{"id":190,"date":"2020-08-13T16:08:48","date_gmt":"2020-08-13T16:08:48","guid":{"rendered":"https:\/\/brooksidepress.org\/basic_obgyn\/?page_id=190"},"modified":"2023-09-30T11:03:46","modified_gmt":"2023-09-30T11:03:46","slug":"48-infertility","status":"publish","type":"page","link":"https:\/\/brooksidepress.org\/basic_obgyn\/overview\/48-infertility\/","title":{"rendered":"48. Infertility"},"content":{"rendered":"<p><iframe loading=\"lazy\" src=\"https:\/\/www.youtube.com\/embed\/6gmMYEDknR0\" width=\"560\" height=\"315\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n<p>Duration = 9:03<\/p>\n<input type='hidden' bg_collapse_expand='69e9dc172b4e63010016065' value='69e9dc172b4e63010016065'><input type='hidden' id='bg-show-more-text-69e9dc172b4e63010016065' value='Show Transcript'><input type='hidden' id='bg-show-less-text-69e9dc172b4e63010016065' value='Hide Transcript'><button id='bg-showmore-action-69e9dc172b4e63010016065' class='bg-showmore-plg-button bg-blue-button  '   style=\" color:#ffffff;\">Show Transcript<\/button><div id='bg-showmore-hidden-69e9dc172b4e63010016065' ><\/p>\n<p>00:00<br \/>\nAPGO educational topic number 48<br \/>\n00:02<br \/>\ninfertility infertility affects 15% of<br \/>\n00:06<br \/>\nreproductive age couples in the United<br \/>\n00:07<br \/>\nStates there are medical psychosocial<br \/>\n00:09<br \/>\nfinancial and ethical considerations<br \/>\n00:12<br \/>\nthat are all issues pertaining to the<br \/>\n00:13<br \/>\ndiscussion of infertility this video<br \/>\n00:15<br \/>\nwill discuss infertility from the<br \/>\n00:17<br \/>\nstandpoint of a heterosexual couple and<br \/>\n00:19<br \/>\nit is important to recognize that<br \/>\n00:20<br \/>\nfertility treatments offer the<br \/>\n00:21<br \/>\nopportunity for Parenthood too many<br \/>\n00:23<br \/>\nnon-heterosexual individuals and couples<br \/>\n00:25<br \/>\nthe objectives of this video are to<br \/>\n00:27<br \/>\ndefine infertility and list the causes<br \/>\n00:29<br \/>\nof male and female infertility describe<br \/>\n00:31<br \/>\nthe evaluation and initial management of<br \/>\n00:34<br \/>\nan infertile couple describe the<br \/>\n00:36<br \/>\npsychosocial issues associated with<br \/>\n00:37<br \/>\ninfertility describe management options<br \/>\n00:40<br \/>\nfor infertility describe ethical issues<br \/>\n00:43<br \/>\nconfronted by patients with infertility<br \/>\n00:44<br \/>\nand lastly describe the impact of<br \/>\n00:47<br \/>\ngenetic screening and testing on<br \/>\n00:48<br \/>\ninfertility associated treatments let&#8217;s<br \/>\n00:51<br \/>\nstart with some basic definitions<br \/>\n00:52<br \/>\ninfertility is defined as the failure of<br \/>\n00:54<br \/>\na couple to conceive after 12 months of<br \/>\n00:56<br \/>\nfrequent unprotected intercourse for con<br \/>\n00:59<br \/>\nnobility is the probability of achieving<br \/>\n01:00<br \/>\na pregnancy in one menstrual cycle it is<br \/>\n01:03<br \/>\nestimated to be 20 to 25 percent in<br \/>\n01:05<br \/>\nhealthy young couples after 12 months of<br \/>\n01:07<br \/>\nunprotected intercourse eighty-five<br \/>\n01:09<br \/>\npercent of couples will achieve<br \/>\n01:10<br \/>\npregnancy what are the possible causes<br \/>\n01:12<br \/>\nof infertility let&#8217;s start with the<br \/>\n01:14<br \/>\nbasics there needs to be production of a<br \/>\n01:17<br \/>\ngood lewisite and production of a good<br \/>\n01:21<br \/>\nsperm the oocyte and sperm need to meet<br \/>\n01:27<br \/>\nto generate an embryo and this embryo<br \/>\n01:32<br \/>\nneeds to make it to the uterine cavity<br \/>\n01:34<br \/>\nand successfully implant into the<br \/>\n01:36<br \/>\nendometrium what are the potential<br \/>\n01:39<br \/>\ncauses that negatively affect this<br \/>\n01:41<br \/>\nprocess male factors account for 20%<br \/>\n01:43<br \/>\nfemale factors account for 65% and there<br \/>\n01:46<br \/>\nare unexplained or other conditions in<br \/>\n01:48<br \/>\n15% let&#8217;s start with male factors the<br \/>\n01:52<br \/>\nmale needs to produce a good sperm thus<br \/>\n01:54<br \/>\nthe evaluation of male infertility<br \/>\n01:55<br \/>\ninvolves a semen analysis it is obtained<br \/>\n01:58<br \/>\nby masturbation after two to three days<br \/>\n02:00<br \/>\nof abstinence a semen analysis evaluates<br \/>\n02:03<br \/>\nthe volume sperm concentration motility<br \/>\n02:05<br \/>\nrapid progression motility and normal<br \/>\n02:08<br \/>\nmorphology if the results are abnormal<br \/>\n02:11<br \/>\nthen the semen analysis should be<br \/>\n02:12<br \/>\nrepeated and a<br \/>\n02:13<br \/>\nassistant Li abnormal the malefactor<br \/>\n02:15<br \/>\nshould be evaluated by urologist or<br \/>\n02:17<br \/>\nreproductive endocrinologist who<br \/>\n02:19<br \/>\nspecializes in male infertility let&#8217;s<br \/>\n02:21<br \/>\nnow move to female factors first there<br \/>\n02:24<br \/>\nneeds to be production of a good Oh a<br \/>\n02:25<br \/>\nsite a good history can often help you<br \/>\n02:27<br \/>\ndetermine if a woman is ovulating each<br \/>\n02:29<br \/>\nmonth a history of regular predictable<br \/>\n02:32<br \/>\nmenses suggests of the Tori cycles<br \/>\n02:35<br \/>\nremember that after ovulation there is<br \/>\n02:37<br \/>\nan increase in progesterone and this can<br \/>\n02:39<br \/>\ncause symptoms such as abdominal<br \/>\n02:40<br \/>\nbloating weight gain and breast<br \/>\n02:42<br \/>\ntenderness in the luteal phase of the<br \/>\n02:44<br \/>\ncycle in addition the progesterone<br \/>\n02:45<br \/>\ncauses a slight increase in body<br \/>\n02:47<br \/>\ntemperature so women can monitor their<br \/>\n02:49<br \/>\novulation by checking their daily<br \/>\n02:51<br \/>\ntemperature which is known as basal body<br \/>\n02:52<br \/>\ntemperature charting alternatively women<br \/>\n02:55<br \/>\ncan purchase ovulation predictor kits<br \/>\n02:57<br \/>\nwhich assess ovulation based on the<br \/>\n02:59<br \/>\nincreased LH production which can be<br \/>\n03:01<br \/>\ndetected in urine<br \/>\n03:02<br \/>\nthese ovulation predictor kits can be<br \/>\n03:04<br \/>\nquite expensive however in order to<br \/>\n03:06<br \/>\nachieve pregnancy a woman has to ovulate<br \/>\n03:08<br \/>\nand she has to ovulate a quality OA site<br \/>\n03:11<br \/>\ncommon causes of ovulatory dysfunction<br \/>\n03:14<br \/>\nand reproductive age women include<br \/>\n03:16<br \/>\npolycystic ovarian syndrome or PCOS<br \/>\n03:18<br \/>\nthyroid disorders and hyperprolactinemia<br \/>\n03:20<br \/>\na woman&#8217;s age also has a significant<br \/>\n03:24<br \/>\nimpact on ovulation and OSI quality as a<br \/>\n03:27<br \/>\nwoman ages<br \/>\n03:28<br \/>\nunfortunately sodor sites remember that<br \/>\n03:30<br \/>\na female has at 20 weeks in utero about<br \/>\n03:33<br \/>\n6 to 7 million oay sites and she is born<br \/>\n03:36<br \/>\nwith about 1 million u.s. i&#8217;ts she has<br \/>\n03:38<br \/>\nabout 400,000 at the time of puberty and<br \/>\n03:40<br \/>\nthere is a more rapid depletion starting<br \/>\n03:42<br \/>\nat around age 38 thus there is a marked<br \/>\n03:45<br \/>\nreduction of fecund ability in a woman&#8217;s<br \/>\n03:47<br \/>\nlate 30s let&#8217;s now talk about what<br \/>\n03:50<br \/>\nhappens after ovulation here&#8217;s the ovary<br \/>\n03:52<br \/>\nand the OA site which gets picked up by<br \/>\n03:56<br \/>\nthe fallopian tube and fertilization<br \/>\n04:02<br \/>\noccurs in the ampulla a portion of the<br \/>\n04:05<br \/>\nfallopian tube the embryo will then<br \/>\n04:08<br \/>\nenter the endometrial cavity<br \/>\n04:10<br \/>\napproximately 5 days after fertilization<br \/>\n04:12<br \/>\nthis process can be impaired if there is<br \/>\n04:15<br \/>\ndamage to the fallopian tube by prior<br \/>\n04:17<br \/>\npelvic inflammatory disease or abdominal<br \/>\n04:19<br \/>\nor pelvic surgeries a history or cell<br \/>\n04:21<br \/>\npentagram evaluates the fallopian tube<br \/>\n04:24<br \/>\npatency for this procedure contrast<br \/>\n04:27<br \/>\nis injected into the uterine cavity note<br \/>\n04:29<br \/>\nthe dark contrast filling the<br \/>\n04:30<br \/>\ntriangular-shaped uterine cavity if the<br \/>\n04:33<br \/>\nfallopian tubes are paitent then the dye<br \/>\n04:34<br \/>\nwill travel through both of the tubes<br \/>\n04:36<br \/>\nthis HSG demonstrates normal fallopian<br \/>\n04:39<br \/>\ntubes for the dye travels all the way<br \/>\n04:41<br \/>\nthrough both of them uterine anomalies<br \/>\n04:44<br \/>\nare surprisingly uncommon causes of<br \/>\n04:46<br \/>\ninfertility if there is a history such<br \/>\n04:48<br \/>\nas abnormal bleeding pregnancy loss<br \/>\n04:50<br \/>\npreterm delivery or previous uterine<br \/>\n04:53<br \/>\nsurgery then assessment of the uterus is<br \/>\n04:55<br \/>\nimportant let&#8217;s now talk about<br \/>\n04:57<br \/>\nmanagement options we have to go back to<br \/>\n05:00<br \/>\nour basic causes of infertility male<br \/>\n05:02<br \/>\nfactors female factors and unexplained<br \/>\n05:04<br \/>\nor other conditions in order to<br \/>\n05:06<br \/>\noptimally try to achieve pregnancy we<br \/>\n05:08<br \/>\nneed to think about how best to correct<br \/>\n05:10<br \/>\nany or all of these factors ovarian<br \/>\n05:12<br \/>\nstimulation these agents will stimulate<br \/>\n05:15<br \/>\nand effectively improve ovulation<br \/>\n05:17<br \/>\nclomiphene citrate is a selective<br \/>\n05:19<br \/>\nestrogen receptor modulators<br \/>\n05:21<br \/>\nwhich competes for estrogen receptors at<br \/>\n05:23<br \/>\nthe level of the hypothalamus and<br \/>\n05:24<br \/>\npituitary this leads to increase granada<br \/>\n05:27<br \/>\ntrope and release from the pituitary<br \/>\n05:28<br \/>\nwhich stimulates increased follicular<br \/>\n05:31<br \/>\ndevelopment from the ovaries there is an<br \/>\n05:33<br \/>\napproximate 10% risk of multiple<br \/>\n05:35<br \/>\ngestation with clomiphene citrate<br \/>\n05:37<br \/>\nsimilarly controlled ovarian<br \/>\n05:39<br \/>\nhyperstimulation with purified human<br \/>\n05:41<br \/>\ngonadotropin stimulates the ovary to<br \/>\n05:43<br \/>\nincrease follicular development there is<br \/>\n05:46<br \/>\na 25% incidence of multiple gestation<br \/>\n05:48<br \/>\nwith purified gonadotropins with<br \/>\n05:51<br \/>\nintrauterine insemination ejaculated<br \/>\n05:53<br \/>\nsemen is washed to remove prostaglandins<br \/>\n05:55<br \/>\nbacteria and proteins and suspended in a<br \/>\n05:57<br \/>\nsmall amount of medium a catheter is<br \/>\n05:59<br \/>\nadvanced through the cervix into the<br \/>\n06:01<br \/>\nuterine cavity let&#8217;s now move to<br \/>\n06:03<br \/>\nassisted reproductive technologies in<br \/>\n06:05<br \/>\nthe United States in vitro fertilization<br \/>\n06:07<br \/>\nor IVF accounts for 99% of all AR T<br \/>\n06:11<br \/>\nprocedures the IVF process involves<br \/>\n06:13<br \/>\novarian stimulation to produce multiple<br \/>\n06:15<br \/>\nfollicles then there will be retrieval<br \/>\n06:17<br \/>\nof the oocytes from the ovaries lewisite<br \/>\n06:20<br \/>\nfertilization and embryo incubation will<br \/>\n06:22<br \/>\noccur in the laboratory and then there<br \/>\n06:24<br \/>\nwill be transfer of embryo or embryos<br \/>\n06:26<br \/>\ninto the woman&#8217;s uterus through the<br \/>\n06:28<br \/>\ncervix there is an approximate 30<br \/>\n06:30<br \/>\npercent risk of multiple gestation with<br \/>\n06:32<br \/>\nIVF and this will of course depend on<br \/>\n06:34<br \/>\nthe number of embryos that are implanted<br \/>\n06:35<br \/>\ninto the uterus the indications for IVF<br \/>\n06:38<br \/>\ninclude blocked or absent fallopian<br \/>\n06:40<br \/>\ntubes a history<br \/>\n06:41<br \/>\nof tubal sterilization severe pelvic<br \/>\n06:43<br \/>\nadhesions severe endometriosis pour-over<br \/>\n06:45<br \/>\nand response to stimulation severe male<br \/>\n06:48<br \/>\nfactor infertility and failed treatment<br \/>\n06:51<br \/>\nwith less aggressive therapies the<br \/>\n06:52<br \/>\nsuccess rates for IVF will depend on the<br \/>\n06:55<br \/>\netiology of the infertility<br \/>\n06:57<br \/>\npre-implantation genetic diagnosis is<br \/>\n06:59<br \/>\nthe genetic profiling of embryos prior<br \/>\n07:01<br \/>\nto implantation for example if a patient<br \/>\n07:04<br \/>\nknows that she or her partner is a<br \/>\n07:05<br \/>\ncarrier for a disease such as cystic<br \/>\n07:07<br \/>\nfibrosis or ty Sachs disease and the<br \/>\n07:09<br \/>\nembryo can be tested for this prior to<br \/>\n07:11<br \/>\nimplantation there are risks to the<br \/>\n07:14<br \/>\nembryo during the biopsy procedure which<br \/>\n07:16<br \/>\npoints to the ethical questions of fetal<br \/>\n07:18<br \/>\nselection what if a patient desires to<br \/>\n07:20<br \/>\nhave pre-implantation genetic diagnosis<br \/>\n07:22<br \/>\nperformed because they do not want a<br \/>\n07:24<br \/>\ncertain gender child the discussion of<br \/>\n07:27<br \/>\ninfertility and assisted reproductive<br \/>\n07:29<br \/>\ntechnologies should also include the<br \/>\n07:31<br \/>\ndiscussion of ethical issues that are<br \/>\n07:32<br \/>\nconfronted both by patients and<br \/>\n07:34<br \/>\nproviders with infertility therapy<br \/>\n07:36<br \/>\nshould insurance companies be required<br \/>\n07:38<br \/>\nto pay for IVF should there be an age<br \/>\n07:41<br \/>\nlimit for which IVF should not be<br \/>\n07:42<br \/>\noffered there is always the question and<br \/>\n07:44<br \/>\ncosts of higher order multiple births<br \/>\n07:46<br \/>\nwhat about egg banking young women can<br \/>\n07:49<br \/>\nbe recruited to donate eggs and through<br \/>\n07:51<br \/>\nthis process some argue that women are<br \/>\n07:53<br \/>\nnot counseled adequately about the risks<br \/>\n07:55<br \/>\nof ovarian hyperstimulation syndrome and<br \/>\n07:57<br \/>\ncan and should a physician legally and<br \/>\n07:59<br \/>\nethically decline ovulation induction<br \/>\n08:01<br \/>\nfor patients with diminished ovarian<br \/>\n08:03<br \/>\nreserve when chances of successful<br \/>\n08:05<br \/>\npregnancy or futile these questions are<br \/>\n08:08<br \/>\ncomplex and many factors including<br \/>\n08:10<br \/>\nsocial class gender race healthcare<br \/>\n08:12<br \/>\nutilization and access need to be<br \/>\n08:14<br \/>\nconsidered in weighing these complicated<br \/>\n08:15<br \/>\ndecisions let&#8217;s conclude by discussing<br \/>\n08:18<br \/>\npsychosocial stress associated with<br \/>\n08:20<br \/>\ninfertility the amount of social support<br \/>\n08:23<br \/>\nthat a patient receives can have<br \/>\n08:24<br \/>\nsignificant effects on stress levels<br \/>\n08:26<br \/>\ncompared to white and Asian women black<br \/>\n08:28<br \/>\nwomen were less likely to report<br \/>\n08:30<br \/>\nencouragement for treatment from their<br \/>\n08:31<br \/>\npartners and family members it is<br \/>\n08:33<br \/>\nimportant to recognize that the<br \/>\n08:35<br \/>\npsychological stress exists and to<br \/>\n08:37<br \/>\ndetermine the patient&#8217;s support network<br \/>\n08:38<br \/>\nand help our patients find resources to<br \/>\n08:41<br \/>\nhelp them through this process this<br \/>\n08:43<br \/>\nconcludes the aapko video on infertility<br \/>\n08:44<br \/>\nwe have described evaluation at initial<br \/>\n08:47<br \/>\nmanagement of an infertile couple and<br \/>\n08:48<br \/>\ndescribed the ethical and psychosocial<br \/>\n08:50<br \/>\nissues associated with this common<br \/>\n08:52<br \/>\ncondition<\/p>\n<p><\/div>\n","protected":false},"excerpt":{"rendered":"<p>Duration = 9:03<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":46,"menu_order":48,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-190","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/brooksidepress.org\/basic_obgyn\/wp-json\/wp\/v2\/pages\/190","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/brooksidepress.org\/basic_obgyn\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/brooksidepress.org\/basic_obgyn\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/brooksidepress.org\/basic_obgyn\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/brooksidepress.org\/basic_obgyn\/wp-json\/wp\/v2\/comments?post=190"}],"version-history":[{"count":3,"href":"https:\/\/brooksidepress.org\/basic_obgyn\/wp-json\/wp\/v2\/pages\/190\/revisions"}],"predecessor-version":[{"id":1293,"href":"https:\/\/brooksidepress.org\/basic_obgyn\/wp-json\/wp\/v2\/pages\/190\/revisions\/1293"}],"up":[{"embeddable":true,"href":"https:\/\/brooksidepress.org\/basic_obgyn\/wp-json\/wp\/v2\/pages\/46"}],"wp:attachment":[{"href":"https:\/\/brooksidepress.org\/basic_obgyn\/wp-json\/wp\/v2\/media?parent=190"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}