Female Fertility Flashcards
How long does it take the average woman to get pregnant?
4 months +/- 3 months
Define infertility?
Failure to get pregnant after 12 months unprotected sex
After how long of failing to get pregnant should a GP investigate? How does age affect this?
- If under 35: after 12 months
- If over 35: after 6 months
(when older, the clock is ticking; therefore investigate sooner)
What’s the cutoff between miscarriage and stillbirth?
20 weeks
Define recurrent miscarriage
Spontaneous loss of two or more pregnancies
How long does folliculogenesis take for a single follicle?
~1 year
Which hypothalamic nucleus detects high oestrogen and flips the feedback loop to allow ovulation?
The periventricular nucleus
How many days after the last menstruation does ovulaiton occur?
14 days (half way point)
What happens to menstrual timing/length of fertility window with age?
- Window gets shorter
- Cycle gets shorter
How can stress affect menstrual timing/fertility?
- Abnormal timing/absent menstruation
- Can decrease fertility (cortisol interferes with estrogen and progesterone production)
How can obesity affect menstrual timing/fertility?
- Causes more menstrual irregularities, menstrual cramping, and menorrhagia
- Decreases fertility by decreasing egg quality
How can nutrition affect menstrual timing/fertility?
- Undernutrition can cause atheltic amenorrhoea, menstrual irregularities, and decreased fertility
- Mediterranean diet high in antioxidants, unsaturated fats, fibres, fruits, vegetables can increase fertility
1° vs 2° infertility
Primary = no pregnancy
Secondary = had >= 1 kid, but can’t get pregnant again
Distribution of male/female/both/unknown infertility causes
Male: 15%
Female: 40%
Both: 15%
Unexplained: 30%
List four ovulatory biological causes for infertility in women, and explain the mechanisms
- PCOS: cysts on ovaries, hormonal disruption, elevated androgens disregulate fertility/menstruation
- Hypothalamic dysfunction: Disruption of GnRH
- Primary ovarian insufficiency/failure: disrupted ovulation
- Thyroid disorders: altered metabolism/growth of ovaries tissues
What is the most prevalent cause of anovulation?
PCOS
List structural causes of infertility in women. What can cause them?
- Tubal disorders (like blocked fallopain tubes; caused by untreated STIs, abortion, surgical compllications)
- Uterine disorders (endometriosis, septate uterus, benign changes like fibroids or polyps)
List four lifestyle factors that can cause infertility in women
- Smoking
- Alcohol consumption
- Illicit drugs
- Prescription medications
List four environmental factors that can cause infertility in women
- Pesticides (ostrogen receptor agonist)
- Heavy metals
- Industrial chemicals (?workplace)
- Plastics/cosmetics
- Radiation (?chemo
A woman has chronic stress, and then the stress is removed, and her cortisol returns to normal. However, she is still infertile, despite being 28 and otherwise healthy/good to go. Why might that be?
- Remember: the hypothalamus is circumventricular
- Over time, cortisol can damage the hypothalamus, leading to hypothalamic insufficiency that then impairs hormonal chemicals upstream
What are ways of preventing female infertility?
- Maintain normal bodyweight
- Treat underlying problems (endo, PCOS, structural alterations, STIs)
- Exercise
- Reducing smoking/drinking
- Don’t delay having kids
- Avoid exposure to certain cosmetics, industrial chemicals, radiation etc. wherever possible
What is the relationship between prolactin and fertiltiy? How might a prolactinoma affect fertility?
- High prolactin can decrease GnRH, which has downstream effects on LH, FSH, oestrogen, and progesterone
- Therefore, prolactinoma is likely to cause infertility
A woman is not ovulating. TTC. What are four common treatment options?
- Ovulation induction
- Ovarian stimulation (FSH/LH/hCG administering)
- Intrauterine insemination
- In-vitro fertilisation
How is endometriosis treated w/ regards to infertility (and otherwise)
- Fertility: IUI timed with ovulation induction (else: IVF)
- Pain management
- Laparoscopic surgery
How might be help a woman with PCOS have kids?
Ovulation induction timed w/ intercourse or IUI
How do we diagnose and treat structural uterine issues that cause infertility?
- Diagnose with transvaginal ultrasound/MRI, and hysterosalpingography (for tubal defects)
- Treat with surgical repair
