2.3B Infertility Continued Flashcards
Psychosocial Support
- Priority for couples seeking fertility treatment
- Life stressor that effects self esteem, relationships, life goals and careers
- Interventions are painful and intrusive
- Timed abstinence can create stress
- Financially expensive
- Can cause distress, anger, isolation, sexual dysfunction, strain on relationship
- Exacerbated with pre-existing anxiety or depression
Lifestyle Change (Non-Medical Therapy)
- Hot baths and tight athletic clothes can cause too high temperature for spermatogenesis
- Some lubricants can diminish sperm motility/quality
- Cell phones worn by belt/hip have been linked to lower sperm quality
- Changes in nutrition may increase fertility
- Exercise and avoiding toxins
- Weight normalization and maintain normal glucose
- Timing of intercourse
Complementary Alternative Measures
- Herbal therapies not proven to work Stress management - Aromatherapy - Yoga - Meditation - Nutritional/Exercise counseling
- Mind/spirit/body exercises
- Acupuncture can lower anxiety and improve pregnancy rates for women going through IVF
Medical Therapy for Women
- Infections treated with antibiotics
- Surgery to correct tubal blockage or pelvic distortion
- Removal of uterine fibroids (growths)
- Laparoscopic removal of endometrial adhesions, implants, and draining of hydrosalpinges (fluid in fallopian tubes)
Medical Therapy for Men
- Corrected thyroid or adrenal gland issues
- Infection treated with antibiotics
- Surgery to correct varicoceles (enlargement of vein), blockages or tumors
- FSH, gonadotropins, clomiphene can be used to stimulate spermatogenesis in men with hypogonadism.
Menotropins
Human menopausal gonadotropins (hMG)
- Helps with Ovarian Follicular growth and maturation
Human Chorionic Gonadotropin (hCG)
- Induces Ovulation
Letrozole (off-label use)
- Ovulation Induction
Exogenous Progesterone
Treatment of Luteal Phase Inadequacy
Metformin (off-label use)
- Restores cyclic ovulation and menses in many women with PCOS
Clomiphene Citrate (FSH/LH) Ovarian Stimulant
- If ovarian reserve is sufficient, this is given to women to stimulate ovary to produce follicles.
Assisted Reproductive Technology (ART)
- Manipulation of egg, sperm, and/or embryo
Types - Introducing sperm into uterus or tubules
- Removing eggs from woman
- Fertilizing egg in laboratory
- Returning embryo to woman or surrogate carrier
Intrauterine Insemination (IUI)
- Ovarian stimulation therapy followed by timed intercourse.
- Used when sperm quality is low, cervical mucus unfavored, presence of semen allergy.
- Preferred technique for introducing donor sperm or sperm that has been washed
In Vitro Fertilization - Embryo Transfer (IVF-ET)
- Used when blockage or inflammation from endometriosis impairs tubal patency or when tubes are surgically removed
- Eggs are removed with intravaginal needle aspiration.
- Sperm is injected in
- Fertilized egg transferred into uterus
Gamete Intrafallopian Transfer and Zygote Intrafallopian Transfer
GIFT similar to IVG-ET requires at least 1 normal uterine tube.
- Oocytes aspirated from follicles via laparoscopy
- Semen collected before laparoscopy
- Ova and sperm are transferred into uterine tube permitting natural fertilization and cleavage (cell division)
ZIFT - is like GIFT but fertilization occurs In Vitro then placed in uterine tube.
Oocyte Donation
Women who have ovarian failure, oophorectomy, genetic defect, fail to achieve pregnancy with own eggs are eligible for donor eggs.
- Donation from women who are 35 or younger, healthy, recruited and paid to undergo ovarian stimulation and oocyte retrieval
Cryopreservation
- Sperm, ovarian tissue, oocytes, or embryos can be cryopreserved for later use.
Sperm Donation
Therapeutic Donor Insemination
- Male partner is absent, produces unfavorable sperm, couple has genetic defect, male partner has anti-sperm antibodies, woman without male partner.
Embryo Donation
- Couples who do not want their frozen embryos release it for other infertile couples
Surrogate Mother and Embryo Host
- Surrogate mother is inseminated with semen from infertile woman’s partner and carries baby until birth. Baby is then adopted by infertile couple
- Ovum is retrieved from infertile woman, fertilized with partner’s sperm, and placed into uterus of an embryo or gestational carrier.
Risks of ART
- Ovarian stimulation, nausea, fluid retention, ovarian hyperstimulation
- Invasive procedures
- Psychological Stress
- General Anesthesia
- Ethical and Legal ssues
Intracytoplasmic Sperm Injection
- Sperm cell injected directly into egg to achieve fertilization (Used with IVF-ET)
- Used when male is has low sperm count, couple has genetic defect, male has anti-sperm antibodies.
Assisted Hatching
- Zona pellucida is penetrated chemically/manually to allow embryo to hatch in uterine wall. Used with IVF-ET
- Used for recurrent miscarriages, improve implantation rate in women with previously unsuccessful IVF attempts, advanced age.
Zygote Intrafallopian Transfer (ZIFT)
- After In-vitro fertilization, ova is placed in uterine tube during zygote phase
Therapeutic Donor Insemination
- Donor sperm used to inseminate the female partner.
- Can be used with IUI, IVF-ET, GIFT, or ZIFT
- Male partner has low sperm count, genetic defect, anti-sperm antibodies, lesbian or transgender couple.
Issues with Treatment to Discuss
- Risk of multiple gestation
- Possible need for multifetal reduction
- Possible need for oocytes, sperm, or embryo’s for the female partner or gestational carrier.
- Freezing embryo for later use
- Possible risk of long term medication and treatment
- Stress Management Techniques
