Class 10: Infertility Flashcards
Female/male factor infertility
defined as the inability to conceive after one year of trying (one year of unprotected intercourse). Female factor (20-40+%) Male factor (20-30%)
Advanced Maternal Age
around 35 years, poor egg quality. Increased occurrence of meiotic errors leading to aneuploidy. More general, less understood egg health issues (making a poor quality embryo)
Endometriosis
over proliferation of the endometrial tissue. Tissue similar to the endometrium found outside the uterus - ovary, oviduct, other places in the pelvic cavity.
Tubal defects
(tubal = fallopian tubes) oviducts are blocked for some reason. Numerous causes including congenital blockage, scar tissue from endometriosis and pelvic inflammatory disease (PID)
Polycystic Ovarian Syndrome (PCO)
a form of tubal defect. Follicles get stuck in “follicular arrest” – ovarian cysts are really small antral follicles. Caused by insufficient FSH, leading to imbalance of LH dominance over FSH.
- Action of LH in the ovary (follicular phase) - binds with theca cell and makes androgens (androstinedione) - Action of FSH in the ovary - binds with granulosa cell
Varicocele
enlarged veins in the scrotum, disrupting temperature regulation in the testis, thus disrupting spermatogenesis
Azoospermia , oligospermia
can be cause by an obstruction in the male tract leading to no sperm in the semen or failures in spermatogenesis (hormonal, genetic, or varicocele)
Ovarian hyperstimulation , ovulation induction
works as an anti-estrogen on the hypothalamus and/or pituitary. General concept: introduce exogenous gonadotropins to stimulate follicle development and ovulation.
- FSH injections to stimulate follicles - LH injection to induce ovulation
Clomiphene citrate (Clomid)
Oral medication taken for ovarian hyperstimulation, taken during days 3-7or 5-9 of the menstrual cycle.
Ovarian Hyperstimulation Syndrome
due to the actions of these exogenous gonadotropins introduced through hyperstimulation, especially hCG → multiple luteinized cysts in the ovary. High estrogen and progesterone production. May see longer term effects of high levels of estrogen and progesterone.
IVF (including basic steps)
semen/sperm from the male partner or donor is placed in the female’s cervix or uterus to “inseminate” female. Steps: (1) Stimulate egg production - ovarian hyperstimulation and ovulation induction through gonadotropin injections. FSH injections to stimulate follicles, LH injections to induce ovulation. (2) Collecting gametes, fertilization - collect eggs from hormonally stimulated woman, male partner provides semen sample (or donor), sperm capacited in vitro (in lab) and mix eggs with sperm (in vitro)
Elective Single Embryo Transfer ( eSET)
Elective Single Embryo Transfer - “elective” patients deliberately choose to transfer only one embryo to prevent risk of pregnancy with multiple fetuses. Number of embryos transferred depends in part on maternal age. Commonly women of older age have more embryos transferred.
Use of frozen embryos
Created by a previous IVF cycle using nondonor eggs. 18% of IVF in 2009. Overall trend towards increasing use of frozen embryos. Can be stored for use years later.
Use of donor eggs
donor eggs allow women of advanced maternal age to carry a baby without complications - it is not the system that is old but rather the woman’s eggs.
Intracytoplasmic Sperm Injection (ICSI)
Technique used when sperm quantity or quality is lacking. Use has been increasing. Used as a treatment for male infertility factor because sperm can be retrieved from testis (even though not mature) or even after man has died! This technique leads to a potential second generation of infertile men (which could never have happened before.)
