Showing posts with label Reproductive Medicine. Show all posts
Showing posts with label Reproductive Medicine. Show all posts

07 May 2012

Female Reproductive Endocrinology



Female Reproductive System
Female Reproductive System.ppt

Female Reproductive Endocrinology
Joel Michael, PhD
GU block/Pregnancy.ppt

Reproductive Endocrinology
Reproductive Endocrinology.ppt

Female Reproductive System Aging
Female Reproductive System Aging.ppt

Endocrinology of reproduction
Reproductive endocrinology.ppt

Female Reproductive Endocrinology
Kenneth L. Campbell
FemaleRepro.ppt

Female Reproductive Endocrinology
Female Reproductive Endocrinology.ppt

Female Reproductive Endocrinology
Joel Michael, PhD
Female Reproductive Endocrinology.ppt

Female Reproductive Endocrinology
Female Reproductive Endocrinology.ppt

Female Reproductive System
Ricki Otten, MT(ASCP)SC
Female Reproductive Endocrinology-1.ppt
Female Reproductive Endocrinology-2.ppt

What is Assisted Reproductive Technology?
Amanda J. Weathers
Assisted Reproductive Technology.ppt

Female Reproductive Endocrinology
gonadalhormones.ppt

Female Reproductive Endocrinology
femalerepro,estrogen.ppt

Read more...

26 January 2012

Sperm Disorders Ppts



Infertility Treatment
by: Joshua Prince, Preston Moore, Candace Lindler
Fertilization Specialists
https://camcom.ngu.edu/Science/biology/BIOL%203465/male%20reproductive%20problems.ppt

Male Reproductive System and Genitourinary Disorders
by Eva Talastas
http://webenhanced.lbcc.edu/vnjm/vn255jm/coursedocs/male.ppt

Developmental, Genetic,  & Pediatric Disease
http://nhscience.lonestar.edu/biol/durham/docs/biol2305/7%20Developmental,%20Genetic,%20&%20Pediatric%20Disease.ppt

Reproductive  Function & Disorders
bby Mandy  Vichas RN, BSN, NPS
http://facweb.northseattle.edu/gmihalyne/nur128/power%20points/SP08%20Reproductive%20Function%20&%20Disorders.ppt

Assessment  and Management of Patients with Endocrine  Disorders
by Linda Self
http://www.atu.edu/nursing/faculty_docs/self/Assessment_and_Management_of_Patients_with_Endocrine_Disorders.ppt

Male  Reproductive System
http://www.netc.edu/faculty/twright/MT%20_Ch07.ppt


Read more...

01 September 2011

Female Genital Cutting



Female Genital Cutting
By:Safa Magid

Female Genital Cutting(FGC)
* Also known as: female circumcision & female genital mutilation
* Female circumcision is the term preferred by cultures who practice this custom

FGC -Definition
* Procedure involving partial or total removal of the external female genitalia or other injury to the female genital organs whether for cultural, religious, or other non-therapeutic reasons.

WHO Classification of FGC
* Type 1: Excision of prepuce w/ or w/o excision of all of the clitoris
* Type 2: Clitoridectomy and partial or total excision of labia minora
* Type 3: Infibulation, includes removing all or part of ext. genitalia and re-approximation of remnant labia majora, leaving a small interoitus for passage of urine and menstrual blood

* Type 1 and Type 2 are the most common forms
* Type 1 and Type 2 account for 80% of the cases
* Infibulation accounts for 15% of the cases

FGC
* Currently ~ 130 million women and girls have had the procedure
* An estimated 2 million girls worldwide are at risk per year

FGC in the US

* Data from 2000 census suggests:
228,000 women and girls are with or at risk for FGC in the United States
* CA, NY, and MD have the most female immigrants and refugees from countries where FGC is prevalent.
* Occurs mostly in 28 sub-Saharan African countries
* FGC is practiced by Christians, Muslims, and adherents to traditional African religions
* Also practiced in Middle East and Asia

Origins and History
* Origins remain unclear
* FGC practiced in Pre-Islamic Arabia, ancient Rome, and Tsarist Russia
* Female circumcision was discovered in ancient Egyptian mummies in 200 B.C.
* Practiced in the United States until the 1970’s to tx hysteria, lesbianism, and erotomania

FGC and Religion
* Christianity:
FGC is not an obligatory religious requirement
* Islam:
FGC is not an obligatory religious requirement

FGC-Procedure
* Performed between the ages of 5-10, or prior to marriage
* Performed by a member of community who is not a healthcare worker
* Often performed w/o anesthesia
* However in metropolitan areas the use of anesthesia is more common

FGC Procedure
* Performed w/o surgical instruments. Razor blades or other instruments which may or may not be sterile are used
* Depending on socio-economic factors FGC may also be performed in a health care facility by qualified health personnel
* WHO is opposed to medicalization of all types of female genital mutilation.
* Reasons currently practiced:
o Rite of passage to womanhood
o Maintains chastity
o Ensure marriageablity
o Belief that it improves hygiene
o Social pressure to adhere to custom
o Belief that it is a religious requirement

Complications
* Prevalence of complications is unknown
* Rate of complications increase with severity of procedure( i.e. women with type III have > complications that women w/type I)
* A study of 120 Somalian women suggests rate of complications are inversely proportional to the age of the child when FGC was performed
* Women who had FGC btwn the ages of 5-8, had more complications than their 9-12 y.o counterparts
* Long and short term complications
* Some women with FGC do not experience complications

Short term complications
* Hemorrhage
* Severe pain
* Shock
* Infection
* Urine retention
* Ulceration of genital region injury to adjacent tissue
* HIV?-Possibly transmitted due to use of unsterilized equipment

Long Term Complications
* Cysts and abscesses
* Post-partum fistulaes: vesico-vaginal
* Keloid scar formation
* Damage to the urethra resulting in urinary incontinence
* Dyspareunia and sexual dysfunction
* Infertility
* Difficulties with labor.

Case Report

* 16 y.o female presents w/severe dysmenorrhea
* PE revealed the absence of a clitoris and fused labia majora with a 1cm opening
* Physicians initially thought pt had corrective surgery for ambiguous genitalia
* Later determined that while visiting Africa with her mother she had FGC performed
* Perinealography revealed:
o Filling of the vagina,urethra, and bladder simulating a urogenital sinus.
o Dilated vagina suggested obstruction
Perinealography

Case Report
* Defibulation procedure was performed
* The patients symptoms of dysmenorrhea eventually resolved

FGC and Obstetric outcomes
* WHO Study

FGC & Length of maternal hospital stay
* FGC and length of maternal hospital stay
o FGC Type I- RR: 1.15
o FGC Type II-RR:1.51
o FGC Type III-RR:1.98

FGC and Mental Health
* Anxiety
* Depression
* PTSD
* Feeling of incompleteness

Defibulation
* Corrective procedure
* Involves division of the fused labia majora with suturing of each labia for hemostasis
* Thus the infibulated scar, which is a flap obstructing the introitus and urethra, is removed
* WHO Indications for defibulation:
* Urinary retention
* Recurrent UTI’s or kidney infections
* Dysmenorrhea
* Dyspareunia or apareunia
* Prior to coitus
* Prior to labor
* It is also reasonable that defibulation can be performed to alleviate any mental health consequences for women who do not meet the WHO indications

Approach to patients with FGC
* Some physicians remain unfamiliar w/FGC & have expressed their shock during PE
* Some women report being reprimanded by physicians for having the procedure done
* Despite the fact the majority had FGC while they were children and were not given a choice

Patients perspective of FGC
* Many pts w/FGC who have immigrated to the West do not feel as if they abused
* Some feel that FGC was done “for them” and not an attack against them

Patients perspective of FGC
* 1st generation pts born in the West who had FGC while traveling abroad often have very different views than their foreign born counterparts
* HC workers may need to modify their approach depending on the pts perspective

Legality of FGC
* U. S. passed a law in March 1997:
* Made performing any medically unnecessary surgery on the genitalia of a girl younger than 18 years of age a federal crime.
* Reinfibulation was not included as a federal crime, so it may be performed with absorbable sutures in a running fashion if a woman chooses the procedure


Resources for pts and HC providers
* African’s Women’s Health Center
o Established in 1999 by Dr. Nawal Nour a Sudanese-American OB/GYN
o Goal of clinic is to provide culturally appropriate holistic care to African women who are refugees who may or may not have undergone FGC
o Defibulation is performed at this clinic

Resources for pts and HC providers
* WHO
* Website with information about FGC
* Includes fact sheet about FGC and guidelines for healthcare workers
* http://www.who.int/topics/female_genital_mutilation/en/
* http://www.who.int/reproductive-health/publications/rhr_01_18_fgm_policy_guidelines/index.html

Dedicated to all of my sisters who have had FGC.
To those who have suffered physical or mental consequences, I am inspired by your courage and strength.

References
Female Genital Cutting.ppt

Read more...

22 February 2010

Female Genital Cutting



Female Genital Cutting
By:Safa Magid

Female Genital Cutting(FGC)
* Also known as: female circumcision & female genital mutilation
* Female circumcision is the term preferred by cultures who practice this custom

FGC -Definition
* Procedure involving partial or total removal of the external female genitalia or other injury to the female genital organs whether for cultural, religious, or other non-therapeutic reasons.

WHO Classification of FGC
* Type 1: Excision of prepuce w/ or w/o excision of all of the clitoris
* Type 2: Clitoridectomy and partial or total excision of labia minora
* Type 3: Infibulation, includes removing all or part of ext. genitalia and re-approximation of remnant labia majora, leaving a small interoitus for passage of urine and menstrual blood

* Type 1 and Type 2 are the most common forms
* Type 1 and Type 2 account for 80% of the cases
* Infibulation accounts for 15% of the cases

FGC
* Currently ~ 130 million women and girls have had the procedure
* An estimated 2 million girls worldwide are at risk per year

FGC in the US

* Data from 2000 census suggests:
228,000 women and girls are with or at risk for FGC in the United States
* CA, NY, and MD have the most female immigrants and refugees from countries where FGC is prevalent.
* Occurs mostly in 28 sub-Saharan African countries
* FGC is practiced by Christians, Muslims, and adherents to traditional African religions
* Also practiced in Middle East and Asia

Origins and History
* Origins remain unclear
* FGC practiced in Pre-Islamic Arabia, ancient Rome, and Tsarist Russia
* Female circumcision was discovered in ancient Egyptian mummies in 200 B.C.
* Practiced in the United States until the 1970’s to tx hysteria, lesbianism, and erotomania

FGC and Religion
* Christianity:
FGC is not an obligatory religious requirement
* Islam:
FGC is not an obligatory religious requirement

FGC-Procedure
* Performed between the ages of 5-10, or prior to marriage
* Performed by a member of community who is not a healthcare worker
* Often performed w/o anesthesia
* However in metropolitan areas the use of anesthesia is more common

FGC Procedure
* Performed w/o surgical instruments. Razor blades or other instruments which may or may not be sterile are used
* Depending on socio-economic factors FGC may also be performed in a health care facility by qualified health personnel
* WHO is opposed to medicalization of all types of female genital mutilation.
* Reasons currently practiced:
o Rite of passage to womanhood
o Maintains chastity
o Ensure marriageablity
o Belief that it improves hygiene
o Social pressure to adhere to custom
o Belief that it is a religious requirement

Complications
* Prevalence of complications is unknown
* Rate of complications increase with severity of procedure( i.e. women with type III have > complications that women w/type I)
* A study of 120 Somalian women suggests rate of complications are inversely proportional to the age of the child when FGC was performed
* Women who had FGC btwn the ages of 5-8, had more complications than their 9-12 y.o counterparts
* Long and short term complications
* Some women with FGC do not experience complications

Short term complications
* Hemorrhage
* Severe pain
* Shock
* Infection
* Urine retention
* Ulceration of genital region injury to adjacent tissue
* HIV?-Possibly transmitted due to use of unsterilized equipment

Long Term Complications
* Cysts and abscesses
* Post-partum fistulaes: vesico-vaginal
* Keloid scar formation
* Damage to the urethra resulting in urinary incontinence
* Dyspareunia and sexual dysfunction
* Infertility
* Difficulties with labor.

Case Report

* 16 y.o female presents w/severe dysmenorrhea
* PE revealed the absence of a clitoris and fused labia majora with a 1cm opening
* Physicians initially thought pt had corrective surgery for ambiguous genitalia
* Later determined that while visiting Africa with her mother she had FGC performed
* Perinealography revealed:
o Filling of the vagina,urethra, and bladder simulating a urogenital sinus.
o Dilated vagina suggested obstruction
Perinealography

Case Report
* Defibulation procedure was performed
* The patients symptoms of dysmenorrhea eventually resolved

FGC and Obstetric outcomes
* WHO Study

FGC & Length of maternal hospital stay
* FGC and length of maternal hospital stay
o FGC Type I- RR: 1.15
o FGC Type II-RR:1.51
o FGC Type III-RR:1.98

FGC and Mental Health
* Anxiety
* Depression
* PTSD
* Feeling of incompleteness

Defibulation
* Corrective procedure
* Involves division of the fused labia majora with suturing of each labia for hemostasis
* Thus the infibulated scar, which is a flap obstructing the introitus and urethra, is removed
* WHO Indications for defibulation:
* Urinary retention
* Recurrent UTI’s or kidney infections
* Dysmenorrhea
* Dyspareunia or apareunia
* Prior to coitus
* Prior to labor
* It is also reasonable that defibulation can be performed to alleviate any mental health consequences for women who do not meet the WHO indications

Approach to patients with FGC
* Some physicians remain unfamiliar w/FGC & have expressed their shock during PE
* Some women report being reprimanded by physicians for having the procedure done
* Despite the fact the majority had FGC while they were children and were not given a choice

Patients perspective of FGC
* Many pts w/FGC who have immigrated to the West do not feel as if they abused
* Some feel that FGC was done “for them” and not an attack against them

Patients perspective of FGC
* 1st generation pts born in the West who had FGC while traveling abroad often have very different views than their foreign born counterparts
* HC workers may need to modify their approach depending on the pts perspective

Legality of FGC
* U. S. passed a law in March 1997:
* Made performing any medically unnecessary surgery on the genitalia of a girl younger than 18 years of age a federal crime.
* Reinfibulation was not included as a federal crime, so it may be performed with absorbable sutures in a running fashion if a woman chooses the procedure


Resources for pts and HC providers
* African’s Women’s Health Center
o Established in 1999 by Dr. Nawal Nour a Sudanese-American OB/GYN
o Goal of clinic is to provide culturally appropriate holistic care to African women who are refugees who may or may not have undergone FGC
o Defibulation is performed at this clinic

Resources for pts and HC providers
* WHO
* Website with information about FGC
* Includes fact sheet about FGC and guidelines for healthcare workers
* http://www.who.int/topics/female_genital_mutilation/en/
* http://www.who.int/reproductive-health/publications/rhr_01_18_fgm_policy_guidelines/index.html

Dedicated to all of my sisters who have had FGC.
To those who have suffered physical or mental consequences, I am inspired by your courage and strength.

References
Female Genital Cutting.ppt


Read more...

11 January 2010

Male Reproductive Problems



Male Reproductive Problems
By:Fertilization Specialists
Joshua Prince
Preston Moore
Candace Lindler

Infertility
* Infertility is the inability of a couple to become pregnant
* 6.1 million people in the United States are effected

Treatment
Normospermia with functional defects
Asthenospermia and teratozoospermia
Oligospermia
Untreatable subfertility
Reversible toxin effects
Disorders of sexual function
Gonadotropin deficiency
Obstructive azoospermia
Sperm autoimmunity
Treatable conditions
Primary seminiferous tubule failure
Untreatable sterility
FREQUENCY (%)

TYPE OF INFERTILITY
Table 1. Classification Of Male Infertility By Effectiveness Of Medical Intervention To Improve Natural Conception Rate

* Sperm count equals the number of sperm per cm3 or cc
* The average has dropped in the past 20 years
* 85-90% are treated with medication or surgery
* Lifestyle changes

Normal Reproduction
* Ovulation
* Spermatogenesis
* Sperm meets with egg in fallopian tube
* Fertilization
* Implantation

Male Reproductive System
Female Reproduction System
Normal Spermatogenesis
Testes

* Normal Testes
* 10-14 grams
* Body of the testis
o Epididymis
o Spermatic Cord
* Embryonal Carcinoma
o hemorrhage and necrosis
* Spermatogonium (2N)
Differentiation
* Primary Spermatocyte (2N)
Meiosis I
* Secondary Spermatocytes
Meiosis II
* Spermatids
Differentiation
* Spermatozoa

Spermatogenesis
* Seminferous Tubules
90% of the testis
* Thousands of sperm per second although spermatogenesis 8-10 weeks
* Stored for months
* Degraded and deposited into the circulatory system if not ejaculated

Klinefelter Syndrome
* XXY instead of XX or XY
* usually male
* lower levels of testosterone
* improper formation of semineferous tubules

Bilateral Anorchia
* vanishing testes syndrome
* testes originally present but reabsorbed before or after birth

Oligospermia
* having too few sperm
* due to:
fever
excessive alcohol
smoking
varicocele
orchitis

Azoospermia
* total lack of sperm in ejaculate
* due to:
fever
undescended testicle
obstructions of seminal vesicles
testicle infection

Cryptorchidism
* 30% of males born premature
* 3% of males carried to term
* Predisposes the person to risk of torsion
* Androgen receptor
* Bilateral has six times the impact on infertility
* Increase in Temperature
* Testicular atrophy
* Treated at Childhood

Abnormalities
* Testicular torsion
of the spermatic cord cuts off the venous drainage, leading to hemorrhagic infarction
It is the twisting of the spermatic cords
Immediate treatment
* Testicular cancer

Illnesses
* Acute
o Hypogonadism
+ Suppression of gonadotropin secretion
o Fever
+ The elevated temperature can induce declines in sperm production for months
* Chronic
o elevated gonadotropin secretion
+ leading to primary testicular disorder

Orchitis
* testicle inflammation
* due to:
mumps
infection
trauma
STD
STDs
* Fibropapilloma
o papilloma virus
o induces testicular warts
o inhibits spermatogenesis
* Chlamydia and gonorrhea
o cause scar tissue which results in duct blockage and
o inhibits spermatogenesis

Stimulants
* Heroin and other opiates
o suppression of LH secretion
* Cocaine and Marijuana
o temporarily can decrease 50% of sperm count
o compounds bind to sperm receptors affecting motility and entry to the secondary oocyte
* Smoking Tobacco
o lowers sperm motility
o reduces sperm life

Age

* Hypoplasia via testicular degeneration
* Nutritional factors, systemic infections, toxins, and other environmental factors
* Basement membrane becomes thickened
* Folds and wrinkles leading to tubular collapse
* Can lead to immune-mediated inflammatory response
* DNA Fragmentation

Gynecomastia
* Testicular Failure
* Androgen receptors
* Cirrhosis
* Tumors
* Illegal steroid
* Feminine characteristics

Examination
* Inflammation would cause pain
* Lack of hair
o Androgen deficiency
* Normal volume equals 15 to 35 ml
* Small is equal to 5 ml or less and would also signal androgen deficiency
* Hard lumps would signal tumors
* Softness would signal reduced spermatogenesis

Varicoceli
* Enlarged and twisted varicose veins
* 15-20% of men
* Elevates the temperature
* Obstructs passage of semen
* Obstructs oxygen supply

Environmental
* Polychlorinated biphenyls
o Teratogens
+ bind to the aryl hydrocarbon receptor
+ mimic estrogen, inhibiting the Leydig cells
* Testosterone
o activates mitogen-activated protein kinase
* Pesticides
o DDT
+ mimics estrogen
* Free Radicals
* Emotional stress
o inhibits secretion of GnRH

Physical Obstruction to Gamete Movement
* Blocked or absent seminal ducts
* Seminal fluid disorders
* Retrograde ejaculation
* Inability to ejaculate

Blocked or Absent Ducts
* Bilateral congenital absence of the vas deferens
* Obstruction of the epididymis or vas deferens
* Mechanical blockage during hernia repairs
* Blocked seminal vesicles

Seminal Fluid Disorders
* Absent antioxidant factors
* Abundant circulating free radicals

Retrograde Ejaculation
* Reverse ejaculation into the bladder
* Causes:
o Prostate surgery
o Certain medications
o Diabetes
o Spinal cord injuries

Inability to Ejaculate
* Erectile dysfunction
o Diabetes
o Prostate surgery
o Urethra surgery
o Blood pressure medications

Hormonal Obstruction to Gamete Movement
* Endocrine disorders
* Steroids
* Unexplained low levels of needed hormones

Endocrine Disorders
* Pituitary disorder
* Feminization
* Kallmann’s syndrome
* Hypothyroidism
* Other Causes
o Steroid Use
o Unexplained low levels of hormones

Improper Fusion of Sperm and Egg
* Antisperm Antibodies
o Immobilization
o Agglutinating
o Sperm-cervical mucus interaction
o Penetration of the egg
o Sperm fertilization
o Zygote development

Improper Fusion of Pronuclei
* CD9 and CD81 antibodies
Miscarriage
* 50% of pregnancies
* occur early in development
chemical miscarriage
molar pregnancy

Chemical Miscarriage
* before pregnancy is know
* dies almost immediately after conception
* causes:

chromosomal abnormalities
uterine abnormalities
hormonal deficiency

Molar Pregnancy
* Complete
egg contributes no DNA
two copies of paternal chromosomes
* Partial
egg does contribute DNA
two copies of paternal chromosomes

References
Male Reproductive Problems

Read more...

Male Obesity and Semen Analysis Parameters



Male Obesity and Semen Analysis Parameters
By:Joseph Petty, MD
Samuel Prien, PhD
Amantia Kennedy, MSIV
Sami Jabara, MD

Background: Obesity

* Obesity is a growing problem.
* The Behavioral Risk Factor Surveillance System, in conjunction with the CDC, conducted a national survey and found that in 2000, the prevalence of obesity (BMI >30 kg/m2) was 19.8%, a 61% increase since 1991.
* Obesity affects female and male fertility.
* In a study comparing IVF success rates and female obesity, it was shown that a 0.1 unit increase in waist-hip ratio led to a 30% decrease in probability of conception per cycle 2.
* In couples complaining of infertility, male factor plays a role in up to 40% of cases.

Background: Semen Parameters
* What parameters best predict fertility?
* National Cooperative Reproductive Medicine Network: 765 infertile couples (no conception after 12 months), and 696 fertile couples
* greatest discriminatory power was in the percentage of sperm with normal morphologic features.

Hypothesis
* Since there is an observed correlation between obesity and male factor infertility, our hypothesis is that an increased BMI is associated with higher rate of abnormal semen parameters, especially sperm morphology.

Recent Studies
* Danish study by Jensen et al. enrolled 1,558 young men (mean 19 years old) when they presented for their compulsory physical exam as part of their country’s military drafting system.
* The authors showed decreased sperm counts and concentration (39 million/mL vs. 46million/mL) in those with an elevated BMI (>25kg/m2). They did not, however, observe a difference in morphology.
* Hormonal differences
* Kort et al. looked at semen analysis results in 520 men
* grouped according to their BMI, and measured the average normal-motile-sperm count (NMS = volume x concentration x %motility x %morphology)
* Kort concluded that men with high BMI values (>25) present with few normal-motile sperm cells
* Hammoud et al., showed a increased incidence of oligospermia and increased BMI and also showed decreased levels of progressively motile sperm
* Considered each parameter separately.

Sexual function
* Agricultural study: The association between BMI and infertility was similar for older and younger men, disproving the theory that erectile dysfunction in older men is a significant factor.
* Hammoud et al., though primarily concerned with hormones, looked at erectile dysfunction directly and showed that there was no correlation with increases in BMI
* Nguyen et al., effect of BMI is essentially unchanged regardless of coital frequency, suggesting that decreased libido in overweight men is not a significant factor

Hormonal Profile
* Danish study, observed decreased FHS and inhibin B levels in the obese.
* Pauli et al., observed with increases in BMI a decreased total T, decreased SHBG, increased estrogen and decreased FSH and inhibin B.
* Inhibin B, cited for its usefulness as a novel marker for spermatogenesis and its role in pituitary gonadotropin regulation.
* Pauli: no correlation of BMI or skinfold thickness with semen analysis parameters, though it was observed that men with proven paternity versus those without had lower BMI.

Interventions: Gastric Bypass
* One case series of 6 male patients after bariatric surgery showed secondary azoospermia with complete spermatogenic arrest.
* none of the subjects had a semen analysis before the bariatric surgery, but all had fathered a pregnancy previously
* malabsorption of nutrients
* Hammoud et al., part of Utah Obesity Study
* effect of the gastric bypass surgery on sex steroids and sexual function
* Cohort of 64 severely obese men
* Along with a significant decrease in BMI, they found decreased levels of estradiol, and increases in total and free testosterone along with a reported improvement in quality of sexual function.
* Semen analysis parameters were not considered in this study

Study Design
* Retrospective chart review for all couples and individual patients presenting for an infertility consultation and evaluation at the Texas Tech Physicians Center for Fertility and Reproductive Surgery from September 2005 through January 2008.
* Intake questionnaire: demographic, medical, surgical and fertility history.

Questionnaire
* Previous pregnancies fathered: current or previous partner
* Psychiatric disorders included any degree of depression, bipolar disorder or any other psychiatric disorder requiring medical therapy.
* Tobacco and alcohol users: whether they admitted to light, moderate, or heavy use, patient underreporting.
* Chemical exposures: contact with pesticides, herbicides, and heavy metals.
* Sexual dysfunction: mainly erectile dysfunction and decreased libido.
* Genitourinary anomalies: hypospadias, varicocele, genitourinary surgery, testicular torsion or inguinal hernia or trauma
* Other medical problems included mainly diabetes, hypertension, thyroid disease, autoimmune disease, and cancer.
* Patients grouped according to their BMI as normal (20-24 kg/m2, N = 24), overweight (25-30 kg/m2, N = 43), or obese (>30 kg/m2, N = 45), as standardized by the World Health Organization
* Semen analysis parameters: morphology, volume, concentration, percent motility, and presence of absence of agglutination, in accordance with World Health Organization (WHO) guidelines
* SPSS statistical software was used to run analysis of variance (ANOVA) and post-hoc Tukey HSD tests between the groups. A p-value <0.05 was considered statistically significant.

Exclusion Criteria
* questionnaire was missing or if they had an otherwise incomplete chart.
* missing vital statistics (i.e. height and weight),
* 235 total charts reviewed,
o 60 no semen analysis or outside lab.
o 63 patients had either missing vital statistics or a missing questionnaire
o This left a total of 112 patients with valid data to be considered.


Results
* The BMI groups were statistically similar as far as demographic characteristics and confounding variables
* There was no statistically significant difference between the semen parameters of all three BMI groups.
* slight trend towards a decreasing sperm concentration with increases in BMI

Conclusion
* In this study, overweight and obese men did not have an increased rate of teratozoospermia, asthenospermia, or oligospermia.

Discussion
* Inconsistencies
* Small sample size
* Kort and data interpretation
* Change the normal hormonal milieu, addressed by Jensen study.
* Sertoli cell function, increased aromatase, role of leptin
* Aggerholm study: altered hormones not correlated with semen abnormalities in overweight men (25.1-30.0 kg/m2), slightly decreased sperm concentration in overweight but not in obese


Future Studies
* What affects morphology specifically?
o Hormones
o Result of secondary disease, i.e.. Diabetes
o Genetic mutations
o Weight loss surgery and other interventions
* Overall, there is no doubt that increases in BMI have a detrimental effect on male fertility, but a satisfactory explanation of the mechanism for this phenomenon has yet to be given.

References
Male Obesity and Semen Analysis Parameters

Read more...

28 July 2009

Male Reproductive System



Male Reproductive System
By:Linda Harmon

Male Reproductive System
* Several organs serve as parts of both the urinary tract and the reproductive systems.
* The structures are the tests, the vas deference and the seminal vesicles, the penis, certain accessory glands, such as the prostate and Cowper’s gland..
* Disorders in these organs may interfere with the function of either or both systems.
* Diseases are usually treated by a urologist.

Health History and Assessment
* Changes in urinary function and symptoms of obstruction caused by an enlarged prostate
* Changes in physical activity
* Sexual function and any manifestations of sexual dysfunction
* Factors that affect sexual functioning (stress, physical disease, use of medications, drugs, or alcohol)

Physical Examination
* Digital-Rectal Exam
o Recommended for every man over the age of 40
o Assess the size, shape, and consistency of the prostate
o Screening for cancer of the prostate
* Testicular Exam
o The male genitalia are inspected for abnormalities
o Note nodules, masses, or inflammation
o Instruct the patient about the technique for TSE

Diagnostic Studies
* Prostate-Specific Antigen
o The prostate gland produces a substance known as Prostate-Specific Antigen (PSA). This is measured in the blood and increases in prostate cancer. It needs to be drawn prior to a rectal exam or urinary catheterization.
* Ultrasound
o Transrectal ultrasound studies are used in detecting nonpalpable prostate cancers and in staging localized prostate cancers,. Needle biopsies of the prostate are commonly guided by ultrasound. Ultrasounds are more sensitive than a digital rectal exam.
* Prostate Fluid or Tissue Analysis
o A biopsy may be necessary to obtain tissue for histologic examination. This can be done with a prostatectomy or via a perineal or transrectal needle biopsy.
* Test of Male Sexual Functioning
o Usually conducted by a special team of health care providers.

Medications Associated with Erectile Dysfunction
* Antiadrenergics and antihypertensives
* Anticholinergics and phenothiazines
* Antiseizure agents
* Antifungals
* Antihormone
* Antipsychotics
* Antispasmodics
* Anxiollytics
* Betablockers
* Calcium channel blockers
* Carbonic anhydrase inhibitors
* H2 antagonists
* Nonsteroidal anti-inflammatory drugs
* Thiazides diuretics
* Tricyclic antidepressant

Conditions of the Prostate

Prostatitis
* Inflammation of the prostate gland caused by infectious agents or other conditions
* Clinical manifestations: perineal discomfort, burning, urgency, frequency and pain with or after ejaculation, fever, chills, rectal or low back pain, urinary tract infections.
* Complications: swelling, urinary retention, epididymitis, bacteremia, pyelonephritis.
* Management: avoid complications, broad spectrum antibiotic agent, bed rest, analgesic agents, antispasmodics, bladder sedatives, sitz baths. Chronic is difficult to treat.
* Nursing Management: antibiotics, comfort measures, analgesics, sitz baths, teaching.
* Self care: administration of antibiotics, sitz baths, fluids encouraged but not forced, foods and liquids with diuretic action or that increase prostatic secretions should be avoided.

Benign Prostatic Hyperplasia
* Enlargement of the prostate, extending upward into the bladder and obstructing the outflow of urine by encroaching on the vesical orifice.
* BPH is one of the most common pathologic conditions in men over 50
* Cause is uncertain
* Hypertrophied lobes cause incomplete emptying and urinary retention.
* Manifestations: frequency, nocturia, urgency, hesitancy, abdominal straining, decrease in volume and force of stream, interruption of stream, dribbling, urinary retention, recurrent UTI, fatigue, anorexia, nausea, vomiting, epigastric discomfort.
* Medical Management: Plan is dependent on cause, severity and condition. Immediate, hormonal, pharmacological, surgical

Cancer of the Prostate
* The most common cancer in men.
* Prostate cancer rates twice as high in African American men. They are more likely to die than men in any other racial or ethnic group.
* Risk factors: increasing age, African American, familial predisposition, diet high in red meat and fat
* Manifestations: urinary obstruction, difficulty and frequency, retention,decrease in size and force of stream, painful ejaculation, hematuria, late signs include backache, hip pain, perineal and rectal discomfort, anemia, weight loss, weakness
* Diagnosis: Early detection increases likelihood of cure. Over 40 requires a digital rectal exam (DRE) – early cancer may be detected as a nodule within the substance of the gland or as an extensive hardening in the posterior lobe.
* Men with prostate cancer experience sexual dysfunction before the diagnosis is made.
* Medical Management: based on the stage, age, symptoms. Surgical management, radiation therapy, hormonal therapy, others.
* Surgical Procedures: the procedure chosen depends on the size of the gland, the severity of the obstruction, the patients age, physical status, presence of associated diseases, and patient preference.
* Complications: hemorrhage, clot formation, catheter obstruction and sexual dysfunction.

Prostatectomy
* Assessment: BPH or Cancer – how has it affected lifestyle, presenting urinary problem, family history, physical condition.
* Nursing Diagnosis: Preop – anxiety, acute pain, knowledge deficit; Postop – acute pain, knowledge deficit
o Potential complications: hemorrhage and shock, infection, deep vein thrombosis, catheter obstruction, sexual dysfunction.
* Planning and Goals: Preop- reduced anxiety and knowledge about disorder and postop experience. Postop – fluid volume balance, relief of pain and discomfort, ability to perform self-care activities and absence of complications.
* Preop Nursing Interventions –reduce anxiety, relieve discomfort, provide instruction, prepare patient.
* Postop Nursing Interventions
o Fluid Balance – carefully monitor intake and output including irrigation, observe for electrolyte imbalance, elevated blood pressure, confusion and respiratory distress.
o Pain Relief – determine cause and location, obstruction may require irrigation, walk but do not sit for prolonged periods.
o Monitoring and managing complications
+ Hemorrhage – drainage normally reddish-pink then clears to light pink within 24 hours after surgery.
+ Infection – first by MD, use aseptic technique. Avoid rectal thermometers, rectal tubes and enemas, monitor for fever chills, sweats, etc.
+ Deep Vein Thrombosis – high incidence of DVT and pulmonary embolism,
+ Obstructed Catheter – observe for distention, restlessness, cold sweats, pallor, drop in blood pressure and increase pulse rate.
+ Complications after catheter removal – incontinence
+ Sexual Dysfunction –related to erectile dysfunction , decreased libido and fatigue.
o Promoting home and community based care.
+ Length of stay depends on type of surgical procedure performed.
+ Instruct on how to manage drainage system, assess for complications, promote recovery.
+ Teach about bladder control issues, perineal exercises, and avoiding activities that produce Valsalva effects.
+ Teach signs and symptoms of complications such as bleeding, clots, decrease in stream, retention or infection.
* Evaluation
o Preoperatively
+ Reduced anxiey
+ Pain and discomfort reduced
+ Understanding of procedure and postop course
o Postoperatively
+ Relief of discomfort
+ Fluid and electrolyte balance
+ Self-care measures
+ Free of complications

Conditions Affecting the Testes and Adjacent Structures

Testes and Structures
* Undescended Testis (Cryptorchidism)
o Congenital condition, failure of one or both testes to descend into the scrotum.
o Treated by orchiopexy
* Orchitis
o Inflammation of testes caused by pyogenic, viral, spirochetal, parasitic, traumatic, chemical or unknown factors. (Mumps)
o Treatment directed at infecting organism, rest, scrotal elevation, icepacks, antibiotics analgesia
* Epididymitis
o Infection of the epididymis may be due to infected prostate or urinary tract, complication of gonorrhea. Chlamydia trachomatis
o Treatment of organism, bed rest, scrotal elevation,antimicrobial agents, cold compresses, avoid straining , lifting and sexual stimulation.
* Testicular Cancer
o Most common cancer in men 15 to 35, highly treatable and usually curable
o Treatment dependent on type of cancer.
o Risk factors – undescended testis, family history, race and ethnicity (Caucasian American men 5 times greater than African American and double the risk of Asian American) ,occupational hazards
* Manifestations: mass or lump, generally painless, heaviness in scrotum, backache, abdominal pain , weight loss, general weakness. Tend to metastasize early.
* Diagnosis: monthly Testicular Self Examinations (TSE), human chorionic gonadotropin and alpha-fetoprotein and tumor markers that may be elevated in those with testicular cancer.
* Medical Management:
o Orchiectomy with gel-filled prosthesis. Retroperitoneal lymph node dissection, radiation, chemotherapy, long term side effects.
* Hydrocele
o a collection of fluid in the tunica vaginalis of the testes
* Varicocele
o Abnormal dilation of the veins of the pampiniform venous plexus in the scrotum
* Vasectomy
o Legation and transaction of part of the vas deferens with or without removal of a segment of the vas deferens.

Conditions Affecting the Penis
Penis
* Hypospadias and Epispadias
o Congenital anomalies of the urethral opening
* Phimosis
o A condition in which the foreskin is constricted so that it cannot be retracted over the glans, can occur congenitally or from inflammation and edema. Correctable by circumcision.
* Cancer of the Penis
o Mostly in uncircumcised men.
o Appears as a painless, wartlike growth or ulcer.
o Bowen’s Disease is a form of squamous cell carcinoma in the situ of the penile shaft.
o Prevention is circumcision in infancy
o Treatment by excision, topical chemotherapy, radiation, partial or total penectomy.
* Priapism
o An uncontrolled, persistent erection of the penis that causes the penis to become large, hard, and painful.
* Peyronie’s Disease
o Buildup of fibrous plaques in the sheath of the corpus cavernosum. When erect, curvature occurs.
* Urethral Stricture
o A condition in which a section of the urethra is narrowed.
o Treatment involved dilation of the urethra or urethrotomy.
* Circumcision
o The excision of the foreskin, or prepuce,of the glans penis. Usually performed in infancy

Male Reproductive System

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05 July 2009

Male Reproductive Problems



Male Reproductive Problems
By:Fertilization Specialists
Joshua Prince
Preston Moore
Candace Lindler

Infertility
* Infertility is the inability of a couple to become pregnant

Treatment
Normospermia with functional defects
Asthenospermia and teratozoospermia
Oligospermia
Untreatable subfertility
Reversible toxin effects
Disorders of sexual function
Gonadotropin deficiency
Obstructive azoospermia
Sperm autoimmunity
Treatable conditions
Primary seminiferous tubule failure
Untreatable sterility
FREQUENCY (%)

TYPE OF INFERTILITY
Table 1. Classification Of Male Infertility By Effectiveness Of Medical Intervention To Improve Natural Conception Rate
* Sperm count equals the number of sperm per cm3 or cc
* The average has dropped in the past 20 years
* 85-90% are treated with medication or surgery
* Lifestyle changes

Normal Reproduction
* Ovulation
* Spermatogenesis
* Sperm meets with egg in fallopian tube
* Fertilization
* Implantation

Male Reproductive System
Female Reproduction System
Normal Spermatogenesis
Testes
* Spermatogonium (2N)
Differentiation
* Primary Spermatocyte (2N)
Meiosis I
* Secondary Spermatocytes
Meiosis II
* Spermatids
Differentiation
* Spermatozoa
Spermatogenesis
* Seminferous Tubules
90% of the testis
* Thousands of sperm per second although spermatogenesis 8-10 weeks
* Stored for months
* Degraded and deposited into the circulatory system if not ejaculated
Klinefelter Syndrome
* XXY instead of XX or XY
* usually male
* lower levels of testosterone
* improper formation of semineferous tubules

Bilateral Anorchia
* vanishing testes syndrome
* testes originally present but reabsorbed before or after birth
Oligospermia
* having too few sperm
* due to:
fever
excessive alcohol
smoking
varicocele
orchitis

Azoospermia
* total lack of sperm in ejaculate
* due to:
fever
undescended testicle
obstructions of seminal vesicles
testicle infection

Cryptorchidism
* 30% of males born premature
* 3% of males carried to term
* Predisposes the person to risk of torsion
* Androgen receptor
* Bilateral has six times the impact on infertility
* Increase in Temperature
* Testicular atrophy
* Treated at Childhood

Abnormalities
* Testicular torsion
of the spermatic cord cuts off the venous drainage, leading to hemorrhagic infarction
It is the twisting of the spermatic cords
Immediate treatment
* Testicular cancer

Illnesses
* Acute
* Chronic
Orchitis
STDs
* Fibropapilloma
Stimulants
Age
Gynecomastia
* Testicular Failure
* Androgen receptors
* Cirrhosis
* Tumors
* Illegal steroid
* Feminine characteristics

Examination
* Inflammation would cause pain
* Lack of hair
* Normal volume equals 15 to 35 ml
* Small is equal to 5 ml or less and would also signal androgen deficiency
* Hard lumps would signal tumors
* Softness would signal reduced spermatogenesis

Varicoceli
* Enlarged and twisted varicose veins
* 15-20% of men
* Elevates the temperature
* Obstructs passage of semen
* Obstructs oxygen supply
Environmental
* Polychlorinated biphenyls
* Testosterone
* Free Radicals
* Emotional stress

Physical Obstruction to Gamete Movement
* Blocked or absent seminal ducts
* Seminal fluid disorders
* Retrograde ejaculation
* Inability to ejaculate

Blocked or Absent Ducts
* Bilateral congenital absence of the vas deferens
* Obstruction of the epididymis or vas deferens
* Mechanical blockage during hernia repairs
* Blocked seminal vesicles

Seminal Fluid Disorders
* Absent antioxidant factors
* Abundant circulating free radicals

Retrograde Ejaculation
* Reverse ejaculation into the bladder
* Causes:
o Prostate surgery
o Certain medications
o Diabetes
o Spinal cord injuries
Inability to Ejaculate
* Erectile dysfunction
o Diabetes
o Prostate surgery
o Urethra surgery
o Blood pressure medications

Hormonal Obstruction to Gamete Movement
* Endocrine disorders
* Steroids
* Unexplained low levels of needed hormones

Endocrine Disorders
* Pituitary disorder
* Feminization
* Kallmann’s syndrome
* Hypothyroidism
* Other Causes

Improper Fusion of Sperm and Egg
* Antisperm Antibodies
o Immobilization
o Agglutinating
o Sperm-cervical mucus interaction
o Penetration of the egg
o Sperm fertilization
o Zygote development
Improper Fusion of Pronuclei
Miscarriage
Chemical Miscarriage
Molar Pregnancy
References

http://www.wernermd.com/Azoospermia.html
http://www.howtomakeafamily.com/experts/lewis/male_factor_infertility.htm
http://infertility.health-info.org/male-infertility/male-infertility-sperm-disorders.html
http://www.merck.com/mmhe/sec21/ch240/ch240e.html
http://www.resolve.org/site/PageServer?pagename=lrn_jfm_mfed
http://www.resolve.org/site/PageServer?pagename=lrn_jfm_mfaa
http://upload.wikimedia.org/wikipedia/commons/b/b5/Gray8.png
http://www.ncbi.nlm.nih.gov/books/bv.fcgi?indexed=google&rid=dbio.section.1412
http://www.nature.com/ncb/journal/v3/n2/full/ncb0201_e59.html
http://www.babycenter.com/0_molar- pregnancy_1363614.bc?Ad=com.bc.common.AdInfo%40575bc872
http://www.wdxcyber.com/chemical_pregnancies.html
http://www.merck.com/mmpe/print/sec19/ch282/ch282f.html
http://uk.answers.yahoo.com/question/index?qid=20061208102440AA2g80G
http://www.varicocelespecialists.com/faq3.htm
http://www.endotext.org/male/male7/maleframe7.htm
http://copa.org/med/sperm.htm
http://www.ivf.com/shaban.html
http://www.ucalgary.ca/UofC/eduweb/virtualembryo/spermatogenesis.html

Male Reproductive Problems.ppt

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Male Obesity and Semen Analysis Parameters



Male Obesity and Semen Analysis Parameters
By:Joseph Petty, MD
Samuel Prien, PhD
Amantia Kennedy, MSIV
Sami Jabara, MD


Background: Obesity
Background: Semen Parameters
* What parameters best predict fertility?
* National Cooperative Reproductive Medicine Network: 765 infertile couples (no conception after 12 months), and 696 fertile couples
* greatest discriminatory power was in the percentage of sperm with normal morphologic features.

Hypothesis
Recent Studies
Sexual function
Hormonal Profile
Interventions: Gastric Bypass
Study Design
* Retrospective chart review for all couples and individual patients presenting for an infertility consultation and evaluation at the Texas Tech Physicians Center for Fertility and Reproductive Surgery from September 2005 through January 2008.
* Intake questionnaire: demographic, medical, surgical and fertility history.
Questionnaire
* Previous pregnancies fathered: current or previous partner
* Psychiatric disorders included any degree of depression, bipolar disorder or any other psychiatric disorder requiring medical therapy.
* Tobacco and alcohol users: whether they admitted to light, moderate, or heavy use, patient underreporting.
* Chemical exposures: contact with pesticides, herbicides, and heavy metals.
* Sexual dysfunction: mainly erectile dysfunction and decreased libido.
* Genitourinary anomalies: hypospadias, varicocele, genitourinary surgery, testicular torsion or inguinal hernia or trauma
* Other medical problems included mainly diabetes, hypertension, thyroid disease, autoimmune disease, and cancer.
* Patients grouped according to their BMI as normal (20-24 kg/m2, N = 24), overweight (25-30 kg/m2, N = 43), or obese (>30 kg/m2, N = 45), as standardized by the World Health Organization
* Semen analysis parameters: morphology, volume, concentration, percent motility, and presence of absence of agglutination, in accordance with World Health Organization (WHO) guidelines
* SPSS statistical software was used to run analysis of variance (ANOVA) and post-hoc Tukey HSD tests between the groups. A p-value <0.05 was considered statistically significant.
Exclusion Criteria
Results
Conclusion
Discussion
* Inconsistencies
* Small sample size
* Kort and data interpretation
* Change the normal hormonal milieu, addressed by Jensen study.
* Sertoli cell function, increased aromatase, role of leptin
* Aggerholm study: altered hormones not correlated with semen abnormalities in overweight men (25.1-30.0 kg/m2), slightly decreased sperm concentration in overweight but not in obese

Future Studies
References

Male Obesity and Semen Analysis Parameters.ppt

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Male Infertility



Male Infertility: Definitions
By:Jeanne O’Brien MD
Assistant Professor of Urology and Male Infertility
University of Rochester Medical Center, Department of Urology

Definitions
* Primary infertility: inability to achieve pregnancy > 1yr
* Secondary infertility: previously fertile, now unable >1 yr
* Azoospermia: no sperm in semen
* Oligospermia: reduced sperm concentration <20 million/ml
* Asthenospermia: reduced percent motility <50%
* Teratospermia: reduced percent normal forms <30%
* IVF: in vitro fertilization
* ICSI: intra-cytoplasmic sperm injection

Etiology of Male Infertility
* Varicocele
* Idiopathic
* Infection
* Genetic
* Endocrine
* Immunologic
* Obstruction
* Cryptorchidism

Male Infertility: Evaluation
* Basic Evaluation:
o History (Questionnaire)
o Physical examination
o Standard semen analysis
o Hormonal evaluation
* Optional Additional Evaluation:
o Genetic counseling and evaluation
o Specialized sperm function tests
o Imaging studies
o Testis biopsy

Male Infertility: History
* Duration of infertility
o Previous treatments
o Female-factor (anovulation, tubal obstruction)
* Sexual history
o timing and mechanics of intercourse
o lubricants (peanut oil, olive oil, egg whites ok)

History
* Childhood & Development
o cryptorchidism
o pubertal development
* Medical History
o systemic illness
* Surgical History
o abdominal, pelvic or scrotal surgery
* Infections
o STDs, prostatitis, orchitis (post-pubertal mumps)
* Environmental gonadotoxins
o smoking
o ETOH
o radiation, chemicals, pesticides, chemotherapy
o Heat exposure (short order cook, tanning booths, hot tub/bath)
* Medications (steroids, herbal supplements, hair growth products)

History: Medications
* Hormonal (pre-testicular)
o e.g. androgens, anti-androgens, estrogens
* Gonadotoxic (testicular)
o e.g. chemotherapy/alkylating agents
* Sperm-toxic (post-testicular)
o e.g. Ca-channel blockers

Anatomy of the male reproductive tract

Physical Examination
* General
o Body habitus (muscle mass), hair distribution
o Evidence of normal virilization
* CNS
o visual fields (r/o pituitary adenoma)
o sense of smell (Kallmann’s Syndrome - HypoHypo)
* Abdomen/Pelvis
o Surgical scars
* Genital/Prostate
* Penis:
o length (normal development)
o position of urethral meatus (deposition of semen)
* Prostate :
o size
o firmness
o tenderness
o presence of cysts (ejaculatory duct)
* Testis:
o -position (cryptorchid?)
o -volume (normal ~15-25ml)
o -firmness (normal = firm)

Testis:
o -Seminiferous tubules
+ Germ cells
+ Sertoli cells
o -Interstitium
+ Leydig cells
+ macrophages, endothelial cells
Spermatogenesis
o ~74 days in humans (epididymal transit ~15 days)
o Clinical correlate: Need to wait 3 months after any intervention (medical or surgical) to see a change in semen quality
* Epididymis:
o -fullness
o -cystic changes
* Vas deferens:
o -congenital absence of vas (CAVD)
+ Cystic fibrosis mutations
+ Woolfian duct anomalies

Genital tubercule Penis
Overview of sexual differentiation in the male
(modified from Male Reproductive Biology, eds Lipshultz, Howards)
Varicocele: Diagnosis
* Definition: dilated testicular veins due to reflux of blood
* Established by physical examination (in a warm room)
* Other modalities used to diagnose a sub-clinical varicocele:ultrasound, venography, doppler stethoscope
* However, the subclinical varicocele does not require repair!
* WHO Fertil Steril 1985
* Howards Fertil Steril 1992

Varicocele
* Etiology: probably multi-factorial
Varicocele: Prevalence
Varicocele-Induced Pathology
* Testis atrophy
* Testis histology (non-specific)
* Leydig cell dysfunction
o Lower serum Testosterone (T) levels
o Blunted T rise in response to LH stimulation
* Testicular Pain
o Mechanism unknown

Semen Analysis
* Semen Parameters Normal range (WHO)
* Volume (1.5 - 5 mL)
* Sperm density (>20 million/mL)
* Sperm motility (>50%)
* Sperm morphology (>30% normal forms)
* Leukocyte density (<1 million/mL)
* Need at least 2 S/As (because parameters are highly variable)
* S/A is not a measure of fertility but fertility potential

In Vitro Maturation of Germ Cells
* Spermatogenesis: orderly differentiation of immature germ cells to mature spermatozoa
* 1. Mitotic phase
* 2. Meiotic phase
* 3. Spermiogenesis
Two separate events observed in vitro
1. Spermatid differentiation (round to elongated)
2. Meiotic progression (spermatocyte to spermatid)
In Vitro Maturation of Germ Cells:
* Sperm head defects
* Sperm mid-piece defects
* Sperm tail defects
Semen Analysis: Critical Review
* Evaluated 765 infertile men and 696 fertile controls to
* determine semen parameter thresholds that best
* discriminate between fertile and infertile men.
* Infertile couples
* Fertile controls
* Methods:
2 semen samples were collected from each patient.
Technicians from the 9 centers were trained at a central site.
Stained sperm smears were sent to a central site for
strict morphology assessment (by a single technician).
* Statistical Analysis:
Classification-and-regression-tree (CART) analysis was
used to define thresholds for classifying infertility
Receiver-operating-characteristic (ROC) curves were used
to test the discriminatory power of each variable

* Results:
* Conclusions:
Spermatogenesis
Abnormal Morphology
Sperm DNA Integrity
Why examine sperm DNA integrity?
Fertilization Pregnancy
Human Sperm DNA: Characteristics
Sperm DNA Packaging
Evolution During Epididymal Transit
Human Sperm DNA Damage: Etiology
Potential causes of DNA fragmentation
Antisperm Antibodies (ASAs)
Etiology & Incidence
Antisperm Antibodies: Testing
Hypo-Osmotic Swelling Test (HOST)
Hormonal Evaluation
Azoospermia: Normal semen volume
Genetic Evaluation
Non-Obstructive Azoospermia (NOA):
Etiology
Management Options
Micro-Testicular Dissection
Obstructive Azoospermia (OA):
Clinical features
Etiology
Management Options
Conclusion

* Male infertility is multifactorial
* Hormones, physiology, environment, anatomy and DNA all play a role
* It is the delicate balance of all of these factors that must be weighed in order to optimize male fertility
* Every evaluation is different and every treatment strategy is geared toward the individual patient and circumstance and must always take into account the female partner

Male Infertility.ppt

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28 June 2009

Endometrial Biopsy



Endometrial Biopsy
By:Lianne Beck, MD
Assistant Professor
Emory Family Medicine

Indications
* Abnormal uterine bleeding: postmenopausal bleeding, malignancy/hyperplasia, ovulation/anovulation, HRT
* Evaluation of patient with one year of presumed menopausal amenorrhea
* Assessment of enlarged utereus (combined with US and neg HCG)
* Monitoring adjuvant hormonal tx (tamoxifen)
* Evaluation of infertility
* Abnormal Pap smear with atypical cells favoring endometrial origin (AGUS)
* Follow-up of previously diagnosed endometrial hyperplasia
* Cancer screening (e.g., hereditary nonpolyposis colorectal cancer)
* Inappropriately thick endometrial stripe found on US
* Endometrial dating


Contraindications
* Pregnancy
* Acute PID
* Clotting disorders (coagulopathy)
* Acute cervical or vaginal infections
* Cervical cancer

Conditions Possibly Prohibiting Endometrial Biopsy
* Morbid obesity
* Severe pelvic relaxation with uterine descensus
* Severe cervical stenosis

Equipment
* Non-sterile Tray (Examination for Uterine Position)
o Nonsterile gloves
o Lubricating jelly
o Absorbent pad to place beneath the patient on the examination table
o Formalin container (for endometrial sample) with the patient's name and the date recorded on the label
o 20 percent benzocaine (Hurricaine) spray with the extended application nozzle *
* Optional Equipment
* Sterile Tray for the Procedure
o Sterile gloves
o Sterile vaginal speculum
o Uterine sound
o Sterile metal basin containing sterile cotton balls soaked in povidone-iodine solution
o Endometrial suction catheter
o Cervical tenaculum
o Ring forceps (for wiping the cervix with the cotton balls)
o Sterile 4 x 4 gauze (to wipe off gloves or equipment)

Procedure
* Patient in lithotomy position, bimanual exam to determine uterine size, position, uterocervical angulation.
* Insert sterile speculum.
* Clean cervix with povidone-iodine solution.
* Sound the uterus. If needed, use tenaculum, grasping the anterior lip of cervix, for counter-traction.
* Pull outward with tenaculum to straighten the uterocervical angle.
* Insert sound to the fundus, using steady moderate pressure. Usually measure 6-8 cm.

* May need cervical dilators if sound will not pass through internal os.
* Insert sterile endometrial biopsy catheter tip into cervix to the fundus, or until resistance is felt, avoiding contamination from nearby tissues.
* Fully withdraw the internal piston on the catheter, creating suction at the catheter tip.
* Obtain tissue by moving with an in-and-out motion and using a 360-degree twisting motion. Allowing tip to exit endometrial cavity will lose suction.
* Once the catheter fills with tissue, withdraw it, and place sample in the formalin container, by pushing piston back into the catheter tip. Make a second pass if necessary.
* Remove tenaculum, apply pressure to any bleeding, then remove speculum.
Follow Up
* Normal endometrial
o Proliferative (estrogen effect or preovulatory)
o Secretory (progesterone effect or postovulatory)
* Atrophic endometrium
o Hormonal therapy
* Cystic or simple hyperplasia w/o atypia
o Progress to cancer is < 5%
o Hormonal manipulation (medroxyprogesterone [Provera], 10 mg daily for five days to three months)
o Close follow-up w/ repeat EBx in 3-12 months
* Atypical complex hyperplasia
o Progresses to cancer in 30 to 45 %
o D&C to exclude endometrial cancer
o Consider hysterectomy for complex or high-grade hyperplasia.
* Endometrial carcinoma
o Referral to a gynecologic oncologist for definitive surgical therapy.

Pitfalls/Complications
References

Endometrial Biopsy.ppt

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24 June 2009

Sexuality & Fertility Issues in Cancer Patients



Sexuality & Fertility Issues in Cancer Patients
bt:Carolyn Vachani, MSN, RN, AOCN

Scope of Sexuality Issues
* 40-100% of cancer patients experience some form of sexual dysfunction
* Issues do not always resolve after therapy
* Almost all cancer treatments have the potential to alter sexual function (surgery, chemotherapy, radiation, hormones)
* Represents major quality of life (QOL) issue
* With intervention, up to 70% of patients can have improved functioning

To Optimize QOL, Nurses Can:
* Learn evidence-based information on how diagnosis/treatment affects sexual function
* Conduct assessments before/during therapy
* Inform patients of possible changes
* Educate clients & partners
* Provide guidance & suggestions for adapting to changes
* Know resources & refer when needed

Survey of Physician/Patient Communications
Nurses’ Beliefs
Johnson’s Behavioral Model
PLISSIT Model for Communication
Sexual Dysfunction in Men
* Chemo/hormonal therapy: Erectile dysfunction, decreased libido, ejaculatory dysfunction, gynecomastia, penile/ testicular atrophy, and infertility
* Radiation/ brachytherapy: Urinary issues, impotence, bowel dysfunction, penile/ testicular atrophy
* Surgery: Urinary issues, impotence, body image, pain, retrograde ejaculation

Sexual Dysfunction in Women
* Chemo/Hormone therapy: Irregular menses, early menopause, hot flashes, insomnia, irritability, depression, vaginal dryness, painful intercourse, infertility, and decreased libido
* Radiation/ brachytherapy: Pelvic fibrosis, vaginal atrophy/stenosis, scarring, decreased lubrication, urinary effects, erythema, edema, ulceration, decreased elasticity, shortening, and increased irritation of vagina
* Surgery: Body image, bowel changes, ROM issues, menopause, pain, changes in vaginal size/sensitivity, loss of nipple

General Nursing Interventions
Ostomy Surgery: Interventions
Interventions for Male Issues
Interventions for Female Issues
Radiation-Induced Vaginal Stenosis
Other Interventions for Women
Resources
* www.eyesontheprize.org (online community for gynecologic cancers)
* Support groups (Gilda’s Club, Wellness Community)
* www.oncolink.org
* www.ustoo.org (prostate cancer website)
* www.fertilehope.org
* www.resolve.org (fertility)
* ACS Sexuality booklets
(available on ACS website)

Pregnancy & Treatment
Risk of Infertility: Radiation
Radiation Risk to Future Pregnancy
Risk of Infertility: Chemo
Azoospermia likely, and are often given with other highly sterilizing agents, adding to the effect
Busulfan (600 mg/M2)
Ifosfamide (42 g/m2)
BCNU (300 mg/m2)
Nitrogen mustard
Actinomycin D
Azoospermia in adulthood if treated before puberty
BCNU (1 g/m2)
CCNU (500 mg/m2)
Prolonged or permanent azoospermia in 90% of men; platinum agents 50%
Chlorambucil (1.4 g/m2)
Cyclophosphamide (19 g/m2)
Procarbazine (4 g/m2)
Melphalan (140 mg/m2)
Cisplatin (500 mg/m2)
Known Effect on Sperm Count
Chemotherapy (dose to cause effect)

Risk for Infertility: Surgery
* Orchiectomy (bilateral)
* Penectomy
* Prostate or bladder surgery damage
* Prostatectomy
* Hysterectomy
* Oopherectomy (bilateral)

Options for fertility preservation in men
* Sperm banking – only after puberty
* Intracytoplasmic sperm injection (ICSI)
* GnRH agonist/antagonists
* Cryopreservation of testicular tissue, then transplant or grow in vivo (+ births in mice)

Options for Fertility Preservation in Women
* Embryo freezing – cycle 12-14 days, 10-25% chance of pregnancy per embryo stored, cost $8-12,000, then cost of storage, thaw & implanting
* Ovarian transposition (oophoropexy) – move ovaries from XRT field, can be laparoscopic, cost ?, been done for 30yrs, 16-90% success rate
* Egg cryopreservation – cycle 12-14 days, 2% chance of live birth per thawed egg, cost ~$8,000, then cost of storage, thaw, fertilizing & implanting

Options for Fertility Preservation in Women
* GnRH agonist/antagonist : theory is to stop proliferation
* Ovarian tissue freezing: 60% follicles lost to freezing, have been 2 live births
* Radical trachelectomy: for cervical cancer, experimental?
Assessing Ovarian Function in Survivors
* FSH & Estradiol
* Anti-Mullerian hormone (AMH)
* Antral follicle count
Financial Assistance
Local Sites for Sperm Banking
* 3 National organizations (by mail)
o www.cryolab.com
o www.reprot.com
o www.xytextissues.com
* Women’s Institute; 815 Locust / Plymouth Meeting
* Penn Fertility 3701 Market
* Fairfax Cryobank 3401 Market (http://www.fairfaxcryobank.com/)
* Drexel Fertility Bala Cynwyd / Center City
* Reproductive Science Institute Jenkintown (http://www.rsiinfertility.com/)
* Women’s Health Group of PA Bryn Mawr

Local Sites for Women
* Women’s Institute: 815 Locust / Plymouth Meeting (http://www.womensinstitute.org/)
* Penn Fertility: 3701 Market (http://www.pennhealth.com/fertility)
* Drexel Fertility: Bala Cynwyd / Center City (http://www.drexelfertility.medem.com)
* Women’s Health Group of PA: Bryn Mawr (http://www.mainlinefertility.com)

References
Sexuality & Fertility Issues in Cancer Patients.ppt

Read more...

16 June 2009

Sexual Development



Sexual Development

UROGENITAL SINUS & TUBERCLE
VULVA
UTERUS
OVARY
VAGINA
UTERINE TUBE
MULLERIAN DUCT
SEXUAL DEVELOPMENT
PROSTATE
PENIS
SEMINAL VESICLE
RETE TESTIS
TUBULUS RECTUS
EFFERENT DUCT
EPIDIDYMIS
DUCTUS DEFERNS
BULBOURETHRAL GLAND
urethra
INTERSTITIAL CELLS
SEMINIFEROUS TUBULE
TESTIS
WOLFFIAN DUCT
MESONEPHRIC DUCT
PARAMESONEPHRIC DUCT
GONAD on hold
OVARY
TESTIS
INTERSTITIAL CELLS
SEMINIFEROUS TUBULE
TUBULUS RECTUS
OVARY
GONAD on hold
Sex-determining Factor
Default pathways
Testosterone
Mullerian-inhibiting Factor
MULLERIAN DUCT
WOLFFIAN DUCT
UROGENITAL SINUS & TUBERCLE
Driven pathways
SERTOLI CELL
OVARY
GONAD on hold
Default pathway
and much more topics are covered

Sexual Development.ppt

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15 June 2009

Fertility Facts



Fertility Facts
Definition:unprotected sex for one year, not pregnant
What can cause infertility?
* Ovulation disorders
* Tube/uterus blockage
* Cervix
* Endometriosis
* Other
* Sperm count and defects
* Erectile or ejaculation deficiency

Intrinsic vs. Extrinsic, Environmental
More detail on female infertility
* Ovulatory failure-polycystic ovarian syndrome (high androgen/estrogenlevels), resistant ovarian syndrome, gonadal dysgenesis
* Impaired gamete/zygote transport-pelvic inflammatory disease, endometriosis
* Implantation defects-progesterone low
* Spontaneous abortion-chromosome abnormality

More detail on male infertility
* Cryptorchidism-Why?
* Chromosome disorders-gonadal dysgenesis
* Obstructions
* Gonadotropin deficiency
Result in:Low sperm count, sperm of poor quality

Female Infertility Tests
* For ovulation
* Post ovulatory block
Laparoscopy
Hysterosalpingogram
Blocked tubes
Male Infertility Tests
* Sperm count/motility
* If low check LH and androgen levels
* Testicular biopsy
Sperm Count
Older, low tech treatments
* Drug treatment for ovulation block
* Intrauterine insemination
* Tubal surgery

High tech Assisted Reproduction Technologies
* IVF-in vitro fert and embryo transfer
* GIFT-gamete intrafallopian tube transfer
* ZIFT-zygote intrafallopian tube transfer
* Intracytoplasmic sperm injection

frozen eggs/ ovary transplant; cloned human embryo
First test-tube baby

Assisted Reproductive Technology
* Estimate 1/100 births now
* Around 40,000/year
* Costs between $7,000 to 15,000 per attempt

IVF
In Vitro Fertilization and Embryo Transfer
Basic Steps in IVF
* Ovary stimulation
* Egg retrieval
* Sperm retrieval-wash sperm
* Fertilization
* Embryo transfer
* Progesterone
Drugs used for ovary stimulation
* Clomiphene (clomid)-anti-estrogen
* hMG (pergonal)-menopausal gonadotropin (FSH and LH)
* FSH-(metrodin)
* GnRH
* GnRH agonists (lupron)-FSH/LH first promoted, then inhibited
* hCG-acts like LH

Why transfer more than one embryo?
* Increase the pregnancy rate
* Leads to increased risk of multiple pregnancies
* In future- Test embryos before transfer
sHLA-G measure of embryo health
Egg retrieval, vaginal, with ultrasound
Gametes mixed for GIFT
Modifications if tube not blocked
If fertilization needs help-transfer zygote
ZIFT
Intracytoplasmic sperm injection
ICSI
Additional twists
* Surrogacy
o Gestational
o Egg donor plus gestational
o Egg donor plus sperm donor plus gestational
* Frozen embryos
* Egg donors
* Frozen eggs
* Cloning
From CDC
IVF Success Rates
Stage Number of Women

Fertility Facts.ppt

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Male Sexual Anatomy & Physiology



Male Sexual Anatomy & Physiology

The Penis
* Nerves, blood vessels, fibrous tissue, and three parallel cylinders of spongy tissue.
* There is no bone and little muscular tissue (although there are muscles at the base of the penis)
* Terms:
* Penis: consists of internal root, external shaft, & glans.
* Root: the portion of the penis that extends internally into the pelvic cavity.
* Shaft: the length of the penis between the glans and the body.
* Glans: the head of the penis; has many nerve endings.
* Cavernous bodies: the structures in the shaft of the penis that engorge with blood during sexual arousal.
* Spongy body: a cylinder that forms a bulb at the base of the penis, extends up into the penile shaft, and forms the penile glans. Also engorge with blood during arousal.
* Foreskin: a covering of skin over the penile glans.

Fig 5.1a Interior structure of the penis:
External penile structures
Scrotum and testes
* Scrotum (or scrotal sac):
* Testis
o Male gonad inside scrotum that produces sperm and sex hormones
* Spermatic cord
o A cord attached to the testis inside the scrotum that contains the vas deferens, blood vessels, nerves, and muscle fibers
Structures inside the testis
Cross-section of seminiferous tubule
Interstitial cells: secrete androgens
Spermatogenic cells: produce sperm
Immature sperm
Vas deferens
Overview: male sexual anatomy
Seminal vesicles
Prostate gland
Cowper’s glands
Semen
Analagous structures in male and female sexual anatomy
Male
Glans
Foreskin
Shaft
Scrotal sac
Testes
Female
Clitoris
Clitoral hood
Labia minora
Labia majora
Ovaries
Group activity: male A & P flashcards
One side: name of term
Other side: definition, function, location
Group activity:
Male reproductive anatomy & physiology
Male sexual function: Erection
How blood inflow helps maintain erection
Ejaculation
Emission phase of ejaculation (phase 1)
Penis size
Penile Augmentation (phalloplasty)
Circumcision
Circumcision: medical perspective
Circumcision and sexual functioning
Discussion question:
Penile cancer
Testicular cancer
Prostate Health Care Issues
Prostate Cancer
Prostate Cancer: Symptoms & diagnosis

Male Sexual Anatomy & Physiology.ppt

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Reproductive Ethics



Reproductive Ethics

Schedule
* Papers
* Understanding the Technology
* Ethical Issues

Reproductive Technology
* Artificial Insemination
* In Vitro Fertilization
* Surrogacy
* Freezing Sperm
* Freezing Embryos
* Freezing Eggs
* (Cloning)

Artificial Insemination
* Essentially, sperm (either from the husband or some other donor) is injected into the reproductive tract of the intended mother.
* Used most commonly when there are concerns about male infertility.
* The sperm can be “washed” first to ensure that there is a high concentration of sperm.
* Actually a general term, not a specific procedure.
* The most common procedure is intrauterine insemination (IUI), where the sperm is inserted directly into the uterus, so as to avoid possible problems with the cervix.
* IUI has a success rate of about 15-20%, and is fairly quick.
* A major disadvantage is that the doctor cannot tell if insemination has been successful because it occurs in the body.
* Another procedure, intracytoplasmic sperm injection (ICSI) involves injecting a single sperm by pipette into an egg.
* ICSI allows men with very low sperm counts to reproduce.
* Can be done in utero, but is becoming more common in vitro.

In Vitro Fertilization
* In these processes, sperm and eggs are combined outside the body, and reinserted after it is clear that insemination has occurred.
* The most common sign that insemination is successful is when the egg has divided into an eight-celled organism. This is the point that the egg(s) are reinserted.
* Depending on the procedure used, can cost between $5,000 and $12,000 an attempt.
* The rate of success for IVF varies from clinic to clinic, and procedure to procedure, but the national average is about 34% (measured in terms of babies per egg retrieval.)

GIFT
* Gamete Intrafallopian Transfer (GIFT) is a hybrid of IVF and AI.
* Eggs and sperm are both retrieved from the potential parents, and screened for problems.
* The sperm and eggs are then placed in a catheter together and inserted directly into one the woman’s fallopian tubes.
* Since the eggs are withdrawn from the body first, GIFT is similar to in vitro, but since the fertilization occurs in the body it is like AI.
* Some find this preferable to traditional IVF, because there is no question about what to do with “excess” embryos.

Surrogacy
* Surrogacy is when the potential parents have someone other than the eventual mother carry the child to term.
* This can be done with AI, or IVF, and can utilize either the eventual mother’s eggs, the surrogate's eggs, or eggs from a donor.
* Surrogates generally fall into two camps: Close relatives or hired surrogates.
* In either case it is routine to sign a contract stating what compensation (if any) will be done, concerns about how the surrogate will handle health issues during pregnancy, and a waiver of the surrogate’s parental rights.

Freezing Sperm
* A.K.A. “Sperm Banks”
* Sperm is collected via masturbation and is stored in a frozen manner. The sperm can be later “thawed,” and used in various reproductive technologies.
* While people who “sell” their sperm gets the most media attention, many men have some sperm frozen if they are going to be undergoing various procedures that could affect future fertility.

Freezing Embryos
* After fertilization, embryos can be frozen for later implantation via IVF.
* Most common with the “excess” embryos from IVF attempts and women who will be undergoing procedures that could effect future fertility.
* A problem with this approach is that embryos require both the egg and the sperm.
* Women who do not know for sure if they want to have children with Father “X,” but wish to save embryos cannot use this procedure.

Freezing Eggs
* Problematic for a long time because in the freezing process ice crystals could form, harming the eggs.
* Involves removing ovarian tissue, and freezing it. After the tissue is “thawed” it is transplanted into a host. Mature eggs are removed, inseminated, and implanted into the birth mother.
* The technology is still evolving, and many caution that there may be lingering side-effects from the freezing of the eggs.
* Allows women who want to preserve fertility, but not commit to having a child with any particular person to do so.

Cloning Technologies
* We will be looking into these next week, but many of the same ethical issues that rise with these technologies are also raised. (But as a bonus, additional ethical issues are raised.)

Ethical Questions
* What concerns do you have about these technologies?
* Has technology outpaced law?

More Questions
* Who has access to these technologies?
* Given problems with overpopulation, should we continue to look into advanced in reproductive technology?
* Is reproduction without sex moral?
* What should happen to eggs/sperm/embryos that have been stored when the donors have died?
* Do you own your genetic material? Can you bequeath it?
The Big Question
* What is to be done with “excess” embryos?

Reproductive Ethics.ppt

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Assisted Reproductive Technologies (ART)



Assisted Reproductive Technologies (ART)
* Artificial Inseminations
* In vitro fertilization (IVF)
* Embryo transfers
* “Cloning”

Some Common Reasons for ART
* Infertility
o Male
o Female
* Absence of one or the other partner
o Lesbian, gay, transgendered parent
o Death of spouse
* Genetic Engineering
o Hereditary disorders
o Sex selection

Artificial Insemination
* Method other than intercourse to facilitate fertilization
* Introduction of semen or washed sperm into the vagina, the uterus or the Fallopian tubes
* Can be from legally recognized partner (husband) = AIH, or from another donor = AID
* Fresh or frozen semen samples (e.g., Select Sires, Inc.)

Long History of AI
* Agricultural uses
o 14th Century breeding of Arabian horses
o 1780 Spallanzani used sperm in dog breeding
o By 1940 many breeders Coops
* Human experience
o John Hunter (1780s) patient with hypospadias
o Marion Sims (mid 1800s) one success out of 55 tries
o By 1941 over 10,000 births in the US by AI
o By 1955 over 50,000
o Now, approx 1 percent of all births in US

The Famous Turkey Baster
Sorting sperm according to sex
* Sperm are sexually dimorphic: half have an X-chromosome, half have a Y-chromosome
* The X-chromosome is much bigger, so “female determining” sperm have more DNA, and are (hypothetically) slightly heavier
* Try to physically separate sperm based on size or DNA content
* Mark either the X or Y chromosome in some way and sort on the basis of the marking.
More than one X chromosome: Sex chromatin (
Flow sorting of marked sperm
IVF: In vitro fertilization
* Surgically remove “ripe” egg from follicle in ovary
* Obtain sperm sample
* Mix egg and sperm in glass (in vitro) dish
* Allow fertilized egg to develop for several days (in nutrient solution at body temp)
* Put embryo(s) (blastocyst) into “prepared” uterus (or Fallopian tube)
* Variation: sperm and egg are put into Fallopian tube
Fertilized egg or “zygote” [note the two nuclei, egg and sperm]
Direct injection of sperm into egg
3 day old human embryo
Embryo Transfers
* One kind of ART
* First Step: IVF
* Transfer Embryo into Recipient
* Combinations of:
o Egg Donor
o Sperm Donor
o Recipient
Outcomes of ART Pregnancies
One-third of ART deliveries are multiple births
Multiple Embryo Transfer
Success rate goes down with age
Births depend on age of eggs not mom
Three Thawed Embryos
Bring on the Clones

Clones in Context
* A clone is any organism whose genetic information is identical to that of a "mother organism" from which it was created.
* A clone is an exact replica of all or part of a macromolecule (e.g. DNA).
* A clone is a computer system based on another company's system and designed to be compatible with it.
* A clone is a butch or masculine gay man, a term mostly associated with the 70s and 80s. The "clone uniform" is mustache, jeans, and white t-shirt. E.g., a “Chelsea Clone” etc….
Reproductive vs Non-reproductive Cloning
Gestational Cloning
* New technology: becoming widely used in animal reproduction
* Allows unlimited reproduction of genetically identical individuals (clones)
* Potential for a sort of “genetic immortality”
* Many possible “good” and “bad” applications
* Societal vs Individual Rights: very unclear

Clones in Context
* Any group of cells that descends from a single cell….
o Includes such groups of cells as freckles, colonies of mold on bread, antibody producing lymphocytes, tumor cells…
* Any organism grown up from a single cell…
o Includes some plants, identical twins, some animals such as “Dolly” the Sheep…

Assisted Reproductive Technologies (ART).ppt

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Sperm Terms



Sperm Terms

Sperm Count – # of sperm
Sperm Mobility- ability of sperm to move
Forward Progression- quality of movement
Sperm Morphology- size and shape of sperm

Factors in Decreased Spermatogenesis
* Exposure to Heat
* Lifestyle Factors
* Age
* Endocrine Problems
* Immunological Problems

Anatomical Problems
Retrograde Ejaculation
Variocele
* Varicose vein around testicle.
* Decrease in sperm production due to increased scrotal temperature.
Cryptochordism
* Failure of one testis or both to descend into the scrotum.
* Decrease in sperm production due to temperature increase associated with being inside the body cavity
Erectile Dysfunction
-Inability to maintain an erection during sexual intercourse
* Many causes including: diabetes, alcohol and antidepressant use, anxiety, low testosterone, and arteriosclerosis
* Treatment includes medications such as Viagra, testosterone therapy, and counseling.

References

Sperm Terms.ppt

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Semen quality in relation to pesticides



Semen quality in relation to exposure to currently used pesticides
By:Shanna H. Swan, PhD
University of Missouri-Columbia
6th International Symposium on Environmental Endocrine Disrupters
Sendai, Japan

Background
Normal morphology
Motile sperm
Concentration

The Study for Future Families (SFF)
SFF Recruitment:
Summary of Semen Parameters
We considered these factors
o Age
o Smoking
o History of infertility
o Body mass index (BMI)
o History of STDS

* Ethnicity
* Recent fever
* Abstinence time
* Analysis time
Differences in semen quality were unchanged by adjustment for these factors
How does mid-Missouri differ from Minneapolis ?
% Acres in farms and use of pesticides
Herbicides
Insecticides
Fertilizer
Pesticides applied (acres)
Study hypothesis
Pesticides found more often in MN
Remaining analyses
Pesticides detected more often in cases than controls Percent of men with pesticide > LOD
Two pesticides were weakly associated with sperm count
Dose response for alachlor in MO men
Drinking water is a likely source of exposure
Examining pesticides and semen quality in a second agricultural center
Use of pesticides in IA is greater than MO
Semen quality in Iowa City and other SFF centers
What is needed?
* Urinary pesticide levels in IA men
* Serum levels of pesticides to examine total exposure
* Tap water pesticide levels
* Replication of study in other areas and countries
The Study for Future Families

Semen quality.ppt

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