Uploaded byDon Yates
Jan 23rd basic infertility new design
The document discusses reproductive endocrinology and the processes involved in fertility preservation, including egg and embryo freezing techniques. It highlights the effects of maternal age on pregnancy rates and chromosomal abnormalities, as well as the importance of evaluations like semen analysis and uterine assessments. Additionally, it outlines various treatments available for infertility, including IVF and genetic testing, along with the benefits of modern technologies like vitrification and embryoscope monitoring.
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Jan 23rd basic infertility new design
- 2. Reproductive Endocrinology &Infertility Southern California Reproductive Center Beverly Hills, California
- 4. EGG RESERVE THROUGHOUTEGGRESERVE THROUGHOUT FEMALE REPRODUCTIVE LIFEFEMALE REPRODUCTIVE LIFE #Oocytes(millions)#Oocytes(millions) 20 wks Birth Menarche Menopause
- 5. MATERNAL AGE ANDPREGNANCY RATESMATERNAL AGE AND PREGNANCY RATES
- 6. Maternal Age (years) Risk forDown Syndrome Total Risk for Chromosomal Abnormalities 20 1/1,667 1/526 25 1/1,250 1/476 30 1/952 1/385 35 1/378 1/192 40 1/106 1/66 41 1/82 1/53 42 1/63 1/42 43 1/49 1/33 44 1/38 1/26 45 1/30 1/21 46 1/23 1/16 47 1/18 1/13 48 1/14 1/10 49 1/11 1/8 MATERNAL AGE AND CHROMOSOMALMATERNAL AGE AND CHROMOSOMAL ABNORMALITIESABNORMALITIES
- 8. EVALUATION OF UTERUS ANDFALLOPIAN TUBES The primary test to document uterine and tubal abnormalities BENEFITS: increased pregnancy rates associated with flushing the fallopian tubes
- 9. Semen Analysis Volume Concentration (Count) Motility (Movement) Morphology (Shape & Size) Male EvaluationMale Evaluation
- 10. Surgical Hysteroscopy(uterine surgery) Laparoscopy (ovarian and tubal surgery) Medical Treatments Oral: Clomiphene citrate (Clomid) Injectable Medications (FSH, LH, HCG) IUI (artificial insemination) In-vitro fertilization (IVF) Genetic Testing (PGD) ICSI
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- 12. Pausing the biologicalclock Egg Freezing - Embryo Freezing
- 13. FERTILITY PRESERVATIONFERTILITY PRESERVATION Challenge Egg is largest cell in human body Scientific breakthrough Vitrification >90% survival rate after warming) No longer experimental Donor Egg Banking – future of egg freezing
- 14. VITRIFICATIONVITRIFICATION Survival rate: >90% Fertilization rate: 72% Clinical pregnancy rate: 60% 1000’s of babies worldwide
- 15. COMMONLY ASKED QUESTIONSCOMMONLYASKED QUESTIONS How are my eggs retrieved? How long will they stay frozen? What if I meet someone after freezing my eggs and we get pregnant naturally? How successful is the fertilization/IVF after freezing?
- 16. Dr. David Hill,PhDDr. David Hill, PhD Scientific DirectorScientific Director ART Reproductive CenterART Reproductive Center
- 17. Lighting Air Temperature Gas Media Dishes Incubation
- 18. Newest diagnostictool Follow development 24hrs/day ~700 images a day Short video of embryo development • Add photos of the Embryoscope
- 21. Experienced andcertified directors Double witnessing verification Blastocyst culture Vitrification (flash freezing) Blastocyst biopsy - PGD 24 chromosome genetic testing Sex selection Time-lapse video analysis (Embryoscope)
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Editor's Notes
- #4 In a similar reivew of 21 publications including over 14,000 infertile couples, Collins et al. reported the distribution of primary diagnoses. Ovulatory factor was most common in 27%; followed by Male factor in 25%; Tubal factor in 22% And unexplained infertility in 17%. Other diagnoses, including endometriosis, cervical factor, luteal phase defect, immunologic, and genetic abnormatlities are diagnosed in only 9%. These two studies are consistent in demonstrating a prominent role of ovulatory and tubal factor. In addition, these studies show how important it is to evaluate both partners of the infertile couple. As a fellow at OliveView, it was fairly common to see a women in the repro endo clinic who had already undergone ovulation induction, only to find that her partner, who had repeatedly refused semen analysis due to self-perceived normal fertility or reported previous conception, had little to no sperm. The bottom line is that both partners should be evaluated in a timely fashion.
- #9 Hysterosalpingography is well established as the primary test of uterine and tubal morphology. A review of anatomic screenoing modalities by the European society of hum reprod found HSG to be the most cost-effective screening tool in couples with infertility. Fluoroscopic visualization, 3 – 4 mL of radioopaque contrast initially to delineate cavity, additional 10 – 20 mL bolus for tubal filling or obstruction. Days 3 -8, prophylatic NSAID reduce discomfirt. There is an approximately 1% risk of postproceduarl infection, especially in the setting of prior or current PID and preexistin tubal damaage. Universal ppx nt recommended but does reduce risk of pprocedular febrail morbidity. In a large meta-analysis, HSG has been shown to have 65% sensitivity and 83% specificity. So while anormal HSG cannot reliably predict normal tubal function, it is reliable for significant tubal pathology. Not for detecting peritubal or peritneal adhesions.
- #11 Well, there is good news these days for infertile couples. Anovulation Tubal Dz Cervical factor