78. Infertility . Female infertility. Etiology and diagnosis. Treatment and prophylactic.

Question 1

sterility of women can be divided into major groups what are they ?

Answer 1

acquired

genetic factors

by location 
- hypothalamic pituitary factors 
-ovarian factors 
-tubal / pelvic factors 
uterine factors 
-cervical factors 
vaginal factors

idiopathic

Question 2

what are the diagnostic tests used to determine ovulation ?

Answer 2

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

Question 3

There are five accepted parameters for scoring cervical mucus what are they ? and what do they indicate ?

Answer 3

amount, stretchability , ferning, viscosity, and cellularity

highly reliable as indicators for folliculogenesis

Question 4

what are the acquired causes for infertility in women ?

Answer 4

age 
smoking 
STI 
body weight and diet 
immune infertility - ASA (antisperm antibodies)
chemotherapy/radiotherspy

Question 5

A woman’s fertility peaks in

Answer 5

early and mid 20’s

Question 6

decline of a women’s fertility is when

Answer 6

accelerated after 35

Question 7

how does a women’s weight affect fertility ?

Answer 7

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.

Question 8

Chromosomal abnormalities causing female infertility ?

Answer 8

turner syndrome - gonadal dysgenesis

Question 9

what are some of the genetic causes of infertility ?

Answer 9

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

Question 10

what are some of the hypothalamic pituitary factors that causes hypogondaotropic hypogondaism ?

Answer 10

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

Question 11

what are the ovarian factors ?

Answer 11

PCOS

diminished ovarian reserve

Question 12

what are the tubal and pelvic factors ?

Answer 12

endometriosis 
pelvic adhesions 
PID 
previous ectopic pregnancy and tubal excision
diverticulosis of fallopian tube

Question 13

what are the uterine factors ?

Answer 13

Uterine malformations

Uterine fibroids / polyps

Asherman’s syndrome

endometritis

Question 14

what are the cervical infertility factors ?

Answer 14

Cervical stenosis

cervical mucus thickening (clomifen citrate)

Antisperm antibodies

cervicitis

cervical cancer

Question 15

what are the vaginal factors ?

Answer 15

Vaginismus
Vaginal obstruction
vaginal Genesis

Question 16

what are the treatment of female infertility ?

Answer 16

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

Question 17

prophylaxis of female infertility

Answer 17

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.

Question 18

what is test of miller ?

Answer 18

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.