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Investigations to evaluate Infertility PowerPoint Presentation

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Description : Check out this medical presentation on Craniopharyngioma, which is titled "Investigations to evaluate Infertility", to know about male and female infertility.

Tags : Craniopharyngioma, Investigations, evaluate Infertility, male, female

Published on : May 13, 2021 | Views : 1861 | Downloads : 3

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Slide 1-

Investigations to evaluate Infertility Dr Atin Singhai Assistant Professor Department of Pathology KGMU, Lucknow
Slide 2-

Definition: 1 yr unprotected coitus without conception 10-15% couples affected Etiology Couples: 35% Tubal and pelvic pathology 35 % Male problems 15% Ovulatory dysfunction 10% Unexplained 5% unusual causes Background
Slide 3-

Etiology Women: 40% Tubal and pelvic pathology 40% Ovulatory dysfunction 10% Unexplained Infertility 10% Unusual causes Normal couple: 25-30% chance of pregnancy per ovulatory cycle Fertility decreases with age Background
Slide 4-

Time of Exposure % Pregnant 3 months 60% 6 months 70% 1 year 85% 18 months 90% Infertility
Slide 5-

DDX Tests/Inv Dx Rx Approach to Infertility
Slide 6-

Production Storage Delivery Approach to Infertility
Slide 7-

1. Production: Hypothalamus Anterior Pituitary Testes Male Infertility
Slide 8-

Hypothalamic-Pituitary-Gonadal Axis
Slide 9-

1. Production Hypothalamus Congenital abnormalities of hypothalamus e.g. Kallman’s syndrome Starvation, stress or severe illness Tumors (craniopharyngioma, metastatic tumor) Head injury Inflammation (sarcoidosis) Infection (tuberculosis) Drugs: marijuana Male Infertility
Slide 10-

1. Production: Pituitary Endocrine: thyroid, prolactin Tumors Inflammation: sarcoidosis, meningitis Infiltration Infarction Trauma/XRT Drugs: anabolic steroids Male Infertility
Slide 11-

Production: Testes: Congenital: Klinefelters (XYY), developmental disorders Disorders of gonadal steroidgenesis Infection: chlamydia, prostatitis, mumps orchitis Autoimmune Cryptorchidism Tumors; chemo/XRT Drugs / alcohol Vascular: testicular torsion Male Infertility
Slide 12-

2. Storage: Temperature Rise in scrotal temperature Occupation Varicocoele Male Infertility
Slide 13-

3. Delivery: Impotence/Ejaculation Neurogenic: medications (α-blockers, methyldopa) Endocrine: diabetes Congenital: absence vas deferens (CF) Genetic: cystic fibrosis Primary ciliary dyskinesia: Kartagener syndrome Hypospadia Vasectomy Male Infertility
Slide 14-

History: Previous children Infections: prostatitis, STD, mumps orchitis Trauma to head or testicles Surgery to testicles or hernia Occupation (sitting, bio hazards) Chemo or Radio therapy Ethanol or Smoking Medication Medical history (DM, HTN) Previous investigations Male Infertility
Slide 15-

Physical Anatomy (meatus) Testicular size Varicocele (valsalva) Rectal exam (protatitis, discharge) Male Infertility
Slide 16-

Investigations: semen analysis Abstain 2-4 days prior At least 2 samples over different period of time If abnormal: Blood work: FSH, LH, TSH, testosterone, PRL Testicular U/S Chromosomal analysis Male Infertility
Slide 17-

Semen analysis: WHO (1992) Volume > 2.0 mL Sperm > 20 million/mL Motility > 50% forward progression or > 25% rapid progression within 60 min Morphology > 30% normal forms WBC < 1 million/mL Male Infertility
Slide 18-

Tx / Interventions: Treat underlying causes Intrauterine Insemination (IUI) Intracytoplasmic Sperm Injection (ICSI) Male Infertility
Slide 19-

Fecundability: probability of achieving a pregnancy within 1 menstrual cycle (25%) Fecundity: ability to achieve a live birth within 1 menstrual cycle (6%) Female Infertility
Slide 20-

Production Storage Delivery Female Infertility
Slide 21-

Production: Hypothalamus Pituitary Ovary Female Fertility
Slide 22-

Hypothalamic-Pituitary-Gonadal Axis
Slide 23-

ppt slide no 23 content not found
Slide 24-

Hypothalamus: Stress Exercise Eating disorders Psychogenic Congenital/genetic: Kallman’s syndrome (hyposmia & hypoplasia olfactory lobes of brain) Starvation/stress or severe illness Tumors (craniopharyngioma, metastatic tumor) Head injury Inflammation (sarcoidosis) Infection (tuberculosis) XRT Drugs Female Infertility
Slide 25-

Pituitary: Sheehan syndrome Tumors: Pituitary adenoma, metastatic Empty sella syndrome Inappropriate gonadal steroid feedback: estrogen excess: obesity/ tumors estrogen deficiency: aromatase deficiency/ ER gene mutation androgen excess: adrenal or ovarian PCOS Testicular feminization (46 XY) - absence androgen receptors Female Infertility
Slide 26-

Ovary Gonadal dysgenesis - Turner’s Syndrome 45XO or mosaics 46 XX/45 XO Testicular feminization XRT / Chemo for childhood malignancies Premature ovarian failure Female Infertility
Slide 27-

Storage (R.P.L. unless severe) Uterine abnormalities Mullerian Agenesis: Mayer-Rokitansky-Kuster-Hauser syndrome Leiomyoma Luteal phase deficiency Female Infertility
Slide 28-

Delivery: Uterine abnormalities Vaginal septum Tubal Disease Infections/ STD/PID Ruptured appendix Septic abortion Endometriosis Female Infertility
Slide 29-

History: Age GTPAL Regulatory of period Prolactin S/S Thyroid S/S Infections, Surgeries Medication, Smoking, Ethanol Medical history Previous investigations Female Infertility
Slide 30-

Examination: Thyroid Breast (milk) Abdomen (masses, scars) Vaginal (abnormalities) Bimanual (Uterus, masses) Female Infertility
Slide 31-

Blood work: TSH PRL D3 FSH D3 LH Luteal phase Progesterone Imaging: Pelvic Ultrasound HSG Diagnostic Laparoscopy (later) Investigations
Slide 32-

Treat the underlying cause Medical Surgical Treatment
Slide 33-

Anovulation: Clomiphene induction  IUI Gonadotropin  IUI IVF Bilateral tubal disease Unexplained infertility after Gonadotropin + IUI failure. Failure of the above ICSI Male factor Unexplained infertility Treatment
Slide 34-

DDx – Hx – Px – Inv - Rx Age is important factor for female Hypothalamic-Pituitary-Gonadal axis central in working up both male and female infertility Investigations: Male: Sperms Female: Tubes (HSG) + Ovaries (FSH, LH, PRL, TSH) Take Home Points
Slide 35-

Multiple Choice Questions
Slide 36-

Infertility is defined as unprotected coitus for ___ months, without conception : 3 6 9 12
Slide 37-

Spermatogenesis and sperm maturation is regulated by : Leydig Cells Sertoli Cells Vas Deferens Intermediate Cells
Slide 38-

Cause/s of male infertility is / are : Kallaman’s syndrome Craniopharyngioma Marijuana abuse All of the above
Slide 39-

Normal semen count is ___ million / ml ≥ 15 ≥ 20 ≥ 25 ≥ 30
Slide 40-

Indication/s for semen analysis is / are : Investigation for infertility to check effectiveness of vasectomy for selection of donor for artificial insemination All of the above
Slide 41-

Thank you