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INFERTILITY AND RELATED GENETICS  Slide 1 INFERTILITY AND RELATED GENETICS  Slide 2 INFERTILITY AND RELATED GENETICS  Slide 3 INFERTILITY AND RELATED GENETICS  Slide 4 INFERTILITY AND RELATED GENETICS  Slide 5 INFERTILITY AND RELATED GENETICS  Slide 6 INFERTILITY AND RELATED GENETICS  Slide 7 INFERTILITY AND RELATED GENETICS  Slide 8 INFERTILITY AND RELATED GENETICS  Slide 9 INFERTILITY AND RELATED GENETICS  Slide 10 INFERTILITY AND RELATED GENETICS  Slide 11 INFERTILITY AND RELATED GENETICS  Slide 12 INFERTILITY AND RELATED GENETICS  Slide 13 INFERTILITY AND RELATED GENETICS  Slide 14 INFERTILITY AND RELATED GENETICS  Slide 15 INFERTILITY AND RELATED GENETICS  Slide 16 INFERTILITY AND RELATED GENETICS  Slide 17 INFERTILITY AND RELATED GENETICS  Slide 18 INFERTILITY AND RELATED GENETICS  Slide 19 INFERTILITY AND RELATED GENETICS  Slide 20 INFERTILITY AND RELATED GENETICS  Slide 21 INFERTILITY AND RELATED GENETICS  Slide 22 INFERTILITY AND RELATED GENETICS  Slide 23
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INFERTILITY AND RELATED GENETICS

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INFERTILITY AND GENETICS

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INFERTILITY AND RELATED GENETICS

  1. 1. INFERTILITY Presented by: Mr. Dinabandhu Barad MSC Tutor, SNC, SOA, DTU
  2. 2. INFERTILITY • Infertility (subfertility): The failure to conceive after one year of unprotected regular sexual intercourse. Subfertility can be primary or secondary. • Primary subfertility: The delay that occurs for couples who have had no previous pregnancies. • Secondary subfertility: The delay that occurs for couples who have conceived previously, although the pregnancy may not have been successful (miscarriage, ectopic pregnancy).
  3. 3. FACTORS AFFECTING FERTILITY Increased chances of conception: • Woman aged under 30 years • Previous pregnancy • Less than three years trying to conceive • Intercourse occurring during six days before ovulation, particularly two days before ovulation
  4. 4. FACTORS AFFECTING FERTILITY • Woman’s body mass index (BMI) 20–30 • Both partners are non-smokers • Caffeine intake less than two cups of coffee daily • No use of recreational drugs
  5. 5. Reduced chances of conception: • Women aged over 35 years • No previous pregnancy • Trying to conceive for over three years • Intercourse incorrectly timed FACTORS AFFECTING FERTILITY
  6. 6. Reduced chances of conception: • Woman’s BMI < 20 or >30 • One or both partners smoke • High caffeine intake • Regular use of recreational drugs FACTORS AFFECTING FERTILITY
  7. 7. CAUSES OF SUBFERTILITY • Abnormal semen quality and sexual dysfunction are contributing factors in 50% of subfertile couples. • Subfertility affects one in 20 men. • Male subfertility are caused by testicular or genital tract infection, disease, or abnormalities. • Systemic disease, external factors (drugs, lifestyle), or combinations of these also result in male subfertility.
  8. 8. DRUGS THAT IMPAIR MALE FERTILITY • Impaired spermatogenesis: Sulphasalazine, methotrexate • Pituitary suppression: Testosterone injections • Antiandrogenic effects: Cimetidine • Ejaculation failure: α blockers, antidepressants • Erectile dysfunction: β blockers, thiazide • Drugs of misuse: Anabolic steroids, heroin, cocaine
  9. 9. TREATMENT OPTIONS AVAILABLE FOR SUBFERTILE MEN • Stopping adverse drugs and drug misuse like sulphasalazine and anabolic steroids misused by athletes • Timing and lifestyle changes • Treating accessory gland infection • Assisted conception: Intrauterine insemination and intracytoplasmic sperm injection and donor insemination.
  10. 10. FEMALE SUBFERTILITY • Anovulation, tubal subfertility, endometriosis, and fibroids are major reasons for female subfertility. • Anovulation: Disorders of ovulation account for 30% of infertility and often present with irregular periods (oligomenorrhoea) or an absence of periods (amenorrhoea). • Many of the treatments are simple and effective; therefore, couples may need only limited contact with doctors.
  11. 11. FEMALE SUBFERTILITY • However, not all causes of anovulation are amenable to treatment by ovulation induction. • Anovulation can sometimes be treated with medical or surgical induction, but it is the cause of the anovulation that will determine whether ovulation induction is possible.
  12. 12. CHROMOSOMAL • Turner’s Syndrome (45,X): Underdeveloped streak ovaries resulting in primary ovarian failure (premature menopause). • Androgen Insensitivity Syndrome (46,XY): Women have 46,XY karyotype with intra-abdominal gonads that are testes but have developed phenotypically as a female because of the absence of androgen receptors. The vagina ends blindly as there is no uterus and pregnancy is impossible.
  13. 13. TUBAL SUBFERTILITY • Patent fallopian tubes are a prerequisite for normal human fertility. However, patency alone is not enough—normal function is crucial. • Fallopian tubes have a crucial role in picking up the eggs and transporting the eggs, sperm, and embryo. • The fallopian tubes are also needed for sperm capacitation and egg fertilization.
  14. 14. TUBAL SUBFERTILITY • The fallopian tube is vulnerable to infection and surgical damage, which may impair function by affecting the delicate fimbriae or the highly specialized endosalpinx. • A fallopian tube obstruction occurs in 12–33% of infertile couples and hence tubal patency should be investigated early.
  15. 15. CAUSES OF TUBAL DAMAGE • INFECTION: Pelvic infection is a major cause of tubal subfertility. Infective tubal damage can be caused by sexually transmitted diseases, or can occur after miscarriage, termination of pregnancy, puerperal sepsis, or insertion of an intrauterine contraceptive device. Pelvic infections are most commonly caused by Chlamydia trachomatis, Gonorrhoea, and genital tuberculosis.
  16. 16. ENDOMETRIOSIS • Endometriosis is present in 20–40% of women who complain of subfertility. • Endometriosis is characterized by the presence of growth of endometrial tissue outside the uterus and is often associated with symptoms of dysmenorrhoea, dyspareunia, and subfertility.
  17. 17. ENDOMETRIOSIS • Pelvic examination may show tenderness, nodules of endometriosis on the uterosacral ligaments or an enlarged ovary, which may be secondary to an ovarian endometrioma. • The diagnosis of endometriosis is generally confirmed by laproscopy. Preoperative ultrasonography is helpful to diagnose the likely cause of a tender and enlarged ovary.
  18. 18. ASSISTED REPRODUCTIVE TECHNIQUES • Many assisted conception modules are offered to subfertile couples based on the etiology of subfertility. • Intrauterine insemination: For men with ejaculatory dysfunction and difficulty in coitus, semen sample is collected, washed, prepared, and deposited into the uterus at a time when ovulation is likely or assisted.
  19. 19. ASSISTED REPRODUCTIVE TECHNIQUES • The sample is washed; prepared motile sperm is deposited in the uterus just before the release of the egg in a natural or stimulated cycle. • The technique is effective when it is combined with mild superovulation using gonadotropins. • It is simpler, cheaper, and less invasive than IVF or ICSI and has fewer complications.
  20. 20. INTRACYTOPLASMIC SPERM INJECTION (ICSI) • A single sperm is injected into the cytoplasm of the egg to attain fertilization. • Multiple defects of sperm (concentration, motility, and morphology) show poor success in IVF; hence, ICSI is preferred. • ICSI is a specialized variant of IVF treatment in which fertilization is achieved by the injection of a single sperm directly into the cytoplasm of the egg. • Only mature eggs are suitable for injection with prepared sperm. • A single sperm is carefully examined and selected for normality of its morphology and with a fine glass needle it is inserted directly into the cytoplasm of the egg.
  21. 21. IN VITRO FERTILIZATION (IVF) • In IVF, oocytes (obtained surgically from ovarian follicles in superovulated cycles) are prepared and are brought together in a dish in the laboratory. • Fertilization takes place outside the body (in vitro = glass). • Cleavage stage embryos derived from these fertilized oocytes are placed in the uterus (embryo transfer) for pregnancy to occur.
  22. 22. DONOR INSEMINATION • It is advised to couples who suffer from azoospermia or failed ICSI. • Donors are hired by sperm banks and are screened for history of medical or genetic disorders and sexually transmitted infections. • The women must have atleast one fallopian tube functional and must be ovulatory to achieve success by donor insemination. • Counselling must be imparted to both partners to explore all the issues related to the use of donor gametes.
  23. 23. THANK YOU
  • KajalWakode

    Sep. 8, 2020
  • DilipKrishnaPodilapu

    Aug. 28, 2020

INFERTILITY AND GENETICS

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