Conception, Infertility and Fetal Development Flashcards
1
Q
Infertility definition
A
inability to conceive or maintain a pregnancy after 12 months of unprotected intercourse OR 6 moths if older than 35
2
Q
primary infertility
A
never had a successful pregnancy
3
Q
secondary infertility
A
had a child and now can’t have another pregnancy
4
Q
abnormalities of the sperm X2
A
azoospermia
oligospermia
5
Q
azoospermia
A
absent sperm in semen
6
Q
oligospermia
A
decreased sperm in semen
7
Q
what can impair the number and function of sperm X11
A
hormones illness GI tract infections anatomic abnormalities exposure to toxins medication/treatments excessive drug use elevated scrotal temperature immunologic factors abnormal erections/ejaculation abnormailites of seminal fluid
8
Q
variocele
A
abnormal enlargement of the scrotu
9
Q
disorders in ovulation X2
A
hypothalamus/pituitary dysfunction
failure to respond to FSH or LH
10
Q
failure to respond to FSH or LH is caused by X11
A
PCOS cranial tumors stress obesity/anorexia disease anatomic abnormalities preemie ovarian failure (early menopause) decreased reserve chemo excessive alcohol intake cigarette smoking
11
Q
abnormalities of the fallopian tubes
A
endometriosis
12
Q
recurrent pregnancy loss can be caused by
A
abnormalities of: fetal chromosomes cervix/uterus endocrine system immunologic/thrombotic factors environmental agents infections
13
Q
who is test first when it comes to infertility
A
men
14
Q
how are men tested for infertility X5
A
semen analysis ultrasonography endocrine analysis testicular biopsy sperm penetration assay
15
Q
how are women tested for infertility X9
A
ovulation prediction hormone analysis hysterosalpingography hysteroscopy laparoscopy basal body temperature spinnbarkeit ultrasonography postcoital test
16
Q
when is a semen analysis taken
A
after 2-3 days of abstinence
17
Q
hysterosalpingography CI
A
iodine allergy
18
Q
hysteroscopy pro
A
no dye needed - allergy risk minimized
19
Q
what is spinnbarkeit
A
examination of the cervical mucus
20
Q
what does the postcoital test determinate
A
if cervical mucus is hostile
21
Q
taking BBT
A
every morning at same time before doing ANYTHING and plot on a chart
22
Q
how long can it take to predict ovulation after starting to monitor BBT
A
3-4 months
23
Q
what indicates ovulation with BBT
A
temp rise of 0.5 degrees over a 48 hr period
24
Q
when are the highest chances of getting pregnant in r/t ovulation
A
2 days prior to ovulation
25
how does weight loss affect pregnancy in PCOS
losing 5-10% of body weight can help achieve pregnancy
26
how does weight gain help in anorexia/super athletes
gaining 5-10% of body weight can achieve pregnancy
27
lifestyle changes to promote pregnancy X2
quitting smoking, drinking, drugs, etc
men wearing boxers
28
STD's and fallopian tubes
STD's can cause scarring in the fallopian tubes
29
Ovarian stimulation medications X2
clomiphene citrate***
| letrozole
30
clomiphene citrate MOA
stimulates PITUITARY GLAND to increase secretion of LH AND FSH
31
clomiphene citrate AE
can cause ovarian hyperstimulation syndrome
32
clomiphene citrate pt ed
increased risk of multiples d/t hyperstimulation syndrome
33
letrozole is used in women with
ovulation problems
unexplained pregnancy
PCOS***
34
letrozole pt ed
increased risk of multiples
35
why do ovarianstimulants make women feel crappy
excess hormones
36
bromocriptine MOA
corrects excess prolactin secretion by pituitary
37
metformin MOA
adjunct tx for use in PCOS
38
menotropins/human menopausal gonadotropins MOA
promotes follicle development
39
follitropins/synthetically manufactured FSH
stimulatory effect on ovarian follicles
40
follitropin pt ed
increased risk of multiples
41
human chorionic gonadotropin (hCG) MOA
stimulates ovulation in female, spermatogenesis in males
stimulates progesterone production by corpus luteum
42
progesterone MOA
luteal phase support
prepares uterine lining
promotes implantation of embryo
basically makes the uterus comfy for baby
43
Intrauterine insemination (IUI)
prepared sperm placed in uterus at ovulation
44
pros of IUI
bypasses cervical mucus
| removes antibodies that interfere with sperm mobility and ability to penetrate ovum
45
in vitro fertilization-embryo transfer (IVF-ET)
eggs are collected from ovaries, fertilized in a lab and then transferred to uterus
46
cons of IVF
not approved by the catholic church
47
when is IVF used
fallopian tube scarring - low sperm count
48
when are assisted reproductive technologies used
only when drug options are exhausted
49
cons of assisted reproductive technologies
not as stable as a natural pregnancy
| high r/o preemie/miscarriage, etc
50
intracytoplasmic sperm injection
single sperm is selected and injected directly into the ovum
51
when is intracytoplasmic sperm injection done
low sperm count
52
cons of intracytoplasmic sperm injections
$$$
| done outside body - nono to catholics
53
gamete intrafallopian transfer (GIFT)
oocytes retrieved and placed with prepared motile sperm then placed in fallopian tubes
54
pros of GIFT
conception occurs inside body - okay with catholics
55
zygote intrafallopian transfer (ZIFT)
zygote is placed in fallopian tub instead of uterus
56
cons of ZIFT
conception occurs outside body - nono wtih catholics
57
donor oocyte
donated eggs collected, inseminated and embryos placed in recipient uterus
58
donor embryo
donated embryo placed in recipients uterus
59
gestational carrier
couple who goes through IVF with embryo placed in a woman with NO GENETIC TIES
60
surrogate mother
woman inseminated with semen and carries fetus to birth
61
therapeutic donor insemination
use of donor sperm
62
zygote
fertilized oocyte with diploid chromosomes (46)
63
where does fertilization take place
fallopian tubes
64
blastocyst
5 days post-conception
STEM CELLS ONLY
65
when does the blastocyst imbed into the uterus
between day 6 and 10
66
common s/sx with implanation
implantation bleeding/spotting
67
what makes the endometrium become thicker and more vascular
estrogen and progesterone
68
how does the zygote let the body know pregnancy has begun
hCG secretion
69
how does implantation occur
trophoblast/chorion secretes enzymes to digest endometrial surface
70
where does implantation occur
upper part of posterior wall of uterus
71
implantation aka
Nidation
72
embryo length
implantation-8 weeks
73
exposure to teratogens and embryo
severe consequences
74
how long is the embryo at the 8th gest. week
3 cm with all organ systems formed
75
when does the heart form and beat
forms during the 3rd gestational week and circulates blood during the 4th gestational week
76
how big is the heart when it is first formed
as big as a poppyseed
77
12 week characteristics X4
kidneys produce urine
sucking reflex present
bile formed by liver
male/female external genitalia can be distinguished by appearance
78
12 week length
87 mm
79
16 week characteristics X3
urine excreted into amniotic fluid
meconium is formed in intestines
fingerprints developing
80
16 week length
140 mm
81
20 week characteristics X2
peristalsis well developed
| skin is thin and covered with vernix
82
20 week length
160 mm
83
24 week characteristic X3
alveoli form in lungs and begin to produce surfactant***
respiratory movements can be detected
fingerprints and footprints developed
84
24 week length
230 mm
85
28 week characteristics X3
sufficient alveoli, surfactant and capillary network to allow respiratory function
eyelids no longer fused at 26 weeks
major sulci and gyri present in brain
86
28 week length
270 mm
87
32 week characteristics X3
surfactant production nears mature levels
maturation of parasympathetic nears that of sympathetic
lanugo disappearing
88
32 week length
300 mm
89
38 week characteristic X7
```
sulci and gyri fully developed
gas exchange capability fully developed
both testes usually palpable at birth
newborn ovaries contain 1 mill follicles
vernix present in major body creases
fetus is plump
lanugo present on upper back and shoulders only
```
90
fetus time
week 9 to birth
91
fetal sensitivity to toxins
not *as* sensitive but CNS is still vulnerable to damaging agents
92
where does exchange of substances between mother and fetus occur
intervillous spaces of placenta
93
how frequently is the blood in the intervillous space changed
3-4 times/minute
| 450-750 mL/minute for perfusion
94
hormones produced by placenta X4
progesterone
estrogen
hCG
hPL
95
viruses can/cannot cross placental membrane
can
96
drugs can/cannot cross placental membrane
can
97
how many membranes form the amniotic sac
amnion and chorion
98
what makes up amniotic fluid
fetal urine and fluid, epithelial cells, vernix, lanugo
99
purposes of amniotic fluid X6
```
cushions impacts
prevents fetal adherence to membranes
allows freedom of fetal movement
provides consistent thermal environment
essnetial for fetal lung development
allows symmetric development
```
100
oligohydramnios
abnormally small amniotic fluid
<50% of amount expected for gestation OR
<400 mL at term
101
oligohydramnios occurs in moms with
vascular changes r/t T1DM
102
oligohydramnios causes X4
poor placental blood flow
PPROM
failure of kidney development
blocked urinary tract
103
oligohydramnios fetal effects X2
poor fetal lung development
| malformations such as skeletal abnormalities
104
hydramnios/polyhydramnios
quantity may exceed 2000 mL
105
hydramnios is seen mostly in which population
diabetic mothers
106
hydramnios causes
poorly controlled DM leading to large quantities of fetal urine and elevated glucose levels
107
hydramnios fetal effects X2
chromosomal abnormalities
| multiple gestations
108
umbilical cord
lifeline between fetus and placenta consisting of
2 arteries
one vein
109
what surrounds the umbilical vessels and what is it's purpose
Wharton's jelly and it protects the vessels from compression
110
succenturiate placenta
one or more accessory lobe of fetal villi have developed
111
vascular connection origins in succenturiate placenta
fetal origin
112
biggest complication of succenturiate placenta
accessory lobe can be retained during third stage of labor leading to hemorrhage
113
circumvallate placenta
fetal surface of placenta exposed through ring opening around umbilical cord
114
complications of circumvallate placenta
increased incidence of late abortion, preemie and fetal death
increasedrisk for antepartum hemorrhage, abnormal maternal bleeding
115
battledore placenta
umbilical cord inserted at or near placental margin
116
complication of battledore placenta
high chances of preemie labor
117
degenerative placenta
infarcts and placental calcifications that interfere with uterine placental fetal O2 exchange
118
when is degenerative placenta most common
preeclampsia, smokers and drug use
119
when is degenerative placenta dangerous
30ish weeks
120
what is degenerative placenta not related to
natural placental degeneration
121
velamentous cord insertion
vessels are unprotected by Wharton's jelly and transverse membranes before coming together into umbilical cord
122
when is velamentous cord insertion most common
multiple gestations
123
major risk with velamentous cord insertion
vasa previa
124
vasa previa
vessels going across cervical opening
125
vasa previa leads to
hemorrhage and misscarriage
126
average cord length
55 cm
127
short cord associated with X3
umbilical hernias
abruptio placentae
cord rupture
128
long cords do what to fetus X2
twist, tangle
129
monozygotic twins
one zygote - genetically identical
one fertilized egg
130
monochorionic
one placenta - 2 cords
131
twin to twin transfusion
blood transfused from donor twin to recipient twiin due to imbalance in blood flow
132
monoamniotic
share same amniotic sac
133
dichorionic
two placentas
134
dizygotic twins
two zygotes
two fertilized eggs
135
dizygotic twins are always what
dichorionic but may fuse if implanted closely
will still have own blood vessels
136
conjoined twins
aberration in twinning process
137
risks for women in multiple gestations
```
increased BV
pregnancy induced HTN
gestational diabetes
anemia
preemie ROM
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