Conception & Sub-Fertility Flashcards

1
Q

What 4 parts of male reproductive system contribute to ejaculate?

A

Testicles and epididymes
Seminal vesicles
Prostate gland
Bulbourethral and urethral glands

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2
Q

Where does the majority of ejaculate come from and what does it contain from these parts?

A
Seminal vesicles (46-80%)
Fructose
Proteins
Semen clotting factors
Interleukins
Prostaglandin E
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3
Q

What’s the volume and pH of ejaculate?

A
  1. 5ml

7. 2

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4
Q

What’s the contents of ejaculate?

A

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)

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5
Q

Outline the structure of a mature human oocyte

A

Oolemma with polar body attached
Ooplasm
Zone Pellucida surrounds everything

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6
Q

Where does fertilisation occur? What happens?

A

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

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7
Q

What happens on sperm entry/binding to the oolema in fertilisation?

A

Causes Ca2+ transients:
Activate oocyte for further development
Release cortical granules avoiding polyspermy

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8
Q

What are the stages of embryo development up until 7 days

A
Pronucleate 6-20 hours
Cleavage 18hrs - 3 days
Compaction 3-4 days
Blastocyst 5-6 days
Hatching 5-7 days
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9
Q

What’s the difference between the inner cell mass and trophectoderm?

A

Inner cell mass -> becomes embryo
Stem cell markers

Trophectoderm secretes hCG, accommodates some abnormal cells

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10
Q

When and where does implantation occur?

A

Around 7 days after ovulation
Should be in upper part of uterus (ectopic when elsewhere)
Requires apposition, adhesion and attachment

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11
Q

What’s the most likely stage of failure in IVF treatment?

A

Implantation

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12
Q

How is infertility defined?

A

1-2 years of attempting pregnancy

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13
Q

When do fertility rates decline?

A

From 30 then more rapidly from 37

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14
Q

What does IVF treatment involve?

A
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
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15
Q

What are some causes of male infertility?

A
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
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16
Q

What are treatments for male infertility?

A

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

17
Q

What’s an intracytoplasmic sperm injection?

A

Injection of one immobilised sperm into egg

Injected avoiding presumed position of oocyte spindle

18
Q

What are some female causes of infertility?

A

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

19
Q

What are risks of fertility treatment?

A

Failure (50% per cycle and age dependent)
Over response of woman to stimulation drugs
Multiple pregnancy
Psychological
Known risks of Embryology processes

20
Q

When can you absolutely not give someone combined pill?

A

Breast cancer
Pregnancy (always do pregnancy test)
Liver disease

21
Q

What are risks of combined pill?

A

Hypertension
Smoking
Thrombophilia
VTE (venous thrombus events), DVT, PE, MI
>35 years old (because of increased risk of clotting)

22
Q

Why would progesterone only pill be prescribed over combined?

A

Better compliance

Acne

23
Q

What’s the disadvantage of pill over condom?

A

STI risk

24
Q

What’re the implants/IUD based on? What’s the biggest side effect?

A

Progesterone

Pelvic inflammatory disease