Before Conception Flashcards
What are the necessities?
Female
1. Favorable cervical mucus
2. Patent tubes (i.e. clear
passage) & mobility
3. Ovulation & release of ova
4. Endometrial preparation
Male
1. Normal semen
2. Normal genital tract
secretions
3. Ejaculate at the cervix
Factors Affecting FEMALE Fertility
Ovarian/tubal
factors:
Anovulation
Medications (i.e. steriods, older antihypertensives, anti-psychotics)
Anomalies
Uterine/cervical
factors:
Anomolies
Endometrial lining, endometriosis
Cervical mucus
Genetic factors:
i.e. CF, Thalasemia, Turner syndrome
Medical/age
factors:
35 years
Chronic conditions (i.e. PCOS)
STIs
Lifestyle/environmental
factors:
Underweight/overweight
Substance use
Occupational/environmental exposures
Factors Affecting MALE Fertility
Hormonal
factors:
Interfere with sperm production
Pituitary or endocrine
Reproductive
factors:
Anomolies
Testicular factors (i.e. scrotal temp)
Sperm transport
Genetic factors:
i.e. CF, Klienfelter
syndrome
Medical/age
factors:
Advanced age
Chronic conditions
STIs
Lifestyle/environmental
factors:
Underweight/overweight
Substance use
Occupational/environmental exposures
Assessment of Infertility
● History & physical exam
● Laboratory data
● Examination of factors affecting
fertility
● Psychosocial considerations
○ Major life stressor
○ Grieving process evident
○ Religious & cultural considerations
○ Insurance coverage
● Genetic testing
○ Inheritance patterns
■ Autosomal dominant
■ Autosomal recessive
■ X-linked dominant
■ X-linked recessive
○ Preimplantation genetic diagnosis
nonmedical management of infertility
Lifestyle changes
■ Healthy BMI
■ Exercise
■ Abstain from alcohol, tobacco,
drugs
■ Lubricants
■ Scrotal temperature
○ Herbal remedies
medical Management of Infertility
○ Treatment of ovulatory dysfunction
■ Clomiphene citrate
■ Letrozole
○ Support ovulation
■ Metformin
○ Stabilize chronic medical conditions
○ Treat infection
surgical management of infertility
○ Hysterosalpingography
○ Laparoscopy
○ Reconstructive surgery
○ Surgical removal of tumors or
fibroids
○ Cryosurgery
Assisted Reproductive Therapies for Management of Infertility
○ Intrauterine insemination (IUI)
○ In vitro fertilization (IVF)
○ Gamete intrafallopian transfer (GIFT)
○ Donor eggs or sperm
○ Donor embryo
○ Surrogacy/Gestational carrier
Preconception Care Assessment
health hx
1. Reproductive history
2. Family planning
3. Medical history
a. Chronic medical conditions
b. Medications
4. Vaccinations
5. Environmental exposures/ infections
current health status
1. Age
2. Physical examination
a. Laboratory studies
3. Medical conditions
a. Medications
4. Mental well-being
5. Lifestyle assessment
a. Substance use
b. Weight/nutrition
Risk Factors for Adverse Pregnancy Outcomes
● Smoking
● Alcohol consumption
● Poor nutrition
● Obesity
● Short interconception intervals
● Low SES
● Prescription & OTC medications
● Pre-existing medical conditions
● Age
● Victim of violence
● Substance abuse
● Racial disparities
● Social determinants of health
Health Promotion Activities & Education
● Providing protection
○ Weight & nutrient management
○ Avoid unintended pregnancies
○ Avoid short interconception intervals
○ Immunizations
● Avoiding harmful exposures
○ Tobacco, alcohol, illicit drugs, & prescription medications
○ Avoidance of teratogenic prescription
drugs
○ Healthy work environment
● Managing conditions
○ Identification of chronic diseases
○ Ensure therapies offer healthy
reproductive outcomes
○ Planned & managed future
conceptions
● Genetic counseling if necessary
