Conception & Sub-Fertility Flashcards
What 4 parts of male reproductive system contribute to ejaculate?
Testicles and epididymes
Seminal vesicles
Prostate gland
Bulbourethral and urethral glands
Where does the majority of ejaculate come from and what does it contain from these parts?
Seminal vesicles (46-80%) Fructose Proteins Semen clotting factors Interleukins Prostaglandin E
What’s the volume and pH of ejaculate?
- 5ml
7. 2
What’s the contents of ejaculate?
Sperm, testosterone, L-carnitine (from testes and epididymes)
Fructose, proteins, semen clotting factors, interleukins, prostaglandin E (from seminal vesicles)
Phosphate, bicarbonate buffers, prostate specific antigen, coagulate, spearmine (from prostate gland)
Lubrication of male reproductive tract and production of anti-sperm antibodies (bulbourethral glands)
Outline the structure of a mature human oocyte
Oolemma with polar body attached
Ooplasm
Zone Pellucida surrounds everything
Where does fertilisation occur? What happens?
In the ampulla of the oviduct
Mature capacitated sperm meets metaphase II oocyte
Acrosome reaction of sperm to penetrate zona pellucida and bind to oolemma
= maturation of oocyte and release of second polar body
What happens on sperm entry/binding to the oolema in fertilisation?
Causes Ca2+ transients:
Activate oocyte for further development
Release cortical granules avoiding polyspermy
What are the stages of embryo development up until 7 days
Pronucleate 6-20 hours Cleavage 18hrs - 3 days Compaction 3-4 days Blastocyst 5-6 days Hatching 5-7 days
What’s the difference between the inner cell mass and trophectoderm?
Inner cell mass -> becomes embryo
Stem cell markers
Trophectoderm secretes hCG, accommodates some abnormal cells
When and where does implantation occur?
Around 7 days after ovulation
Should be in upper part of uterus (ectopic when elsewhere)
Requires apposition, adhesion and attachment
What’s the most likely stage of failure in IVF treatment?
Implantation
How is infertility defined?
1-2 years of attempting pregnancy
When do fertility rates decline?
From 30 then more rapidly from 37
What does IVF treatment involve?
Ovarian stimulation Brings gametes together more reliably Selects embryos for quality Places them in the uterus Cryopreserves additional spare embryos Does not fix cause of infertility
What are some causes of male infertility?
Impotence (drug induced/paraplegia) No sperm in ejaculate = azoospermia (testicular failure, obstructive eg vasectomy, retrograde ejaculation so into bladder) Not many sperm Poorly motile Abnormal morphology of sperm Anti-sperm antibodies Y chromosome microdeletions Sperm DNA damage Sperm don’t bind to or fertilise the egg
What are treatments for male infertility?
Correct hormonal imbalances/blockages/psychological problems
Obtain best possible sample from ejaculate
Obtain best possible sample from surgical retrieval
Consider sperm donor
Intracytoplasmic sperm injection
What’s an intracytoplasmic sperm injection?
Injection of one immobilised sperm into egg
Injected avoiding presumed position of oocyte spindle
What are some female causes of infertility?
Age
Anovulation: polycystic ovarian disease, primary/secondary ovarian failure
Tubal disease or blockage
Uterine abnormality
IVF diagnosis: egg anomaly, fertilisation failure, abnormal embryo development, implantation problem
What are risks of fertility treatment?
Failure (50% per cycle and age dependent)
Over response of woman to stimulation drugs
Multiple pregnancy
Psychological
Known risks of Embryology processes
When can you absolutely not give someone combined pill?
Breast cancer
Pregnancy (always do pregnancy test)
Liver disease
What are risks of combined pill?
Hypertension
Smoking
Thrombophilia
VTE (venous thrombus events), DVT, PE, MI
>35 years old (because of increased risk of clotting)
Why would progesterone only pill be prescribed over combined?
Better compliance
Acne
What’s the disadvantage of pill over condom?
STI risk
What’re the implants/IUD based on? What’s the biggest side effect?
Progesterone
Pelvic inflammatory disease
