78. Infertility . Female infertility. Etiology and diagnosis. Treatment and prophylactic. Flashcards
sterility of women can be divided into major groups what are they ?
acquired
genetic factors
by location - hypothalamic pituitary factors -ovarian factors -tubal / pelvic factors uterine factors -cervical factors vaginal factors
idiopathic
what are the diagnostic tests used to determine ovulation ?
menstrual anamnesis - consideration of STI , surgery , endocrinopathies
basal temperature rise in 0.5-1 degrees
cervical mucus test
endometrial biopsy
progesterone level on 21-23rd (mi luteal phase 7 days after ovulation) inmenstrual cycle
if progesterone is less than 10ng/ml it is an anoulatroy cycle
over 15nmol/l confirms ovulation
folliculomtery in transvaginal ultrasound
urine test based for preovulatory LH surge
hysterosalpingography , laparoscopy
measurement of PROLACTIN
Day 2 or 3 measure of FSH and estrogen, to assess ovarian reserve.
measurement of TSH
examination of ASA
test of Miller
premature ovarian failure :
The anterior pituitary secretes FSH and LH at high levels due to the dysfunction of the ovaries and consequent low estrogen levels. Typical FSH in POF patients is over 40 mlU/ml
cervical infertility factor diagnosis :postcoital test
vitality and mobility of the sperms is decreased from 1 to 10 hours after the intercourse, the test is positive
There are five accepted parameters for scoring cervical mucus what are they ? and what do they indicate ?
amount, stretchability , ferning, viscosity, and cellularity
highly reliable as indicators for folliculogenesis
what are the acquired causes for infertility in women ?
age smoking STI body weight and diet immune infertility - ASA (antisperm antibodies) chemotherapy/radiotherspy
A woman’s fertility peaks in
early and mid 20’s
decline of a women’s fertility is when
accelerated after 35
how does a women’s weight affect fertility ?
too much body fat causes production of too much estrogen and the body begins to react as if it is on birth control
Too little body fat causes insufficient production of estrogen and disruption of the menstrual cycle.
Chromosomal abnormalities causing female infertility ?
turner syndrome - gonadal dysgenesis
what are some of the genetic causes of infertility ?
Premature ovarian failure (POF) is the loss of function of the ovaries before age 40 - triad for the diagnosis is amenorrhea, hypergonadotropism, and hypoestrogenism.
Kallmann syndrome (KS) is a genetic disorder that prevents a person from starting or fully completing puberty. - hypogonadotropic hypogonadism- distnguih it from others lack of smell.
Hypergonadotrophic ovarian failure- by mutations in BMP15 gene responsible for folliculogenesis for primordial follicles
Fragile X mental retardation- premature ovarian - premature ovarian filing
changes in FSH receptor - hypergonadotropic hypogonadism or overstimulation of the ovaries
what are some of the hypothalamic pituitary factors that causes hypogondaotropic hypogondaism ?
hypopituitarism -
-tumor ,
- inflammation
- sheehans syndrome -PPH –> gland is vulnerable to low blood pressure, pituitary damage
- radiation induced hypopituitarism
hyperprolactinemia - leads to hypoestrogenism
-pitutory adenoma
- acromegaly
- Hypothalamic-pituitary stalk damage—> granuloma , radiation, trauma
- drug induced
dopamine antagonists
what are the ovarian factors ?
PCOS
diminished ovarian reserve
what are the tubal and pelvic factors ?
endometriosis pelvic adhesions PID previous ectopic pregnancy and tubal excision diverticulosis of fallopian tube
what are the uterine factors ?
Uterine malformations
Uterine fibroids / polyps
Asherman’s syndrome
endometritis
what are the cervical infertility factors ?
Cervical stenosis
cervical mucus thickening (clomifen citrate)
Antisperm antibodies
cervicitis
cervical cancer
what are the vaginal factors ?
Vaginismus
Vaginal obstruction
vaginal Genesis
what are the treatment of female infertility ?
Ovulation induction for anovulation
- blockage of ovulation - with contraception , causing a rebound phenomena
antiestrogens applied 5-9th day of menstruation
exogenous gonadtropin hormones
gnrh agonist
assisted reproductive technology such as IVF or IUI in for location abnormalities
prophylaxis of female infertility
Maintaining a healthy lifestyle -exercise, caffeine and alcohol, and smoking have all been associated with decreased fertility. Eating a well-balanced, nutritious diet
controlling chronic diseases such as diabetes and hypothyroidism increases fertility prospects.
safer sex that sexually transmitted diseases will impair fertility;
obtaining prompt treatment for sexually transmitted diseases reduces the likelihood that such infections will do significant damage.
Regular physical examinations (including pap smears) help detect early signs of infections or abnormalities.
Not delaying parenthood.
Egg freezing. cryogenically frozen and ready for her use later in life, reducing her chances of female infertility.
what is test of miller ?
test evaluates the ability of the sperms to penetrate the cervical mucus after incubation of the sperm and the mucus on a slide during 45 minutes at 37o C.
