgical sperm recovery

Donor sperm

– Oligospermia» IUI

Natural cycle Stimulated cycle (x 3 cycles)

IF FAILED FOR IVF/ICSI

– OligoastenoteratozoospermiaICSI



Modern Methods of Infertility

Treatment - Female Test for ovulation

– Check for regular menstruation

– Check mid-cycle progesterone

– Early cycle hormonal profile» If abnormal – ovulatory disorder

With ovarian egg reserve – Rx: ovarian stimulation

No ovarian reserve – ovarian failure – Rx: egg donation

Test for tubal occlusion

– HSG

– Laparascopy» If tubal occlusion

Mild obstructon – Laparascopic tubal surgery

Severe obstruction - Open tubal surgery

IF FAILED FOR IVF



Assisted Reproduction - Male

IUI(Husband) – Oligospermia

– Unexplained Infetility

IUI(Donor)

– Oligospermia

– Azoospermia

– Genetic heritable disease

– Severe rhesus iso-immunization

X 6 cycles, If Failed for ICSI

ICSI

– Severe oligospermia

– Azoospermia (ICSI+TESA)

– Poor fertilization at previous IVF



AssistedReproduction – Female.

IVF Treatment

Ovulation induction

– Pituiary down regulation

– Ovarian stimulation

– Egg maturation

– Ultrasound monitoring

Oocyte retrieval – ultrasound guided

Sperm recovery – Masturbatory, surgical or frozen Embryo transfer - UGET

Hormonal support after embryo transfer.



IVM (in vitro maturation)

Polycystic ovaries

Young women

Risk of ovarian hyperstimulation



Oocyte Donation

Screening of oocyte donors

Indications

– Ovarian failure

» Premature

» Menopausal

» Chemotherapy/radiotherapy

– Oophorectomy

– Genetic heritable disorder

– IVF failure with own egg



Embryo Donation and Surrogacy

Need for screening embryo donors

– Source of donated embryos

Indications for embryo donation – same asfor egg donation with Male azoospermia

Surrogacy – Uterus absent/non-functional

Pregnancy with life-threateningcomplications



Male fertility preservation

Sperm cryoconservation

Thawed sperm can be used in IUI, IVF or ISCI

procedures depending on sperm quality

Cryoconservation of testicular

tissueSuitable only for ISCI procedure



Female fertility preservation

Mature oocyte/ zygote/ embryo

cryoconservation

Immature oocyte cryoconservation Ovarian tissue cryoconservation



Conclusion

Need for ART

» Accessibility

» Affordability

Little Resources

Cooperate support



THANK YOU FOR YOURATTENTION

infertility and modern methods of treatment-joy

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