Lecture Notes, Biology 203, Human Sexuality and Reproduction

Reproductive Dysfunction

  1. Reproductive Dysfunction (Infertility)
    1. General
      1. Problem can be found in male, female, or combination of both
      2. Probability of achieving pregnancy is bell curve with peak at 1 year--couple of normal fertility may take any time from 0 to 2 years to achieve a pregnancy
      3. After a year of unsuccessful attempt, or when couple is distressed, they should see a fertility specialist
      4. Fertility specialist can discuss statistics, provide educational information, decrease couple's anxiety
      5. About 20% of couples who see a specialist achieve a pregnancy before any treatment begins
      6. Relative fertility of couple is significant factor
    2. Sources of fertility problems in the female
      1. Diagnosis of problem
        1. Basal body temperature
          1. Can determine when or if ovulation is occurring
          2. Must measure accurate oral temperature before rising each morning and graph
          3. After three cycles, should be able to observe 0.2-0.3 degree Fo drop just before ovulation and 1o rise just after ovulation
        2. Endometrial biopsy
          1. Sample of endometrium in 2nd half of cycle)
          2. Examined microscopically for normal reaction to hormone production
        3. Measurement of blood progesterone (esp. 2nd half of cycle)
        4. Daily measurement of all four hormones in blood (LH, FSH, E, P)
        5. Injection of radiopaque dyes into uterus to see whether Fallopian tubes are scarred or blocked due to infection, endometriosis
        6. Laparoscopic observation of outsides of Fallopian tubes, ovaries, etc., to look for scarring, endometriosis
      2. Solutions for woman who does not ovulate
        1. Clomid (stimulates pituitary to make FSH, inducing follicle development in ovary, 5% risk of multiples, 70% become pregnant)
        2. Pergonal (FSH/LH from postmenopausal women, acts directly to stimulate follicle in ovary, 10-20% hyperstimulated ovaries, 10-30% multiples)
      3. Solutions for woman with blocked Fallopian tubes
        1. Chance of surgical repair depends on location of damage
        2. If near uterus, internal scarring can be repaired in about 80% of women
        3. If near fimbriae (damage to cilia), internal scarring can be repaired in about 30% of women
        4. If external, scarring can be repaired in about 50% of women
    3. Sources of fertility problems in male
      1. Identification of problem
        1. Are sperm produced?
        2. Are sperm released?
        3. Are sperm in good condition?
        4. Examination of testes, epididymis, vas deferens, urethra, semen constituents
      2. Diagnosis by sperm "count"
        1. Requires sample of fresh semen, usually obtained by masturbation or postcoital (mixed with cervical fluids)
        2. Minimum of three counts to be reliable
        3. Number of sperm: 40-60 million
        4. Motility: 80%
        5. Appearance: normal shape, form
        6. Should gel in about 1 min., reliquefy in 10-30 min.
        7. Amount: 2.5-5 ml
        8. Normal sugars and other chemicals
        9. Can be deficient in some respect as long as normal in rest
      3. Diagnosis by testicular biopsy (sample of tissue to examine walls of seminiferous tubules)
      4. Examination of vas deferens and urethra, also epididymis and testes
        1. To determine whether scarred from infections
        2. May use radiopaque dyes
        3. STD's often cause scarring of vas deferens
        4. Mumps causes damage to epididymis
      5. Examination for varicose vein of testes
        1. If a man has fertility problems and has a varicose (enlarged) vein in testis, repairing it may help
        2. Not all men who have such a varicose vein have fertility problems
        3. Increases temperature near site of sperm manufacture, inhibiting it
        4. Worsened by wearing tight clothes that hold testes closer to body, frequent hot baths
      6. Correction of problem
        1. Surgery to correct blocked tube or varicose vein
        2. If sperm count indicates problem, artifical enhancement of sperm before using in assisted reproductive technique may be necessary