Contraception, Infertility & Assisted Reproductive Technologies (ART) PDF

Chapter Contraception, Infertility & Assisted Reproductive Technologies (ART) Lesson Overview: Contraception Barrier method Terminal method Infertility Male & female infertility Assisted Reproductive Technologies (ART) Definitions Types & examples PPT by: P...

Chapter Contraception, Infertility & Assisted Reproductive Technologies (ART) Lesson Overview: Contraception Barrier method Terminal method Infertility Male & female infertility Assisted Reproductive Technologies (ART) Definitions Types & examples PPT by: Pro Dasigo Contraception Contraception Definitions: Contraception = against conception The preventive methods to help women avoid unwanted pregnancies are called contraceptive methods. Need for contraception Definitions: To avoid unwanted pregnancies. To regulate the timing of pregnancy To regulate the interval between pregnancy Ideal contraceptive Definitions: Safe Effective Acceptable Reversible Inexpensive Long lasting Requires little or no medical supervision Contraception Barrier Methods Barrier Methods Definitions: Male condoms : Female condoms IUD Diaphragm Pills Injectables Spermicides Patch Rings Withdrawal Calendar Method Condom Male Condoms Definitions: Most commonly known and used contraceptive A male condom is worn on the penis. It is usually made of latex, a type of rubber. But some are made of materials that are safe for people with latex allergies A condom is a sheath-shaped barrier device used during sexual intercourse to reduce the probability of pregnancy or a sexually transmitted infection. Female Condoms Definitions: Female condoms are a barrier method of contraception worn inside the vagina. They prevent pregnancy by stopping sperm meeting an egg. Diaphragm Definitions: A contraceptive diaphragm or cap is a circular dome made of thin, soft silicone that's inserted into the vagina before sex. It covers the cervix so sperm cannot get into the womb (uterus) to fertilise an egg. When used correctly with spermicide, a diaphragm or cap is 92-9 6 % effective at preventing pregnancy. Spermicides Definitions: Are surface active agents which attach themselves to spermatozoa and kill them. Available in various forms: Foams Creams Suppositories Soluble films Hormonal Contraceptives Definitions: Combined pill: combination of estrogen and progestogen Progestogen only pill: used in people above 40 years of age Post coittal contraception: Levonorgestrel Ullipristal Mifepristone Hormonal Contraceptives - Adverse effects Definitions: Cardiovascular effects Carcinogenesis Metabolic effects Liver adenomas Weight gain Breast tenderness Intrauterine Device (IUD) Definitions: IUD Injectables Definitions: Injectable contraceptive: combination of estrogen and progestogen Patch contraceptive Definitions: Patch contraceptive: used in people above 40 years of age Ring contraceptive: Levonorgestrel Ullipristal Mifepristone Combined pill: combination of estrogen and progestogen Progestogen only pill: used in people above 40 years of age Post coittal contraception: Levonorgestrel Ullipristal Mifepristone Microneedle Patch Contraception Terminal Methods Terminal Methods Definitions: Permanent methods One time method Vasectomy Tubal Ligation Infertility Infertility Definitions: Infertility - is defined as a failure to conceive within one or more years of regular unprotected intercourse. Types of infertility: Primary infertility: denotes couples who have never been able to conceive. Secondary infertility: indicates difficulty in conceiving after already having conceived. Infertility problems affects 1 in 7 couples. Etiology: Conception depends on fertility potential of both male and female partner. Male Infertility Male Factors Definitions: Defective spermatogenesis Obstruction of efferent duct Failure to deposit sperm high in the vagina Errors in the seminal fluid Defective spermatogenesis Definitions: Congenital: due to undescended testes; spermatogenesis is depressed. Hypospadias Thermal factor: vericocele Infection: mumps, orchitis damage, spermatogenesis Gonadotrophin suppression: happens in malnutrition, heavy smoking and high alcohol consumption. Endocrine factors: raised FSH level is seen in idiopathic testicular failure Loss of sperm motility Genetic: Kilenfelters syndrome (44 + XXY) Latrogenic: cytotoxic drugs, radiation therapy and antidepressant drugs are likely to obstruct spermatogenesis. Obstruction of efferent ducts Definitions: Gonococcal or tubercular infection. Surgical trauma during vasectomy. Failure to deposit sperm high in the vagina Definitions: Erectile dysfunction Ejaculatory defects such as premature retrograde or absence of ejaculation Hypospadias Errors in the Seminal Fluid Definitions: Low fructose content High prostaglandin content Unusually low volume of ejaculation Male infertility Problems with sexual function eg. difficulty with ejaculation, reduced sexual desire. Pain and swelling in the testicle area. Recurrent respiratory tract infection Decreased facial or body hair Having a low sperm count Gynacomestia Inability to smell Diagnosis & Examination (male infertility) Definitions: History collection Physical examination: general appearance of external genitalia Semen analysis test: semen volume, sperm motility and culture. Genetic test: Sex chromosome and somatic mutation. Endocrine test: serum testosterone, serum LH and FSH Treatment of Male Infertility Definitions: Treatment of male partner is indicated in extreme oligospermia, azospermia, low volume ejactulation and impotency. May consist of: Improvement of general health Avoiding specific medications Medications to treat specific causes Specific treatment Surgical management Treatment of Male Infertility Definitions: Improvement of general health: Reduction of weight in obese. Avoidance of alcohol and heavy smoking. Avoidance of occupation that may elevate testicular temperature. Avoiding medicaitons Medication that interferes with spermatogenesis such as beta blockers, anti depressant, cytotoxic drugs, cimetidine should be avoided. Medication to treat specific causes: HCG, H M G for hypogonadism. Dopamine agonists to improve low libido Clomophene citrate Antibiotics for genital tract infection Specific treatment: Includes intrauterine insemination, Invitro fertilization, intracytoplasmic sperm injection Surgical Treatment Definitions: Vasovasostomy: a surgical procedure in which the effects of a vasectomy are reversed. A minor surgical procedure to allow men who have had vasectomies father children again. Allows men who have had vasectomies to father children again. Creates an opening between the separated ends of the vas deferens. Female Infertility Female Infertility Definitions: Causes of female infertility: Ovulation problems Fallopian tube damage Risk factors Genetics: Turner syndrome (44= XO) Ovulation Problems Definitions: A hormonal imbalance: FSH or LH secretion Anovulation Polycystic ovarian disease Eating disorders such as anorexia or bulimia. Stress Alcohol or drug use Intense exercise that causes a loss of body fat. Fallopian Tube Damage Definitions: Previous infection due to gonorrhea. Fibroids Endometriosis: appearance of endometrial tissue outside the womb. Causes pain. Ectopic pregnancy A congenital effect Risk Factors Definitions: Characteristics at the biological, psychological, family, community, or cultural level that precede and are associated with a higher likelihood of negative outcomes. Age, poor diet and being over or underweight Diagnosis Definitions: Laboratory test: Measurement of FSH and progesterone. Endometrial biopsy is performed to verify ovulation Hysterosalpinography Laparoscopy Pap smear to check for signs of infection. Hysterosalpinography Definitions: an X-ray procedure that is used to view the inside of the uterus and fallopian tubes Laparoscopy Definitions: a type of surgical procedure that allows a surgeon to access the inside of the abdomen (tummy) and pelvis without having to make large incisions in the skin. Pap Smear Definitions: A Pap smear, also called a Pap test, is a procedure to test for cervical cancer in women. A Pap smear involves collecting cells from your cervix — the lower, narrow end of your uterus that's at the top of your vagina. Treatment Definitions: Treatment of female infertility consist of fertility restoration drugs, fertility restoration surgeries and assisted reproductive technologies (ART). Treatment is usually non-specific. Fertility Restoration Drugs Definitions: To stimulate ovulation. Drugs are: Clomophene citrate Human menopausal gonadotrophins Follicle stimulating hormones Gonadotrophin releasing hormone analog Bromocriptine. Fertility Restoration Surgeries Definitions: Tissue removal: this surgery removes endometrial or pelvic adhesions with lasers or ablation. Tubal surgeries: if fallopian tubes are blocked or filled with fluid, tubal surgeru improve changes of becoming pregnant. Laparascopic surgery: surgergy is performed to remove adhesions and create a new tubal opening Salpingectomy: improve chances of pregnancy with in vitro fertilization. Salpingectomy Definitions: Assisted Reproductive Technology Assisted Reproductive Technologies (ART) Definitions: ART involves removing of eggs from a woman’s body and mixing with sperm in the laboratory. Involves: TESA IUI IVF Zygote intrafallopian transfer (ZIFT) Gamete intrafallopian transfer (GIFT) Intracytoplasmic sperm injection (ICSI)  ASSISTED REPRODUCTIVE TECHNOLOGIES (ART) advanced techniques which are used to bring eggs and sperms together all fertility treatments in which both eggs and embryos are handled TESA is a surgical sperm retrieving procedure, performed when the male has viable sperm quality but is unable to ejaculate during sex or masturbation. Intrauterine Insemination (IUI) Definitions: It is a procedure in which a catheter is inserted through the cervix into the uterus to deposit a sperm sample directly into the uterus. Intrauterine Insemination (IUI) Definitions: The sperm is placed directly into the uterus using a small catheter. The goal of this treatment is to improve the chances of fertilization by increasing the number of healthy sperm that reach the fallopian tubes when the woman is most fertile. In Vitro Fertilization Definitions: Is a process by which an egg is fertilized by sperm outside the body. In vitro = in glass In Vitro Fertilization Definitions: During in vitro fertilization, mature eggs are collected from ovaries and fertilized by sperm in a lab. Then a procedure is done to place one or more of the fertilized eggs, called embryos, in a uterus, which is where babies develop. One full cycle of IVF takes about 2 to 3 weeks. Louise Joy Brown is an English woman who was the first human to have been born after conception by in vitro fertilisation experiment. Her birth, following a procedure pioneered in Britain, has been lauded among "the most remarkable medical breakthroughs of the 20th Century". Intracytoplasmic sperm injection (ICSI) Definitions: ICSI is the most successful form of treatment who are infertile. ICSI only requires one sperm which is injected directly into the egg and fertilized egg is transfered to uterus. IVF vs ICSI Definitions: Zygote intrafallopian transfer (ZIFT) Definitions: ZIFT is an ART designed to transfer the fertilized embryo into the fallopian tube instead of the uterus Zygote is placed in the fallopian tube through which it will reach into the uterus It is similar to IUF Gamete intrafallopian transfer (GIFT) Definitions: Involves transferring eggs and sperm into the women’s fallopian tubes so fertilization occurs in the woman’s body. Gamete intrafallopian transfer (GIFT) uses multiple eggs collected from the ovaries. The eggs are placed into a thin flexible tube (catheter) along with the sperm to be used. The gametes (both eggs and sperm) are then injected into the fallopian tubes using a surgical procedure called laparoscopy. Lecture References Further books & references: