ppt on infertility by ROBEL

Addis Ababa UniversityFaculty of Medicine

Department of medical Physiology

Presentation on Infertility ROBEL ABAY

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Presentation objectives

• Define infertility• List risk factors for female infertility• List and explain common cause of female infertility• List causes of male infertility • Explain pathophysiology of male infertility

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What is infertility?

• Couples that have been unable to conceive a child after 12 months of regular sexual intercourse without birth control are infertile.

• Women who have repeated miscarriages are also said to be infertile.

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Infertility Etiology

Female Infertility

• In order for a woman to become pregnant:– Egg must be released from one of her ovaries

(ovulation)– Egg must go through the fallopian tube toward the

uterus– Sperm must join with the egg in the fallopian tube

(fertilization)– Fertilized egg must attach to the uterine wall

(implantation)• Infertility can result from problems that interfere with

any of these steps.

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What Increases the Risks?• Age

• Stress

• Poor diet

• Smoking

• Alcohol

• STDs

• Overweight

• Underweight

• Caffeine intake

• Too much exercise6infertilityApr 11, 2023

The Age Factor

• A woman's fertility naturally starts to decline in her late 20's.

• After age 35 a woman's fertility decreases rapidly.

• A woman is born with all the eggs she'll have, and with time, the supply diminishes.

• The remaining eggs also age along with the rest of the body.

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Common Causes of female Infertility

• Severe endometriosis• Pelvic Inflammatory Disease (PID)• Ovulation disorders• Elevated prolactin• Polycystic ovary syndrome (PCOS) • Early menopause• Benign uterine fibroids • Pelvic adhesion

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Physical Obstructions

• Endometriosis• Pelvic Inflammatory Disease• Uterine Fibroids • Pelvic Adhesions• Ovarian Failure

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Endometriosis

• Occurs when the uterine tissue implants and grows outside of the uterus, affecting the function of the ovaries, uterus and fallopian tubes.

• Scar tissue can block the fallopian tubes and prevent the egg from entering the uterus.

• There is a 25-35% rate of infertility in moderate to severe cases of Endometriosis

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PID• Pelvic inflammatory disease (PID) is a spectrum of

infections of the female genital tract that includes endometritis, salpingitis, tuboovarian abscess, and peritonitis.

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Uterine Fibroids and Pelvic Adhesions

• Fibroids are benign tumors in the wall of the uterus

• May cause infertility by blocking the fallopian tubes

• Pelvic adhesions are bands of scar tissue that bind organs after pelvic infection, appendicitis, or abdominal or pelvic surgery

• This scar tissue formation may impair fertility.

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Ovarian failure

• Ovarian failure can be a consequence of medical treatments, or the complete failure of the ovaries to develop or contain eggs in the first place (Turner's Syndrome).

• Ovarian failure can also occur as a result of treatments such as chemotherapy and pelvic radiotherapy for cancers in other body areas. These therapies destroy eggs in the ovary.

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Hormonal Obstructions

• Ovulation disorders

• Elevated prolactin

• Polycystic ovary syndrome

• Early menopause

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Ovulation disorders

• Disruption in the part of the brain that regulates ovulation can cause low levels of luteinizing hormone (LH) and follicle-stimulating hormone (FSH).

• Even slight irregularities in the hormone system can affect ovulation.

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Elevated prolactin

• Also called Hyperprolactinemia

• Can cause irregular or no ovulation

• Irregular periods

• May cause galactorrehea, milk production when not pregnant

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PCOS

• Polycystic ovary syndrome (PCOS)

• Produces too much androgen hormone (male hormones)

• Causes an irregular or no menstrual cycle

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Early menopause

• Absence of menstruation

• Early depletion of ovarian follicles before age 35

• Although the cause is unknown, certain conditions are associated with early menopause, including immune system diseases, radiation or chemotherapy treatment, and smoking

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Other Causes

• Medications• Thyroid problems• Cancer and treatment• Other medical conditions

– conditions associated with delayed puberty or amenorrhea, sickle cell disease, HIV/AIDS, kidney disease and diabetes

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Fertilization Problems

• Anti-sperm antibodies (ASA)

• Oocyte membrane proteins

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Immune Infertility

• The developing embryo may be miscarried due to the mother’s immune system recognizing it as a “foreign body” and attacking it.

• Also, the woman may produce anti-sperm antibodies (ASA) to her partner’s sperm.

• ASA neutralize sperm by clumping them together and destroying their membranes.

• They also coat over receptors involved in sperm-egg binding and fertilization.

• An estimated 12 to 15 percent of unexplained infertility in women is linked to ASA.

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Membrane Proteins

• Receptin, an Oocyte membrane protein, is responsible for binding sperm with the egg.

• If this protein is not receptive or present, fertilization cannot occur.

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Development Problems

• Hard Eggs• Teratogens

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Hard Eggs

• If the egg is too 'hard', then the embryo cannot hatch out of the zona pellucida and it dies.

• To fix this problem, scientists can make a tiny hole in the egg to give it a head start.

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Hard Eggs

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Teratogens

• Damage from external sources, including viral infections, x-rays and other radation, and poor nutrition

• Depending on the stage of development at which the exposure to the teratogen takes place, a variation of developmental malformations may occur.

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Male infertility

• PRETESTICULAR

• TESTICULAR

• POST TESTICULAR

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PRETESTICULAR

• ENDOCRINE

1. Hypogonadotrophic hypogonadism

2. Hyperprolactinemia

3. DM

4. Hypothyroidism

5. Androgenic steroid abuse

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Coital disorders

1. Erectile dysfunction

2. Ejaculatory failure

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Causes of erectile dysfunction

Anything that interferes with the nerve pathway can cause erectile dysfunction

• Trauma such as head and spinal cord injuries, stroke, Parkinson's disease, and diseases with systemic effects such as multiple sclerosis and diabetes can diminish nerve function and lead to impotence.

• Aging• medications and alcoholism can also cause

impotence

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Ejaculatory failure

Ejaculatory failure can be grouped under 4 categories –a. unejaculation – no ejaculation of sperms.b. Retrograde ejaculation – semen is ejaculated in

bladder.c. Premature ejaculation – inability to control

ejaculation for sufficient length of time during intravaginal containment to satisfy female partner

d. Ejaculatory obstruction – failure to achieve erection.

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TESTICULAR

• GENETIC Klienfelter syndrome, Y chromosome deletion, Immotile cilia syndrome

• CONGENITAL Cryptorchidism

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Testicular contn’d

• ORCHITIS1. Infective2. Traumatic

• VASCULAR1. Torsion 2. Varicocele • IDIOPATHIC

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POST TESTICULAR

• OBSTRUCTIVE1. Epididymal2. Vasal• ACCESSORY GLAND INFECTION1. Prostitis2. Seminal vesiculitis• IMMUNOLOGIC1. Post vasectomy2. idiopathic 34infertilityApr 11, 2023

References

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THANK YOU

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