ch. 9 infertility Flashcards
infertility
the inability to become pregnant after 1 year of UNPROTECTED intercourse
- prolonged time to conceive (after one year)
- affects 1 in 5 individuals age between 15-49
- increases with age, esp. in women >35 years old
sterility
inability to conceive
- d/t vasectomy, tubal ligation, anatomic issue
factors associated with infertility female
1) hormonal and ovulatory factors
2) tubal and peritoneal factors
3) uterine factors
4) vaginal-cervical factors
5) other: anemia, obesity, substance use, thyroid disfunction, genetic disorders (eg. turner syndrome)
hormonal and ovulatory factors (infertility)
- developmental anomalies
- high prolactin levels
- anovulation: ovary never releases ova, leads to primary amenorrhea
tubal and peritoneal factors (infertility)
- inflammation
- tubal adhesions (d/t ectopic pregnancy, STI)
- endometriosis (presence and overgrowth of endometrial tissue outside uterus)
- chronic cervicitis (inflammed cervix acts as toxic environment for fetus)
uterine factors (infertility)
- developmental anomalies (born w/o vagina/uterus)
- endometritis: inflammation of the inner lining of the uterus
- bicornuate uterus: septum runs down middle uterus, leads to increase chance miscarriage, can’t conceive after!
factors associated with infertility male
1) poor sperm quality
2) structural or hormonal disorders
3) other factors: genetic disorders, decrease in libido (d/t anti-htn meds, SSRIs, etc.), erectile dysfunction
causes of poor sperm quality
- substance use (smoking, marijuana)
- age
- STI’s-
- environmental hazards exposure (factory, construction, radiation, toxic materials)
- high temperatures around scrotum (construction, landscape)
- nutritional deficiencies
- obesity
- anti-sperm antibodies (men and women can both develop)
structural or hormonal disorders (male infertility)
- undescended testes
- hypospadias: urethra is behind penis, almost looks circumcised)
- varicocele: enlargement of veins within scrotum
- obstructive lesions
- low testosterone levels
transgender fertility issues: options for reproduction (2)
1) cryopreservation: extract ova or sperm from patient before starting gender-reassignment hormone therapy to preserve option to have children later on in life
2) discontinue gender-reassignment hormone therapy to pursue fertility care (hold)
TIP: traumatic for patients with gender dysphoria, best care is provided by an interprofressional team!
assessment of female infertility
1) diagnostic tests:
- detection of ovulation (basal body temp., FSH/LH/prolactin)
- hormone analysis
- imaging: transvaginal ultrasound, MRI, sonohysterography, hysterosalpingography, laparoscopy
assessment of male infertility
1) evaluation of general health (smoke)
2) semen analysis (assess sperm number, morphology, and motility)
3) ultrasonography (scrotal, transrectal -> prostate gland location)
4) genetics
5) other tests:
- hormonal causes
- chronic disease causes
- causes from environmental hazards
- nutritional deficiency
infertility care mgmt interventions
1) psychosocial:
- major life stressor: can affect relationships, life goals, careers
- can exacerbate pre-existing anxiety or depression
2) nonmedical:
- lifestyle changes: vacation to relax
3) complementary and alternative measures
4) medical therapy:
- correcting pre-existing factors
- ovarian stimulation -> commonly used medications (fig 9.6)
assisted reproductive therapy (ART) most common
manipulation of eggs, sperm, and/or embryo
- intrauterine insemination (IUI)
- in vitro fertilization-embryo transfer (IVE-ET) -> intracytoplasmic sperm injection, assisted hatching, preimplantation genetic testing (PGT)
- gamete intrafallopian transfer (GIFT) -> ZIFT
- oocyte donation (sperm donation, ova donation)
ART types
- zygote intrafallopian transfer (ZIFT)
- oocyte donation
- cryopreservation
- fertility preservation (elective fertility preservation)
- sperm donation (therapeutic donor insemination (TDI))
- embryo donation
- surrogate mothers & embryo hosts
- risks of ART
- adoption
- choosing to live without children
