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OB Test 4 > Chapter 9 - Infertility > Flashcards

Chapter 9 - Infertility Flashcards

1
Q

infertility affects

A

about 10%-15% of the reproductive-age population

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2
Q

Subfertility:

A

prolonged time to conceive

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3
Q

Sterility:

A

inability to conceive

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4
Q

A normal couple has

A

has 20% chance to conceive each ovulatory cycle

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5
Q

Diagnosis and treatment of infertility require

A

physical, emotional, and financial investment

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6
Q

Causes:

A 
20% idiopathic (unexplained)
Of the other 80%:
40% female
40% male
20% factors in both partners
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7
Q

Female infertility

A

Congenital or developmental factors-surgical reconstruction
Hormonal and ovulatory factors
Tubal/peritoneal factors
Uterine factors
Vaginal-cervical factors - Isoimmunization

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8
Q

Anovulation

A

not ovulating

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9
Q

Primary anovulation:

A

caused by a pituitary or hypothalmic hormone disorder (ex. congenital adrenal hyperplasia) (usually can’t be fixed)

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10
Q

Secondary anovulation:

A

relatively common caused by disruption of the hypothalmic pituitary ovarian axis (can be fixed, usually emotional stress)

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11
Q

Factors that can make a woman infertile

A 
Menopause before 40
Obesity
PCOS
Amenorrhea after BCP-rare
Increased prolactin level-medications, stress, surgery
Radiation,chemo
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12
Q

PCOs

A

physical ovarian syndrome - not ovulating after 6 months after coming off of birth control pills

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13
Q

Tubal/Peritoneal Factors

A 
Motility of tube and fimbriated end affected by infections, adhesions, scarring, tumors
Chlamydia
Surgery-ruptured appy, trauma surgery
Endometriosis
(STDs can seal tubes shut)
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14
Q

Uterine Factors

A

Bicornuate uterus
Vagina divided by septum
Asherman syndrome

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15
Q

Asherman syndrome:

A

uterine adhesions or scar tissue. Can be form too vigorous scrapping with elective abortion or miscarriage

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16
Q

Vaginal-Cervical Factors

A

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

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17
Q

male infertility can be caused by structural and hormonal disorders

A

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

18
Q

Azoospermia:

A

no sperm cells produced

19
Q

Oligospermia:

A

few sperm cells produced

Substance abuse

20
Q

Male Infertility

A 
Mumps - after puberty more likely to be infertile
Genetics
Endocrine disorders
STI’s
Exposure to radiation
21
Q

Considerations

A 
Religious
Cultural
Ethnic
Cost
Insurance coverage
Emotional stress
(most couples won't see fertility specialist for 1 year)
22
Q

Diagnostic test for female infertility

A 
Detection of ovulation
Hormone analysis
Ultrasonography
Hysterosalpingography (die in tube)
Hysteroscopy 
Laparoscopy (look in)
Timed endometrial biopsy
23
Q

Detection of ovulation-

A

basal boy temperature, cervical mucous characteristics, endometrial biopsy, pelvic ultrasound

24
Q

Serum progesterone level-

A

need sufficient amount to accommodate implantation and sustain pregnancy

25
Q

Hormone Analysis

A 
Levels of :
Prolactin
Follicle stimulating hormone (FSH)
Luteinizing hormone (LH)
Estradiol (E2)
Progesterone
Thyroid studies
26
Q

Ultrasound

A

Can be abdominal or transvaginal
Assess for: fibroid tumors, ovarian cysts, follicular development, uterine cavity
(most women 1st transvaginally)

27
Q

Hysterosalpingography

A

Contrast through cervix (dye, can flush tubes out with dye)

Assess for : congenital defects, endometrial polyps, PID, scar tissue, adhesions

28
Q

Hysteroscopy

A

Scope through cervix to view uterine cavity

29
Q

Timed Endometrial Biopsy

A

Scheduled 2-3 days before expected menses
Histological exam
Expect tissue to be dated with respect to normal menstrual development

30
Q

Laparoscopy

A

General or local anesthesia

Able to view pelvic structures intraperitoneally

31
Q

Assessment of male infertility

A

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)

32
Q

Assessment of the couple

A

Postcoital test (PCT) sample from cervical OS within several hours after intercourse evidence is lacking in validity of test

33
Q

Plan of care and interventions

A 
Psychosocial
Nonmedical-weight loss, high scrotal temp, less alcohol, smoking cessation,
Herbal alternative measures-see list 204
Medical
Surgical
34
Q

Medical

A

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

35
Q

–> clomid

A

makes women release more eggs

36
Q

Assisted therapy -

A

IVF - ET, ICSI, PGD, GIFT, ZIFT

37
Q

IVF- ET:

A

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.

38
Q

ICSI-

A

Intracytoplasmic sperm injection-introduce sperm directly into egg-can use poor quality sperm or less sperm

39
Q

PGD-

A

Preimplantation genetic diagnosis-genetic testing before impantation of IVF embryo

40
Q

GIFT-

A

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

41
Q

ZIFT-

A

Zygote intrallopian transfer-similar to GIFT except IVF then zygote is placed in uterine tube-<1% of all ART

42
Q

Donation

A 
Oocyte donation
Embryo donation
Embryo Host (surrogate)
Therapeutic Donor Insemination (TDI)-normal female fertility TDI works about 70% of the time
Adoption

OB Test 4 (9 decks)

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