Chapter 19 - Module 2 - Infertility Flashcards
Infertility, defined
Infertility is the failure to achieve a successful pregnancy after 12 months or more of regular unprotected intercourse.
Classification is primary (a couple who has never been pregnant) or secondary (the inability to become pregnant, or to carry a pregnancy to term, following the birth of one or more biological children).
Secondary infertility rates > primary infertility rates
Infertility can be …
Wanted (tubal ligation) or unwanted (experienced by about 15% of couples in the U.S. and is a profound and extremely difficult challenge, a major life crisis).
Infertility and age
For women over 35, infertility evaluation and treatment is considered after six months of attempting pregnancy, instead of one year, because:
- remaining time for successful pregnancy is limited
- fecundity declines gradually beginning at age 32 and more rapidly after 37
- incidence of conditions impairing fertility (e.g. fibroids, endometriosis) increases
- higher risk of pregnancy loss
Sperm production relies on …
Sperm production relies on a functioning hypothalamic-pituitary-testicular axis that has many similarities to the hypothalamic-pituitary-ovarian axis in women.
The pituitary produces follicle-stimulating hormone (FSH) and luteinizing hormone (LH) in response to the secretion of gonadotropin-releasing hormone (GnRH) by the hypothalamus.
FSH and LH, in males
FSH and LH in males initiate testicular production of era a d testosterone which are necessary for spermatogenesis. Takes about 72 days.
Female infertility etiologies
- majority: d/t ovulatory dysfunction and tubal and pelvic problems
- combined or interactional causes
Infertility, rates d/t gender
55% d/t female factors
35% d/t male factors
10% no known cause, “unexplained infertility”
Ovulatory dysfunction
Ovulatory dysfunction may involve either a total lack of ovulation or the occurrence of irregular ovulation. Anovulation usually evidenced by irregular menstrual bleeding patterns or amenorrhea.
Causes of ovulatory dysfunction
Numerous causes are possible, can result from any interruption of the hypothalamic-pituitary-ovarian (HPO) axis
- hyperandrogenic disorders
- physiologic anovulation at either end of the reproductive spectrum
- hyperprolactinemia
- pituitary tumors
- thyroid disorders
- eating disorders
- low or high BMI
- medications
- stress
- shortened Luteal Phase, less than 13 days elapse between the midcycle LH surge and the onset of menses.
Tubal problems as a cause of infertility …
Usually related to blockages within the tubes. Can be anatomical, but more likely as a result of the progression of STIs to pelvic inflammatory disorder (PID).
Tubal problems can be d/t previous ectopic pregnancy or tubal surgery.
Other pelvic problems to consider in infertility …
- endometriosis
- Asherman syndrome
- other uterine factors
Endometriosis
Endometriosis is a condition in which menstrual tissue grows outside of the uterus rather than being sloughed off with each menstrual period. May or may not cause pain. Amount of pain is unrelated to extent of disease process.
Asherman syndrome
Asherman syndrome results from intrauterine adhesions that obstruct or obliterate the uterine cavity. Asherman syndrome is usually caused by over zealous postpartum curettage, but can also occur after cesarean birth, myomectomy, or other uterine surgery.
Hypomenorrhea, amenorrhea, or dysmenorrhea may be present.
Other potential uterine causes of infertility …
Other uterine causes of infertility include fibroids, endometrial polyps, and chronic endometritis. The effects of these factors on fertility are unknown, and these are not a common cause of infertility.
Male etiologies of infertility
Male factors may be d/t anatomical or structural problems, abnormalities in sperm production, and sexual, hormonal, and genetic conditions.
Structural causes of male infertility …
A structural cause of male infertility is undescended testes (cryptorchidism). Normally descended by age 2, if not, internal body temperatures, higher than external, may damage sperm.
Hypospadias may make it difficult to deposit semen in the woman’s vagina.
Untreated or recurrent STIs in the male may result in scarring and blockage of the reproductive tract.
Hypospadias
Hypospadias is a congenital anomaly that results in the urethral outlet being located on the shaft of the penis rather than at the end.
Mumps and male infertility …
Mumps contracted in males, particularly after adolescence, may result in orchitis or testicular inflammation, usually unilateral, so rarely sterility results.