2.3a Infertility Flashcards
Infertility
- Prolonged time to conceive
- If a couple does not achieve pregnancy after 1 year of unprotected sex they are advised to seek fertility evaluation
- Evaluation is recommended at 6 months for women older than 35 and have risk factors for infertility.
Sterility
- Inability to conceive
Primary Fertility
- Difficulty conceiving when there has never been a pregnancy
Secondary Fertility
- Difficulty conceiving after having had a pregnancy regardless of outcome
Fecundity
- Ability to carry pregnancy to live birth.
Fertility Requirements
- Normal reproductive tract in both male and female
- Normal hypothalamic-pituitary-gonadal axis that supports gametogenesis (meiosis of gametes)
- Sperm remains viable in female reproductive tract for 48 hours but only few retain fertilization potential after 24 hours.
- Ova remains viable for 24 hours.
Causes of Female Infertility
- Delaying pregnancy towards later in life
- Organ damage from toxins and diseases (endometriosis)
- Obesity
- Smoking
- Tubal Infection
- Depression
Causes of Male Infertility
- Unfavorable sperm production (>50 y/o)
- Physical or endocrine dysfunction
- Cumulative metabolic disease
- Toxins
Causes of Infertility
- 10% - 20% have idiopathic causes of infertility
Female Infertility Causes (cont)
- Hormonal and ovulatory factors
- Tubal/Peritoneal factors
- Uterine factors
- Vaginal-cervical factors
Male Infertility Causes (cont)
- Structural disorders
- Hormonal disorders
Causes of Decreased fertility
- Heavy caffeine/alcohol consumption
- Hyperprolactinemia (increased prolactin)
- Very low weight or poor diet
- Cancer treatment (ovarian surgery)
- Primary amenorrhea (failure of menses by age 15)
- Secondary amenorrhea (failure of menses 3x in a row)
- Ovulatory dysfunction (obesity, polycystic ovarian syndrome, strenuous exercise, endocrine dysfunction)
- Early menopause (before age 40) runs in family. Menopause is when ovaries don’t respond to ovulation inducing drugs
- Smoking, depression, environmental pollution exposure.
Tubal/Peritoneal Factors
- Impaired tubal motility and patency can come from infection, adhesion, scarring, tumor, or intentional sterilization
- One tube can be shorter than the other causing abnormal uterus
- Inflammation can cause pelvic infection which impairs fertility
Endometriosis
- Inflammatory peritoneal damage caused by endometrial tissue migrating out of uterus and implanted on pelvic organs or connective tissue.
- This results in adhesions which lead to pelvic distortion.
- Inflammatory changes are high risk factor for ovarian dysfunction and blocked tubal transport.
Uterine Factors
- Minor anomalies are common, Major are rare
-
Mullerian Malformations of Uterine Cavity
- Bicornate (separated uterus)
- Tumors of endothelium and myometrium (polyps and myomas) impairs implantation and normal fetal growth.
Asherman Syndrome
- Uterine adhesions or scar tissue
- Characterized by hypomenorrhea (low bleeding)
- Adhesions prevent normal cyclic endometrial proliferation necessary for implantation.
Vaginal-Cervical Factors
- When there is vaginal/cervical infections and inflammation, white blood cells reduce the number of viable sperm before entering cervical canal.
- Emotional stress, antibiotic therapy and diabetes diminish supportive alkalinity of cervical mucus.
- Some women develop anti-sperm antibodies.
- Fertility rate increases after age 35.
Ovarian Reserve
- Total number of follicles
- Decrease in number is the primary reason for age related infertility
Inadequate Progesterone
- Produced by ovarian corpus luteum
- Necessary to maintain uterine lining
- Inadequate and thin uterine lining will lead to incapable nourishment of implanted blastocyte.
Fertility Assessment
- Evaluation of cervix, uterus, tubes, peritoneum
- Detection of ovulation
- Assessment of immunologic compatibility
- Evaluation of psychogenic factors
Laparoscopy
Direct visualization of outside of uterus, ovaries, and tubes via the abdomen
Hysteroscopy
- Direct visualization of the inside of the uterus via the cervix
Basal Body Temperature
- Ovulation detected by increase in temperature due to progesterone
Serum Assay of Plasma Progesterone
- Checks adequacy of corpus luteal producing progesterone
Hysterosalpingogram
- Checks shape and patency of uterus
Ovulation Detection Kit
- Detects Luteinizing Hormone 12-36 hours prior to ovulation
Assessment of Male Infertility
- Evaluation of general health, penis, meatus, testes, scrotum, prostate, hair distribution, breast development.
- Semen analysis
- Assessment of immunologic compatibility
- Endocrine evaluation
- Genetic Screening
- Psychological Factors
Semen Analysis
- Most basic male fertility test
- Complete semen analysis
- Assess sperm number, morphology and motility
Ultrasonography
- Scrotal ultrasound
- Examines testes for presence of varicocele (enlargement of veins) and abnormalities
- Transrectal ultrasound
- Evaluates ejection ducts, seminal vesicles, and vas deferens for obstruction
Male Infertility
- Hypopituitarism (pituitary doesn’t produce enough hormones)
- Nutritional Deficiency
- Obesity and Metabolic Disease
- Trauma
- Environmental radiation/toxic substances
- Tobacco, alcohol, medication, drugs, anabolic steroids
- Gonadotropic inadequacy
- Genetic testing for other issues
- Hormone analysis of testosterone, gonadotropin, FSH, LH
Transgender Fertility Issues
- Cryopreservation of oocytes or sperm prior to surgery
- Intact reproductive organs can discontinue hormonal therapy and proceed with fertility care.
Religious and Cultural Considerations
Jewish - Accepting of most infertility treatments
Orthodox Jewish - Religious laws that govern marital relations
Roman Catholic Deems Unacceptable
- IVF, Masturbation to collect semen, TDI, Freezing of Embryos.
