Common Reasons for Impaired Fertility Flashcards
what are factors that may impair female fertility
- biological
- age
- lifestyle factors and environmental exposures
- gender affirming care
- psychological impacts
define infertility
- disease of male or female reproductive system defined by failure to achieve a pregnancy after 12 months or more of regular unprotected sexual intercourse
define primary infertility
- when an individual has never achieved a pregnancy
define secondary infertility
inability to achieve a subsequent pregnancy following at least one prior pregnancy
prevalence of infertility
- 1 in 6 people of reproductive age experience infertility
- globally between 48 and 188 million people suffer from infertility
- based on regional infertility prevalence, lifetime prevalence of infertility very similar no matter where you are on planet
does infertility prevalence matter change if from high-income country vs low- and middle-income country
no
causes of infertility (ie/ female or male or unexplained or both) for patients in A&NZ who attend IVF
- female-related 39%
- male-related 15%
- female / male 13%
- unexplained 30%
list 4 examples of ovulatory disorders which can be a biological cause of female infertility
- polycystic ovary syndrome (PCOS)
- hypothalamic dysfunction
- premature ovarian insufficiency / premature ovarian failure
- thyroid disorders
[biological causes - ovulatory disorders] describe polycystic ovary syndrome (PCOS)
characterised by:
- presence of multiple small follicles (containing oocytes) / cysts on enlarged ovaries
commonly observed with:
- irregular / absent menstrual cycles
- hyperandrogenism
- associated metabolic impacts
- associated psychological impacts
[biological causes - ovulatory disorders] describe hypothalamic dysfunction
- disruption of hormone release from hypothalamus results in irregular or absent ovulation
[biological causes - ovulatory disorders] describe premature ovarian insufficiency / failure
- occurs when ovaries stop functioning <40yrs leading to irregular or absent ovulation
[biological causes - ovulatory disorders] describe thyroid disorders
- abnormal thyroid function - either hypothyroidism or hyperthyroidism - that can disrupt ovulation
[biological causes - ovulatory disorders] what is the most prevalent cause of anovulation and major contributor to infertility
polycystic ovary syndorme (PCOS)
[biological causes - ovulatory disorders - PCOS] prevalence of PCOS
- 5-18% of reproductive age girls, women, and those assigned female at birth
[biological causes - ovulatory disorders - PCOS] is PCOS heritable?
yes
[biological causes - ovulatory disorders - PCOS] how does ethnic variation affect PCOS
- manifestation
- how it affects people
list 2 structural issues which can be biological causes of female infertility
- tubal disorders, including blocked oviducts
- uterine disorders
[biological causes - structural issues - tubal disorders] how do blockages in oviduct contribute to infertility
- blockages prevent sperm from reaching ovulated oocyte in oviduct
[biological causes - structural issues - tubal disorders] causes of tubal disorders
can be caused by:
- untreated sexually transmitted infections (STIs)
- complications of unsafe abortion
- postpartum sepsis
- abdominal / pelvic surgery
[biological causes - structural issues - uterine disorders] list 3 types of uterine disorders and an example of which can impact female fertility
- inflammatory (eg. endometriosis)
- congenital (eg/ septate uterus - thin piece of tissue remaining in uterine cavity)
- benign (eg/ fibroids or polyps)
[biological causes - structural issues - uterine disorders - inflammatory] describe endometriosis briefly
- endometrial-like tissue (lesions) found outside uterine cavity
(note: endometrial tissue = tissue that normally lines uterus)
[biological causes - structural issues - uterine disorders - inflammatory] symptoms of endometriosis
symptoms vary but commonly associated w/
- dysmenorrhoea (pain during menstruation)
- dyspareunia (pain during intercourse)
- chronic pelvic pain
- bowel disturbances
[biological causes - structural issues - uterine disorders - inflammatory] prevalence of endometriosis
~10% of reproductive age girls, women, and those assigned female at birth
[biological causes - structural issues - uterine disorders - inflammatory] is subfertility / infertility commonly associated with endometriosis incl prevalence numbers
- yes
- infertility is 30-50% higher for those with endometriosis
- 25-50% of women with infertility have endometriosis
[biological causes - structural issues - uterine disorders - inflammatory] what are factors of endometriosis that contribute to the associated infertility
- unable to have sex at time of ovulation due to dyspareunia
- disrupted function of oviducts due to adhesions (blockages)
- reduced number of viable oocytes
- endometrium is less responsibe to progesterone
via atresia, the number of oocytes _______ with age
decrease
when is highest number of oocytes present & how many
20wks gestation
6-7 million oocytes
how many oocytes at birth, puberty, and age 51
1-2 million at birth
300,000-500,00 at puberty
1000 at age 51
what declines gradually with age for females and at what ages is it accelerated and what age thereafter does it decrease more rapidly
- fertility
- accelerates ~32yrs
- decreases more rapidly after ~37yrs
what other decline occurs with oocytes with age
- decline in oocyte quality
since oocyte quality declines with age, what trend is seen regarding live birth outcomes of eggs
- live birth outcome is dependent on age of oocyte
- with increasing age, see decrease in chance of a live birth
- note: if donor egg is used, patient carrying embryo ageing is not significant to live birth occurring
lifestyle factors of substance abuse that can affect fertility - list 4
- alcohol
- smoking
- illicit drugs
- prescription medications
[lifestyle factors - substance abuse] describe alcohol use regarding fertility
- excessive alcohol consumption
- can disrupt ovulation and menstrual cycle
=> impairs infertility
[lifestyle factors - substance abuse] describe smoking regarding fertility
- smoking associated w decreased ovarian reserve (lower quantity and / or quality of oocytes) and premature ovarian ageing
=> incr risk of infertility
[lifestyle factors - substance abuse] describe illicit drugs regarding infertility
- use of various drugs incl marijuana, cocaine
- associated w irregular menstrual cycles and reduced fertility
[lifestyle factors - substance abuse] describe prescription medications regarding infertility
- some medications when abused can negatively affect fertility
environmental factors of toxins that can affect fertility - list 3
- environmental pollutants and toxins
- occupational exposures
- plastics / cosmetics
[environmental factors - toxins] describe what kinds of exposures to environmental pollutants and toxins can impact fertility
- pesticides
- heavy metals
- industrial chemicals
may disrupt hormonal balance
[environmental factors - toxins] describe what kind of occupational exposures can impact fertility
- workplace exposures including in manufacturing or agriculture may pose risks
[environmental factors - toxins] describe how plastics / cosmetics can impact fertility
- some plastics and cosmetics contain endocrine-disrupting chemicals
- that can interfere w hormone signalling
=> negatively affect fertility
environmental factors of cancer treatments that can affect fertility - list 4
- chemotherapy drugs
- radiation therapy
- surgery
- hormone therapies
[environmental factors - cancer treatment] describe how chemotherapy drugs can impact fertility
- chemotherapy drugs can damage oocytes
- leading to diminished ovarian reserve
- varies based on drug type, drug dosage, patient age
[environmental factors - cancer treatment] describe how radiation therapy can impact fertility
- pelvic radiation may affect ovaries
- causing damage to oocytes
=> reducing fertility - dependent on radiation dose and area treated
[environmental factors - cancer treatment] describe how surgery impacts fertility
- removal (partial or whole) of reproductive organs or structures may impact fertility
[environmental factors - cancer treatment] describe how some hormone therapies used in cancer treatment can impact fertility
- some hormone therapies used in cancer treatment may cause temporary or permanent fertility
what does gender affirming care for transgender men and non-birnary people involve
- involves use of hormone therapy to achieve testosterone levels that is within typical range for cisgender males for patient to obtain desired level of masculinisation
are the effects of prolonged androgen (testosterone) exposure in gender affirming care on fertility known & what has this led to clinically
- no, remain unknown
- thus, clinical consensus that fertility preservation occur before hormone treatment
how can psychological stress disrupt hormones
- stress leads to release of cortisol
- cortisol can interfere w reproductive hormones
[psychological factors] what can chronic stress result in
- chronic stress can lead to irregular menstrual cycles or amenorrhoea (absence of menstruation)
[psychological factors] how can stress lead to impaired ovulation
- stress can negatively impact hypothalamus
- which is region of brain involved in regulation and induction of ovulation
[psychological factors] what can prolonged stress result in
- prolonged stress may reduce oocyte quality
list risk factors for female infertility
- advanced age
- smoking / tobacco
- medical conditions (eg/ endometriosis, polycystic ovary syndrome)
- certian medical treatments (eg/ cancer treatments)
- STIs
(+)- weight (over or under)
in gender affirming care for transgender men and non-binary people, if fertility preservation is begun after androgen therapy, what does it require
- requires pausing testosterone administration -> can cause psychological stress
