Fertility and Infertility Flashcards by Miss J

What issues are involved in fertility and infertility

Complex issues:

Physical
Psychological
Economic
Social

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What are global Factors affecting fertility

Fertility rates tend to be highest in the least developed countries. Deaths outnumber babies being born
Education: educated people (particularly women) tend to have fewer children, wait til later in life for financial stability, and typically raise healthier and more educated children that repeat this cycle

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Define: Infertility

is “a disease of the reproductive system defined by the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse.

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Define: Primary Infertility

When a woman is unable to ever bear a child, either due to the inability to become pregnant or the inability to carry a pregnancy to a live birth she would be classified as having primary infertility.
OR
A women whose pregnancy spontaneously miscarries, or whose pregnancy results in a still born child.

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Define: Secondary Infertility

Woman who is unable to bear a child, either due to the inability to become pregnant or the inability to carry a pregnancy to a live birth following either a previous pregnancy or a previous ability to carry a pregnancy to a live birth
OR
Those who repeatedly spontaneously miscarry or whose pregnancy results in a stillbirth, or following a previous pregnancy or a previous ability to do so

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List factors affecting Infertility in Females

Age
Body fat
Drug use
Alcohol
Medical/ surgical issues
Environmental issues
Socio-economic issues
Cultural issues
Religious issues

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Factors affecting Infertility in Females

Explain: Age

increases in age are associated with a decrease in fertility
> 35yrs associated with poorer infant outcomes (low birth weight, preterm birth, stillbirth/FDIU, IUGR)
Eggs have a higher rate of chromosomal abnormalities as age increases, which increases the likelyhood of miscarriage
Eggs production numbers also reduce with age
other health conditions developed during their reproductive lifetime can also impact on fertility

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What are some causes of female infertility

Ovulation disorders
Tubal infertility
Endometriosis
Uterine or cervical causes
No known cause

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List ovulation causes of infertility

PCOS
Hypothalmic dysfunction
Hyperprolactinaemia
Premature ovarian insufficiency

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Explain: PCOS

Poly cystic ovarian syndrome

Causes:
- Genetic &amp; environmental
Symptoms"
- Infertility
- Hirsutism
- Acne
- Obesity
- Pelvic pain
- Acanthosis nigricans (thick dark patches of velvety skin)

(Some symptoms of PCOS result from insulin resistance. Too much insulin causes the production of androgens which leads to PCOS symptoms)

Effects 10% of female population
Diagnosed through haematology and on ultrasound
No cure- but drugs can be given to help increase likelyhood of ovulation, reduce effect of insulin on other hormones required for ovulation

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List causes of Tubal infertility

Pelvic inflammatory disease (PID) (chlamydia, ghonorhea and others)
Surgical complications (abdominal or uterine)
Pelvic tuberulosis

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Explain: Endometriosis

is where the endometrium implants outside the uterus and commonly involves the ovaries, bowel or pelvic tissue

Extra uterine endometrial tissue
It displaces endometrial tissue and unable to be excreted from the body
Can lead to formation of endometriomas around ovaries
surrounding tissue can become irritated leading to scar tissue and adhesion formation

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What are uterine or cervical causes of infertility or miscarriages

Benign Polyps or Tumours: can block the fallopian tubes or disrupting implantation (however women can still become pregnant)
Congenital uterine abnormalities: cause problems becoming or remaining pregnant
Cervical Stenosis :Inherent malformation or damage to the cervix
Incompatible cervical mucous: may prevent sperm form entering the uterus

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List causes of Male infertility

Sperm production: most common cause. Due to a problem in the sperm production process in the testes. Caused by medications, overheating, chromosomal abnormalities etc
Blockage of sperm: sperm is unable to exit the body with the semen during ejaculation
Sperm antibodies in semen and/or blood: reduces sperm motility and block egg binding. due to injury, infection or unknown causes
Sexual problems: erection or ejaculation problems
Hormonal problems:

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What are some complemetnary infertility treatments available

Weightloss
Enhanced nutrition
Traditional chinese medicine
Antioxidants

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Define: Assisted reproductive technology (ART)

is the use of fertility treatments to concieve

What are the objects of the ART Act

To prevent the commericalisation of human reproduction
to protect the interest of the following persons
- a person born as the result of ART treatments
- a person providing a gamete for use in ART treatment or for research
- a women undergoing ART treatment

Explain: ART Act

aims to achieve their objectives by requiring ART providers to be registered within the NSW Ministry of Health and by setting core standards for the provision of ART treatment.

What are the terms of ART act in relation to their objectives

Gametes can only be used in a manner consistant with the gamete providers consent. The individual remains in control of the use of their own genetic material
It prohibits the anonymous donation of gametes and requires ART providers to place information about donors on a central register

What are the ART Act infertility treatments

Donor Gametes

Sperm: healthy 21-41yrs old
Ova: 21-35 years old
Already had a successful pregnancy and a live birth
Embryo: left from previous ART cycles

Surrogacy

altruistic surrogacy ONLY
Under Aus/NZ law surrogacy agreements are not legally binding. The birth mother of is considered the mother of the child regardless of genetics. Parenting orders or adoptions forms will need to be completed in order to transfer parental rights

Define: Donor insemination

is the use of donor sperm by a woman

What are the different types of ovarian stimulation

Minimal/natural stimulation: follicular development is stimulated with the use of clomiphene citrate. Lower success rate but reduced cost and drugs needed
Clomiphene citrate: drug used
Contraceptive pill
Down regulation

How soon is egg retrieval done after follicle stimulation hormones are administered

generally 24-48hrs later under GA or epidural anaesthetic

What are frozen eggs/sperm stored in

liquid nitrogen

How does embryo transfer occur

the embryo and transfer media is placed inside the transfer catheter which is inserted into the vagina through the cervix and released inbthe uterine cavity

What are some of the complications of IVF

Surgical complications Drug allergy/interaction Multiple embryos/pregnancies Ovarian hyperstimulation syndrome Higher chance of pregnancy complications: GDM Pre-eclampsia Preterm birth

Explain: Ovarian hyperstimulation syndrome

is a medical condition affecting the ovaries of some women taking fertility medication to stimulate egg growth. ``` 4 types: Mild Moderate Severe Critical ```

What are the 4 types of Ovarian hyperstimulation syndrome

MILD: ovaries are enlarged, mild abdominal distension, abdominal pain, nausea Moderate Severe: enlarged ovaires, haemoconcentration, thrombosis, distension, respiratory distress Critical: enlarged ovaries, renal failure, respiratory distress

Explain: Clomid (clomiphene citrate)

INDICATION Clomid is indicated for the treatment of ovulatory failure in carefully selected infertile women who wish to become pregnant. Commonly associated diagnoses include polycystic ovary syndrome, lactation amenorrhoea syndrome, psychogenic amenorrhoea, certain cases of secondary amenorrhoea of undetermined aetiology, and post-oral contraceptive amenorrhoea DESCRIPTION The ovulatory response to cyclic Clomid therapy appears to be mediated through increased output of pituitary gonadotrophins, which in turn stimulates the maturation and endocrine activity of the ovarian follicle and the subsequent development and function of the corpus luteum. Clomiphene citrate is a white to pale yellow powder. DOSE The recommended dose for the first course of Clomid is 50 mg (one tablet) daily for five days SIDE EFFECT Side effects are dose-related being more frequent and more severe when higher doses of Clomid are administered. - Tachycardia, visual disturbances, fatigue,, multiple pregnancies, extra uterine pregnancies.. - Ovarian hyperstimulation syndrome (OHSS) has been reported in patients receiving Clomid therapy alone or in combination with gonadotrophins. Rare cases of severe forms of OHSS have been reported where the following symptoms have occurred: pericardial effusion, anasarca, hydrothorax, acute abdomen, renal failure, pulmonary oedema, ovarian haemorrhage, deep venous thrombosis, torsion of the ovary and acute respiratory distress

What are some interventions for nausea and vomiting in pregnancy

- Avoid known triggers - avoid an empty stomach - eat small meals often - eat when less nauseous - drink small amounts of fluid regularly (2L_ - have dry crackers before getting up in morning - get out of bed slowly

List anti-emetic drugs for nausea and vomiting in pregnancy

Order of use- depending of efficacy - Pyridoxine (VitB6) 25-50mg orally up to 4x daily (200mg/day safe) - Metoclopramide 10mg orally 3x daily (category A) - Ondansetron tablet or wafer 4-8mg 2-3x daily (category B1) - Prednisolone 50mg orally 1x daily for 3 days, then 25mg daily, then 5 mg daily (category A)

Explain: Physiological Fertility in woman

Birth: 1-2 million oocytes Puberty: 400 000 oocytes By 37yrs: 25 000 oocytes >37yrs: continues to drop over the years until menopause 50yrs: msot owman have approx 1000 oocytes left

List common first line investigatory tests for infertility

WOMEN: - cervical smear test - urinalysis for Chlamydia trachomatis (which may block the fallopian tubes) - blood test to measure progesterone - test for rubella (<3months harm to fetus) - blood test at menstruation to check hormone imbalances such as (Follicle-stimulating hormone, luteinising hormone, oestradiol) MEN: - sperm test to check for abnormalities - urine test for Chlamydia trachomatis

What are the 4 steps of IVF

Ovarian stimulation, Egg recovery, Insemination Embryo replacement