Assisted Reproductive Technology (ART) and Infertility

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Questions and Answers

What is the term for the absence of sperm in the ejaculate?

Oligozoospermia

Teratozoospermia

Asthenozoospermia

Azoospermia (correct)

What is the purpose of controlled ovarian stimulation in IVF or ICSI?

To reduce the risk of OHSS

To produce multiple oocytes for fertilization (correct)

To improve sperm motility

To increase the chances of embryo implantation

What is the significance of prolonged liquefaction in semen analysis?

Improved sperm motility

Better sperm morphology

Impaired sperm movement (correct)

Increased sperm count

What is the normal volume of semen in a semen analysis?

>1.5ml -5.0ml Signup and view all the answers

What is the purpose of sperm preparation for ART?

To select the best sperm for fertilization Signup and view all the answers

What is the term for the abnormal formation of sperm?

Teratozoospermia Signup and view all the answers

What is the purpose of oocyte culture in IVF or ICSI?

To allow for embryo development Signup and view all the answers

What is the significance of sperm agglutination in semen analysis?

It is a sign of immune reaction Signup and view all the answers

What is the purpose of seminal fluid analysis (SFA) in IVF or ICSI?

To evaluate overall sperm quality Signup and view all the answers

What is the normal pH range of semen in semen analysis?

Slightly alkaline >7.0 Signup and view all the answers

What is the estimated number of couples suffering from infertility worldwide?

48.5 million Signup and view all the answers

What is the primary cause of female infertility?

Age Signup and view all the answers

Which of the following is NOT a male specific cause of infertility?

Endometriosis Signup and view all the answers

What is the term for the transfer of gametes or embryos into the fallopian tube?

GIFT Signup and view all the answers

What is the term for the testing of embryos for genetic disorders before implantation?

PGT Signup and view all the answers

What is the primary cause of infertility in Malaysia?

Unexplained Signup and view all the answers

Which of the following is a dietary factor that can contribute to infertility?

All of the above Signup and view all the answers

What is the term for the freezing of gametes or embryos for future use?

Cryopreservation Signup and view all the answers

Study Notes

Infertility

Definition: Infertility is a condition where a couple is unable to conceive after a year of regular, unprotected sexual intercourse.
Primary infertility: When a couple has never had a child before.
Secondary infertility: When a couple has had a child before, but is unable to conceive again.
Worldwide statistics: 48.5 million couples suffer from infertility.
Malaysian statistics: Total fertility rate (TFR) declined from 4.9 children per woman in 1970 to 1.7 in 2020.

Causes of Infertility

General causes:
- 1/3 female factors
- 1/3 male factors
- 1/3 both/unexplained factors
Age: Decreased fertility by 50% at age 40, more related to female factor.
Genetic factors
Health conditions:
- Diabetes
- Thyroid
- STD
- Cancer
- Hypothalamic-pituitary factors
Environmental factors:
- Pesticides
- Chemicals
- Heavy metals
- Radiation
Lifestyle:
- Excessive alcohol intake
- Smoking
- Drug abuse
Medications:
- Anti-depression
- NSAIDs
- Uncertified local products
Chemotherapy
Dietary factors:
- Nutrient deficiencies (selenium, zinc, vit B, C, E)
- High cholesterol
- Caffeinated coffee

Female Factors

Vaginismus
Tubal factors:
- History of PID
- Tubal surgery
- Previous ectopic pregnancy
Pelvic causes:
- Endometriosis
- Adhesions
Ovarian disorders:
- Uterine/cervical factors:
  - Congenital uterine anomaly
  - Aging
  - Diminished ovarian reserve
  - Endocrine disorder
  - PCOS

Male Specific Causes

Obstruction in male reproductive ducts -> azoospermia
Hormonal disorders -> abnormalities in hormones produced by pituitary gland, hypothalamus, and testicles
Varicocele, accessory gland infection, hydrocele
Psychosexual problem:
- Erectile dysfunction
- Premature ejaculation
- Physical disabilities

Fertility Treatment

Timed sexual intercourse
Intrauterine insemination (IUI)
Assisted Reproductive Technology (ART)
- In vitro fertilization (IVF)
- Intracytoplasmic sperm injection (ICSI)
- Gamete intrafallopian transfer (GIFT)
- Zygote intrafallopian transfer (ZIFT)
- Cryopreservation – gametes, embryos
- Pre-implantation genetic testing (PGT)

Important Steps for IVF or ICSI

Controlled ovarian stimulation
Oocyte retrieval
Embryo freezing
Oocyte culture
Embryo transfer
Oocyte freezing
Insemination of gametes – IVF or ICSI

Steps for IVF or ICSI

Step 1: Hormone stimulation
Step 2: Oocyte retrieval / ovum pick up
Step 3: Oocyte / ovum / egg culture
Step 4: Sperm preparation

Sperm Preparation

Seminal fluid analysis (SFA)
Sperm DNA fragmentation – not routine
Sperm preparation for ART

Seminal Fluid Analysis (SFA)

Abstinence 2-5 days before test
Obtained by masturbation / coitus interruptus
Collected in a sterile container
Do not use lubricant / condom
Must bring to lab within 45min – 1 hr (kept in body temperature)

Semen Analysis

Macroscopic:
- Color: grayish white
- Liquefaction
- Viscosity
- Volume: >1.5ml -5.0ml
- pH (strips): Slight alkaline >7.0
Microscopic:
- Sperm concentration/count
- Sperm motility
- Sperm morphology

Sperm Concentration

Makler chamber
x 20 objective
Haemocytometer
Normal concentration: > 15 x 106/ml (in 10 boxes)
Total count: Normal concentration x Volume (per ejaculate)

Sperm Motility

Class 1: rapid progressive motility
Class 2: slow progress motility
Class 3: non-progressive motility
Class 4: immotile (no flagellar activity)
Total motility: Normal class 1+2>=30%

Sperm Morphology

Examples of abnormal morphology

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Description

This quiz covers the definition of infertility, primary and secondary infertility, and the decline of fertility rates worldwide. It also explores the history and investigations of infertility for both partners.