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Bài giảng Vô sinh - Hiếm muộn trình bày về điều kiện thụ thai, vô sinh, tỷ lệ thụ thai sau các lần điều trị vô sinh - hiếm muộn, nguyên nhân gây vô sinh, bất thường trong quá trình sinh tinh, đánh giá sự rụng trứng. Mời các bạn tham khảo bài giảng để nắm bắt nội dung chi tiết.
VÔ SINH –HIẾM MUỘN Điều kiện thụ thai Sản xuất trứng tinh trùng khỏe mạnh ! Ống dẫn trứng thông cho phép tinh trùng tiếp cận đến trứng ! Tinh trùng có khả xuyên vào trứng thụ tinh trứng ! Phôi làm tổ tử cung ! Thai khỏe mạnh ! Vô sinh ! Khụng th cú dự mun cú sau Ô năm (< 35 tuổi) hay tháng (>35 tuổi) ¤ Tác động đến 15% cặp vợ chồng " 6.1 ¤ Khả triệu cặp vợ chồng vô sinh nam nữ Vô sinh ! Tuổi sinh sn n Ô Nhỡn chung 15-44 l tui sinh sn Ô S sinh sn gim i ẵ độ tuổi 37-45 thay đổi trình rụng trứng ¤ 20% phụ nữ có trước 30 ¤ 1/3 cặp sau 35 tuổi có vấn đề sinh sản Rụng trứng giảm " Sự khỏe trứng giảm " ! • Các vấn đề sức khỏe bắt đầu xuất • SAB Nếu điều trị thích hợp có đến 85% cặp vợ chồng vơ sinh có Vơ sinh ! Vụ sinh nguyờn phỏt Ô Mt ! cp v chồng khơng có Vơ sinh thứ phát ¤ Vơ sinh xảy sau có đứa Percent of Couples Conceiving Tỉ lệ mang thai sau lần điều trị 100 90 80 70 60 50 40 30 20 10 0 12 18 Months of Treatment (cycles) 24 Tuổi khả mang thai Pregnancy Rates % Cycle number Tuổi số lần sẩy thai Nguyên nhân gây vô sinh ! ! Nam ¤ ¤ ¤ ¤ ¤ ¤ ¤ ¤ Age ETOH Drugs Tobacco Health problems Radiation/Chemotherapy Age Enviromental factors " " N Pesticides Lead Ô Stress Ô Poor diet Ô Athletic training Ô Over/underweight Ô Tobacco Ô ETOH Ô STDs Ô Health problems Nguyên nhân vô sinh Không rụng trứng (10-20%) ! Khiếm khuyết giải phẫu quan sinh sản nữ (30%) ! Bất thường trình sinh tinh (40%) ! Khơng giải thích (10%-20%) ! Anatomic Abnormalities ! Surgical treatments Ô Lysis of adhesions Ô Septoplasty Ô Tuboplasty Ô Myomectomy ! Surgery may be performed Ô laparoscopically Ô hysteroscopically ! If the fallopian tubes are beyond repair one must consider in vitro fertilization Assisted Reproductive Technologies (ART) Explosion of ART has occurred in the last decade ! Theses technologies help provide infertile couples with tools to bypass the normal mechanisms of gamete transportation ! Probability of pregnancy in healthy couples is 30-40% per cycle, live birth rate 25% ! ¤ this varies depending on age Primary Diagnosis of Women Undergoing ART- 1998 12% 15% 9% 2% 27% 9% 26% Tubal factor Male factor Ovulation dysfxn Endometriosis Unexplained Uterine factor Other Emotional Impact Infertility places a great emotional burden on the infertile couple ! The quest for having a child becomes the driving force of the couples relationship ! The mental anguish that arises from infertility is nearly as incapacitating as the pain of other diseases ! It is important to address the emotional needs of these patients ! Conclusion Infertility should be evaluated after one year of unprotected intercourse ! History and Physical examination usually will help to identify the etiology ! If patients fail the initial therapies then the proper referral should be made to a reproductive specialist ! Test Question Case ! A couple in their late 20’s with primary infertility for 18 months The women has regular monthly cycles The husband has never fathered a child Neither partner has a history of STD’s or major illness No difficulties with erection or ejaculation Which is the most likely cause of their infertility? A Anovulation B Abnormality of Spermatogenesis C Female Anatomic disorder D Immunologic disorder Case ! Spermatogenesis- causes 40% infertility, anovulation-10-20% and anatomic defects- 30-40%-the majority of which being from salpingititis Given the history of regular menstrual cycles and no infections, anovulation and anatomic defects is unlikely Which study would not be indicated as part of the initial evaluation? A Basal Body temperature record B Semen Analysis C Hysterosalpingogram D Diagnostic Laparoscopy ! Case ! ! Diagnostic Laparoscopy- This should be reserved until the initial tests are completed All the other tests are used in the initial workup Anovulation is found in the female partner, despite her regular cycles The next step is? A Induce ovulation with clomid B Perform artificial insemination C Induce ovulation with gonadotropins (pergonal) D Perform diagnostic laparoscopy to rule out other causes Case ! Induce ovulation with clomid- Gonadotropins would be used if the patient failed clomid Artificial insemination and laparoscopy are not indicated yet Case A 37 yo women with a history of gonococcal salpingitis presents with her spouse for evaluation of infertility ! What study is most indicated on the initial evaluation? ! A Basal body temperature record B Semen analysis C Hysterosalpingogram D Endometrial Biopsy Case ! ! Without evidence of anovulation the endometrial bx is not indicated The couple should have A, B, and C The HSG reveals bilateral tubal obstruction A consultant recommends she not have surgery because of the poor prognosis of pregnancy What should be recommended next? A Intrauterine insemination B In vitro fertilization C No therapy at all D Adoption Case ! Because of the obstruction in the tubes the only appropriate therapy would be in vitro fertilization Insemination would not get the sperm past the obstruction Adoption is also and option Questions? Causes for Abnormal SA ! No sperm Ô Klinefelters Abnormal Count ! Few sperm syndrome Ô Sertoli only syndrome Ô Ductal obstruction Ô Hypogonadotropichypogonadism Ô Genetic disorder Ô Endocrinopathies Ô Varicocele ¤ Exogenous (e.g., Heat) Cont causes for abnormal SA ! Abnormal Morphology Ô Ô Ô ! Varicocele Stress Infection (mumps) ! Abnormal Volume Ô " " " Abnormal Motility Ô ¤ ¤ ¤ ¤ Immunologic factors Infection Defect in sperm structure Poor liquefaction Varicocele No ejaculate " Ô Ductal obstruction Retrograde ejaculation Ejaculatory failure Hypogonadism Low Volume " " " " " Obstruction of ducts Absence of vas deferens Absence of seminal vesicle Partial retrograde ejaculation Infection ... Nguyờn nhõn vô sinh Không rụng trứng (1 0-2 0%) ! Khiếm khuyết giải phẫu quan sinh sản nữ (30%) ! Bất thường q trình sinh tinh (40%) ! Khơng giải thích (10 %-2 0%) ! Đánh giá cặp vô sinh Đánh giá... sinh ! Khơng thể có dự mun cú sau Ô nm (< 35 tui) hay thỏng (>35 tui) Ô Tỏc ng n 15% cp v chng " 6.1 Ô Kh triu cp vợ chồng vô sinh nam nữ Vụ sinh ! Tui sinh sn n Ô Nhỡn chung 1 5-4 4 l tui sinh. .. Nếu điều trị thích hợp có đến 85% cặp vợ chồng vơ sinh có Vơ sinh ! Vơ sinh ngun phỏt Ô Mt ! cp v chng khụng bao gi cú Vụ sinh th phỏt Ô Vụ sinh xy sau có đứa Percent of Couples Conceiving Tỉ