INFERTILITY

TRYING TO GET PREGNANT

Before Seeking Fertility Treatment Video:

HOW OVULATION AND PREGNANCY HAPPEN VIDEO:

INFERTILITY Diminished or absent ability to conceive and bear

offspring.

A couple is considered to be experiencing infertility if: Conception hasn’t occurred after 12 months of sexual

activity without the use of contraception. Conception hasn’t occurred after 6 months of sexual

activity without the use of contraception if 35 years or older

Infertility can have many causes and may be related to factors in the male, female, or both.

Treatment can include medications and assisted reproductive technologies.

INFERTILITY DIAGNOSIS

A complete medical history and a physical exam are the first steps in diagnosing a fertility problem.

Both partners need to be evaluated. The couple may also need blood tests,

semen specimens from the man, and ultrasound exams or exploratory surgery for the woman.

If a woman has an infertility problem, she will be referred to a doctor who specializes in reproductive endocrinology.

STATISTICS

7.4 million women, or 11.9% of women, have ever received any infertility services in their lifetime.

1 in 8 couples (12% of married women) have trouble getting pregnant or sustaining a pregnancy.

1/3 is attributed to female partner, 1/3 is attributed to the male, and 1/3 is a combination of both.

A couple ages 29-33 with a normal functioning reproductive system, has only a 20-25% chance of conceiving in any given month without medical assistance.

STATISTICS

Approximately 44% of women with infertility have sought medical assistance. Of those who seek medical intervention, approximately 65% give birth.

Approximately 85-90% of infertility cases are treated with drug therapy or surgical procedures. Fewer than 3% need advanced reproductive technologies like in vitro fertilization (IVF)

15 states have passed law requiring insurance policies to cover some level of infertility treatment, Illinois is one of them!

WHAT CAUSES INFERTILITY IN MEN?

A problem called Varicocele (VAIR-ih-koh-seel) Veins on a man’s testicles are too large. This

heats the testicles and the heat can affect the number or shape of sperm.

Making too few of sperm, or none at all

Injuries or damage done to reproductive system can block the sperm.

INCREASES IN RISK OF INFERTILITY IN MEN

Heavy alcohol use Drugs Smoking cigarettes Age Environmental toxins Heath problems such as: mumps, kidney

disease or hormone issues Medicines Radiation treatment and chemotherapy for

cancer

INFERTILITY IN WOMEN Most cases involve problems with ovulation

Without ovulation, no eggs can be fertilized Signs: irregular or absent menstrual cycles Hormone imbalance can also affect ovulation

Less common (but still possible) Blocked fallopian tubes

Due to pelvic inflammatory disease, or endometriosis

Physical problems with the uterus

Uterine fibroids Non-cancerous clumps of tissues and muscle on walls of

uterus

ENDOMETRIOSIS During monthly menstruation, the female body sheds the

endometrium - uterine lining - in the process commonly known as a "period". In women and girls who have endometriosis, some of these menstrual fluids are retained in the body and abnormally implant in areas outside of the uterus. These implants, or nodules, eventually accumulate on the bladder, bowel, ovaries, cul de sac, and other nearby organs, leading to the development of adhesions, scarring and invasive nodules. This can cause symptoms that vary from painful periods, chronic pelvic pain, infertility, pain associated with intercourse and sexual activity to painful bowel movements, rectal pain and urinary pain or difficulty.

Video:

INCREASE IN RISK OF INFERTILITY IN WOMEN

Age Smoking Excess alcohol use Stress Poor diet Athletic training Being overweight or underweight Sexually transmitted infections Health problems that cause hormonal

changes

HOW AGE AFFECTS A WOMAN’S CHANCE

20% of women in the United States have children after the age of 35.

1/3rd of women who are over 35 have fertility issues

Reasons: Ovaries become less able to release eggs She has a small number of eggs left Her eggs are not as healthy She is more likely to have health conditions that

can cause fertility problems She is more likely to miscarry

HOW MANY EGGS DOES A WOMAN HAVE?

A female typically has about 400,000 potential eggs, all formed before birth.

Only approximately 480 of these “eggs” will actually ever be released during her reproductive years.

One egg per cycle matures and is released from its ovary.

The egg is released into the fallopian tube. If a sperm is present, the egg will be fertilized. If an egg is not fertilized, the lining of the uterus breaks down and is shed (menstruation).

OPTIONS FOR INFERTILE WOMEN

Intrauterine Insemination (IUI) Artificial Insemination

Assisted Reproductive Technologies: In vitro fertilization (IVF) Zygote intrafallopian transfer (ZIFT) or Tubal

Embryo Transfer Gamete intrafallopian transfer (GIFT) Intracytoplasmic sperm injection (ICSI)

INTRAUTERINE INSEMINATION (IUI)

An infertility treatment that is often called artificial insemination.

In this procedure, the woman is injected with sperm inside the uterus to facilitate fertilization.

This treatment DOES NOT involved any manipulation of a women’s eggs

Sometimes the woman is also treated with medicines that stimulate ovulation before IUI.

INTRAUTERINE INSEMINATION (IUI)

IUI provides the sperm an advantage by giving it a head start, but still requires a sperm to reach and fertilize the egg on its own.

A catheter is used to inject the processed sperm directly into the uterus.

This process maximizes the number of sperm cells that are placed in the uterus, thus increasing the possibility of conception.

ASSISTED REPRODUCTIVE TECHNOLOGIES

A group of different methods used to help infertile couples.

Requires Manipulation of women’s eggs’ART works by removing eggs from

a woman's body. The eggs are then mixed with

sperm to make embryos. The embryos are then put back in

the woman's body.

IN VITRO FERTILIZATION (IVF)

Means fertilization outside of the body. IVF is the most effective ART. It is often used when a woman's fallopian

tubes are blocked or when a man produces too few sperm.

Doctors treat the woman with a drug that causes the ovaries to produce multiple eggs.

Once mature, the eggs are removed from the woman. They are put in a dish in the lab along with the man's sperm for fertilization.

After 3 to 5 days, healthy embryos are implanted in the woman's uterus.

IN VITRO FERTILIZATION (IVF)

IN VITRO FERTILIZATION (IVF)

First introduced in 1981More than 4 million babies have been

born world wide as a result of IVF

Multiple births: Generally, in women who use IVF to establish a live birth….About 63% are single babies32% are twins5% are triplets or more.

ZYGOTE INTRAFALLOPIAN TRANSFER (ZIFT) OR TUBAL EMBRYO TRANSFER

Similar to IVFFertilization occurs in the

laboratoryThen the very young embryo is transferred to the fallopian tube instead of the uterus.

ZYGOTE INTRAFALLOPIAN TRANSFER (ZIFT)

ZYGOTA INTRAFALLOPIAN TRANSFER (IZFT)

Commonly chosen by couples who:1. Have failed to conceive after

at least one year of trying 2. Who have failed five to six

cycles of ovarian stimulation with Intrauterine Insemination

GAMETE INTRAFALLOPIAN TRANSFER (GIFT)

Involves transferring eggs and sperm into the woman's fallopian tube.

Fertilization occurs in the woman's body. Few practices offer GIFT as an option. (Not as

common)

One of the main differences between this procedure and the (IVF) and (ZIFT) procedures is that the fertilization process takes place inside the fallopian tube rather than in a laboratory. However, healthy tubes are necessary for GIFT to work.

GAMETE INTRAFALLOPIAN TRANSFER

INTRACYTOPLASMIC SPERM INJECTION (ICSI)

Often used for couples in which there are serious problems with the sperm.

Sometimes it is also used for older couples or for those with failed IVF attempts.

In ICSI, a single sperm is injected into a mature egg obtained from Invitro Fertilization.

Then the embryo is transferred to the uterus or fallopian tube.

INTRACYTOPLASMIC SPERM INJECTION (ICSI)

RISKS ASSOCIATED WITH ART

Conceiving 2 or more fetusesMultiple pregnancies increase the risk of:Premature babiesLow birth weightMother and infant health

complicationDisability of one of more

children

ETHICAL ISSUES INVOLVED WITH FERTILITY

Fertility treatment can be a minefield of legal and ethical issues. These vary from country to country, but also by religious beliefs within those countries. Each one of us also has our own personal opinions, which complicate things even more.

ETHICAL ISSUES INVOLVED WITH FERTILITY For many people, the act

of conception is holy and sacred, and should not be interfered with in any way.

The catholic church believes that life begins at the moment of conception, and only permits the fertilization of eggs that will be used, insisting on the implantation of all viable embryos.

For others, having a baby is the most important thing, and the methods involved do not worry them.

Others believe that life does not really start for some weeks, and they are happy with the idea of fertilizing many eggs, selecting the strongest and healthiest embryos, and discarding the rest.

ETHICAL ISSUES INVOLVED WITH FERTILITY

High-cost treatments are out of financial reach for some couples.

Debate over whether health insurance companies should be forced to cover infertility treatment.

Allocation of medical resources that could be used elsewhere

The legal status of embryos fertilized in vitro and not transferred in vivo.

Anti-abortion opposition to the destruction of embryos not transferred in vivo.

Egg Freezing Process

ETHICAL ISSUES INVOLVED WITH FERTILITY

IVF and other fertility treatments have resulted in an increase in multiple births, provoking ethical analysis because of the link between multiple pregnancies, premature birth, and a host of health problems.

Infertility caused by DNA defects on the Y chromosome is passed on from father to son. If natural selection is the primary error correction mechanism that prevents random mutations on the Y chromosome then fertility treatments for men with abnormal sperm (in particular ICSI) only defer the underlying problem to the next male generation.

IN CLASS ASSIGNMENTAnalyze each fertility option discussed in class.

Determine whether you believe each option is ethical or unethical

Write a brief explanation (bullet point) as to why

ETHICAL ISSUES FACING FERTILITY

There are also questions of legal rights and responsibilities…

In 2007, a Quebec woman froze some of her eggs so that her daughter could use the eggs to have children in the future. Because her daughter cannot have her own children (infertile). The outcome would be that she would bear her mother’s children (or her own siblings).

There are currently no laws whatsoever that exist for this type of situation.