Chapter 9 - Infertility Flashcards
infertility affects
about 10%-15% of the reproductive-age population
Subfertility:
prolonged time to conceive
Sterility:
inability to conceive
A normal couple has
has 20% chance to conceive each ovulatory cycle
Diagnosis and treatment of infertility require
physical, emotional, and financial investment
Causes:
20% idiopathic (unexplained) Of the other 80%: 40% female 40% male 20% factors in both partners
Female infertility
Congenital or developmental factors-surgical reconstruction
Hormonal and ovulatory factors
Tubal/peritoneal factors
Uterine factors
Vaginal-cervical factors - Isoimmunization
Anovulation
not ovulating
Primary anovulation:
caused by a pituitary or hypothalmic hormone disorder (ex. congenital adrenal hyperplasia) (usually can’t be fixed)
Secondary anovulation:
relatively common caused by disruption of the hypothalmic pituitary ovarian axis (can be fixed, usually emotional stress)
Factors that can make a woman infertile
Menopause before 40 Obesity PCOS Amenorrhea after BCP-rare Increased prolactin level-medications, stress, surgery Radiation,chemo
PCOs
physical ovarian syndrome - not ovulating after 6 months after coming off of birth control pills
Tubal/Peritoneal Factors
Motility of tube and fimbriated end affected by infections, adhesions, scarring, tumors Chlamydia Surgery-ruptured appy, trauma surgery Endometriosis (STDs can seal tubes shut)
Uterine Factors
Bicornuate uterus
Vagina divided by septum
Asherman syndrome
Asherman syndrome:
uterine adhesions or scar tissue. Can be form too vigorous scrapping with elective abortion or miscarriage
Vaginal-Cervical Factors
Vaginal fluid acidic (pH 4-5)
Cervical mucous normally alkaline pH(7 or >)
pH can be affected by vaginal cervical infections (bacterial vaginosis), blood, pathogenic bacteria, irritants such as IUD, polyp, antibiotics, diabetes, severe emotional stress
male infertility can be caused by structural and hormonal disorders
Undescended testes (can get fixed as a kid)
Hypospadias
Varicocele (varicose vein of the scrotum)
Low testosterone levels
Azoospermia: no sperm cells produced
Oligospermia: few sperm cells produced
Substance abuse
Azoospermia:
no sperm cells produced
Oligospermia:
few sperm cells produced
Substance abuse
Male Infertility
Mumps - after puberty more likely to be infertile Genetics Endocrine disorders STI’s Exposure to radiation
Considerations
Religious Cultural Ethnic Cost Insurance coverage Emotional stress (most couples won't see fertility specialist for 1 year)
Diagnostic test for female infertility
Detection of ovulation Hormone analysis Ultrasonography Hysterosalpingography (die in tube) Hysteroscopy Laparoscopy (look in) Timed endometrial biopsy
Detection of ovulation-
basal boy temperature, cervical mucous characteristics, endometrial biopsy, pelvic ultrasound
Serum progesterone level-
need sufficient amount to accommodate implantation and sustain pregnancy
Hormone Analysis
Levels of : Prolactin Follicle stimulating hormone (FSH) Luteinizing hormone (LH) Estradiol (E2) Progesterone Thyroid studies
Ultrasound
Can be abdominal or transvaginal
Assess for: fibroid tumors, ovarian cysts, follicular development, uterine cavity
(most women 1st transvaginally)
Hysterosalpingography
Contrast through cervix (dye, can flush tubes out with dye)
Assess for : congenital defects, endometrial polyps, PID, scar tissue, adhesions
Hysteroscopy
Scope through cervix to view uterine cavity
Timed Endometrial Biopsy
Scheduled 2-3 days before expected menses
Histological exam
Expect tissue to be dated with respect to normal menstrual development
Laparoscopy
General or local anesthesia
Able to view pelvic structures intraperitoneally
Assessment of male infertility
Semen analysis-
Ultrasonography-scrotal US, abnormalities in scrotum and spermatic cord
(ph 7.2 or higher, viscosity, density - more than 20 million per ml, motility)
Assessment of the couple
Postcoital test (PCT) sample from cervical OS within several hours after intercourse evidence is lacking in validity of test
Plan of care and interventions
Psychosocial Nonmedical-weight loss, high scrotal temp, less alcohol, smoking cessation, Herbal alternative measures-see list 204 Medical Surgical
Medical
Clomid, human menopausal gonadotropin, human chorionic gonadotropin
Metformin and dexamethasone can potentiate clomid for anovulation in women who have PCOD
>25% of multiples with meds
–> clomid
makes women release more eggs
Assisted therapy -
IVF - ET, ICSI, PGD, GIFT, ZIFT
IVF- ET:
IN Vitro Fertizlization-Embryo Transfer- Ovarian stimulation using Rx collected midcycle using needle, fertilized with sperm in a dish for up to 6 days then transferred to uterus using US.
ICSI-
Intracytoplasmic sperm injection-introduce sperm directly into egg-can use poor quality sperm or less sperm
PGD-
Preimplantation genetic diagnosis-genetic testing before impantation of IVF embryo
GIFT-
Gametic intrafallopian transfer-similar to IVF-eggs induced and harvested, sperm collected-sperm and egg placed in uterine tube allowing for natural fertilization-<1% ART use this technique
ZIFT-
Zygote intrallopian transfer-similar to GIFT except IVF then zygote is placed in uterine tube-<1% of all ART
Donation
Oocyte donation Embryo donation Embryo Host (surrogate) Therapeutic Donor Insemination (TDI)-normal female fertility TDI works about 70% of the time Adoption
