INFERTILITY AND MODERN METHODS OF TREATMENT

Reproductive Health & Infertility

Reproductive Health (RH)

WHO Definition Goals of RH
Capacity to reproduce

Infertility
Involuntary childlessness Definition

Prevalence
Global 10% Regional Variations

Europe 5-10% Sub-Saharan Africa10-30%

Major RH problem in Africa

Etiology
STD - irreversible tubal damage Post abortion, post parturm infections Lack of ovulation Uterine disorders Male factors Cancer therapy

Social implications
Children as a basis of marriage Social stigma High cultural premium Women affected less than men

Methods of treatment
Prevention Conventional ART

Preventive approach

STDs - Reduce transmission

Education Condoms Screening of common STDs

Safe abortion Safe delivery

Modern Methods of Infertility Treatment - Male

Semen Analysis
Azoospermia
Obstructive

Surgery Sperm recovery Surgical sperm recovery Donor sperm

Non-obstructive (Testicular failure)

Oligospermia
IUI
Natural cycle Stimulated cycle (x 3 cycles) IF FAILED FOR IVF/ICSI

Oligoastenoteratozoospermia
ICSI

Modern Methods of Infertility Treatment - Female

Test for ovulation

Check for regular menstruation Check mid-cycle progesterone Early cycle hormonal profile
If abnormal ovulatory disorder

With ovarian egg reserve Rx: ovarian stimulation No ovarian reserve ovarian failure Rx: egg donation

Test for tubal occlusion

HSG Laparascopy
If tubal occlusion
Mild obstructon Laparascopic tubal surgery Severe obstruction - Open tubal surgery IF FAILED FOR IVF

Assisted Reproduction - Male

IUI(Husband)
Oligospermia Unexplained Infetility

IUI(Donor)
Oligospermia Azoospermia Genetic heritable disease Severe rhesus iso-immunization
X 6 cycles, If Failed for ICSI

ICSI
Severe oligospermia Azoospermia (ICSI+TESA) Poor fertilization at previous IVF

AssistedReproduction Female. IVF Treatment

Ovulation induction
Pituiary down regulation Ovarian stimulation Egg maturation Ultrasound monitoring

Oocyte retrieval ultrasound guided Sperm recovery Masturbatory, surgical or frozen Embryo transfer - UGET Hormonal support after embryo transfer.

IVM (in vitro maturation)

Polycystic ovaries Young women Risk of ovarian hyperstimulation

Oocyte Donation
Screening of oocyte donors Indications

Ovarian failure
Premature Menopausal Chemotherapy/radiotherapy

Oophorectomy Genetic heritable disorder IVF failure with own egg

Embryo Donation and Surrogacy

Need for screening embryo donors

Source of donated embryos

Indications for embryo donation same as for egg donation with Male azoospermia Surrogacy Uterus absent/non-functional Pregnancy with life-threatening complications

Male fertility preservation

Sperm

cryoconservation

Thawed sperm can be used in IUI, IVF or ISCI procedures depending on sperm quality

Cryoconservation

of testicular

tissue
Suitable only for ISCI procedure

Female fertility preservation

Mature

oocyte/ zygote/ embryo cryoconservation Immature oocyte cryoconservation

Ovarian tissue cryoconservation

Conclusion

Need for ART

Accessibility Affordability

Little Resources Cooperate support

THANK YOU FOR YOUR ATTENTION