causes of infertility Flashcards
estrogen effect on mucus
thins the cervical mucus –> nearing ovulation
progesterone effect on mucus
thickens it; prevents sperm in or out
hysterosalpingogram
radio-opaque dye followed through the uterus and tubes to look for lesions
normal semen has ____ sperm per mL
20 million
half are motile and 30%+ are normal
infertility with >10million total motile sperm
treat w…
intrauterine insemination=
concentrated motile sperm placed inside uterus
infertility with 3 to 10million total motile sperm
treat w…
in vitro fertilization (IVF)
fertilized in dish and transferred into the uterus
infertility with less than 3 million total motile sperm
treat w…
ICSI
intracytoplasmic sperm injection
inject a single sperm into an oocyte
hydrosalpinx + ddx and treatment
fallopian tube obstruction preventing oocyte/sperm interaction, complete obstruction = infertility
• ddx using Hysterosalpingogram
• **remove hydrosalpinx and then perform IVF
endometriosis
diagnosis and treatment
endometrial tissue in abnormal locations
D/t: menstrual reflux, metaplasia, hematologic/lymphatic/iatrogenic spread
- CANNOT use hysterosalpingogram unless: adhesions block tubes or encase ovaries
- Ultrasound can identify it
- Laparoscopy – direct visualization – then excise or ablate
polycystic ovarian syndrome
required 2 of 3: ovulatory dysfunction (error in oocyte production), hyperandrogenism, or polycystic ovaries
- Increased androgens; follicles grow to small size, then die; ovulation is rare
- Ultrasound shows at least 10 follicles of less than 10mm per ovary; thickened ovarian stroma
- Laparoscopy – enlarged ovaries
diminished ovarian reserve
how to predict
less ability to produce oocytes that can be fertilized (occurs with older age)
• Antral follicle count – predicts number of oocytes available
o antral follicles carry a premature cohort of oocytes; count below 4 suggests poor fertility
congenital uterine anomalies
dysfunction of embryogenesis, resulting in abnormal uterus
• Types: uterine didelphys, bicornate uterus, unicornuate uterus, or septate uterus
• Hysterosalpingogram – dye provides contour; cant differentiate bicornuate and septate uterus reliably
• Ultrasound – CAN separate bicornuate vs septate
• Surgery is NOT useful for didelphys, unicornuate, and biornuates;
US vs hysterosalpingogram
which can differentiate bicornuate uterus and septate uterus?
US can
hysterosalpingogram CANNOT
leiomyoma
fibroids; benign uterine tumor pf excessive scar-like tissues
o Treat: hysterosalpingogram (cant see those within the wall) or ultrasound (CAN see those within wall) Hysterectomy or just the leiomyomas (myomectomy)
which imaging allows you to see fibroids WITHIN the wall
Ultrasound
