infertility-2 - Infertility Infertility David Toub, M.D....

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Infertility Infertility David Toub, M.D. Medical Director Newton Interactive QuickTimeª and a Microsoft Video Utility decompr are needed to see this picture.
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Definitions Definitions Infertility Inability to conceive after one year of unprotected intercourse (6 months for women over 35?) Fertility Ability to conceive Fecundity Ability to carry to delivery
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Statistics Statistics 80% of couples will conceive within 1 year of unprotected intercourse ~86% will conceive within 2 years ~14-20% of US couples are infertile by definition (~3 million couples) Origin: Female factor ~40% Male factor ~30% Combined ~30%
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Etiologies Etiologies Sperm disorders 30.6% Anovulation/oligoovulation 30% Tubal disease 16% Unexplained 13.4% Cx factors 5.2% Peritoneal factors 4.8%
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Associated Factors Associated Factors PID Endometriosis Ovarian aging Spermatic varicocoele Toxins Previous abdominal surgery (adhesions) Cervical/uterine abnormalities Cervical/uterine surgery Fibroids
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Emotional and Educational Emotional and Educational Needs Needs Disease of couples, not individuals Feelings of guilt Where to go for information? Options Feelings of frustration and anger Support groups (e.g. Resolve)
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Overview of Evaluation Overview of Evaluation Female Ovary Tube Corpus Cervix Peritoneum Male Sperm count and function Ejaculate characteristics, immunology Anatomic anomalies
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The Most Important Factor in The Most Important Factor in the Evaluation of the Infertile the Evaluation of the Infertile Couple Is: Couple Is:
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HISTORY HISTORY
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History-General History-General Both couples should be present Age Previous pregnancies by each partner Length of time without pregnancy Sexual history Frequency and timing of intercourse Use of lubricants Impotence, anorgasmia, dyspareunia Contraceptive history
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History-Male History-Male History of pelvic infection Radiation, toxic exposures (include drugs) Mumps Testicular surgery/injury Excessive heat exposure (spermicidal)
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History-Female History-Female Previous female pelvic surgery PID Appendicitis IUD use Ectopic pregnancy history DES (?relation to infertility) Endometriosis
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History-Female History-Female Irregular menses, amenorrhea, detailed menstrual history Vasomotor symptoms Stress Weight changes Exercise Cervical and uterine surgery
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When Not to Pursue an Infertility Evaluation Infertility Evaluation Patient not sexually-active Patient not in long-term relationship? Patient declines treatment at this time
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This note was uploaded on 12/24/2011 for the course STEP 1 taught by Professor Dr.aslam during the Fall '11 term at Montgomery College.

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infertility-2 - Infertility Infertility David Toub, M.D....

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