Fertility and Pregnancy Flashcards
5 Factors involved in healthy conception?
1) Release of a healthy, non-damaged oocyte.
2) Production of sperm with adequate motility, DNA integrity, count and morphology.
3) Adequate transport of sperm and egg to Fallopian tubes
4) Penetration of the sperm into the oocyte.
5) Implantation of the embryo into a healthy uterus lining.
What are 5 female structural abnormalities that may impair fertility?
1) Cervical stenosis: Narrow / closed cervix.
2) Uterine septum: Poor environment for embryo to implant due to poor vascular supply of blood
3) Uterine polyps and fibroids: May disrupt implantation.
4) Fallopian tube / obstruction: Pelvic inflammation, STDs, endometriosis (scar tissue), ectopic pregnancy.
5) Ovarian cysts: Can cause infection and scars of fallopian tubes.
What are 5 female hormonal issues that may impact fertility?
1) Polycystic Ovarian Syndrome — elevated androgens, anovulation,
irregular cycles, ↓ uterine lining development, implantation issues.
2) Hyper or hypothyroidism — irregular cycles, ovulatory disorders, miscarriage, pre-term birth, pre-eclampsia.
3) Amenorrhoea — due to hypothalamic dysfunction, , excess exercise, undereating, low BMI, high stress (ACTH / cortisol).
4) Obesity / insulin resistance — lack of ovulation / ↑ androgen levels.
5) Premature ovarian failure — loss of ovarian function < 40 due to chemotherapy / radiotherapy, genetic, SLE.
Compare oestrogen and progesterone including roles regarding to conception/ fertility , where they are produced, and signs of dominance for each hormone.
Oestrogen:
* Highest in first half of the menstrual cycle.
* Creates proliferative endometrium.
* Important for ovulation.
Dominance= Fibroids, Endometriosis, PCOS, Heavy bleeding, Tender and swollen breasts, PMS, Shorter menstrual cycles, Poor memory, Brain fog, Hypothyroidism, Fatigue, Mood swings, Miscarriages
Progesterone:
* Highest in second half of menstrual cycle.
* Maintains secretory endometrium.
* Important for implantation and
the survival of the embryo.
Dominance: Breast tenderness, Water retention, Bloating, SOB, Dizziness, Drowsiness / lack of concentration, Sense of physical instability, Long luteal phase, Discomfort in the legs * Decreased libido, Weight gain, Insomnia, Light periods
- Both hormones are produced in the ovaries, adrenals and placenta.
- Both are stored in the adipose (fat) tissue.
5 ways to optimise the oestrogen/ progesterone ratio?
Reduce stress — regular healthy meals, optimise sleep, ↓ over-exercising, address emotional stressors.
* Optimise liver function — to detoxify excess oestrogen.
* Avoid endocrine disruptors (e.g., home / personal products).
* Avoid alcohol — ↑ oestrogen levels by promoting the induction of aromatases and by impairing hepatic oestrogen metabolism.
* Reduce body weight if obese — oestrogen is stored and produced in fat cells.
* Optimise digestion and elimination —to excrete excess oestrogen.
* Consider herbs such as Vitex agnus castus.
3 drugs that may impact female fertility and why?
1) NSAIDs (long-term use or ↑ dosage) — inhibit ovulation and lower progesterone levels.
2) Chemotherapy — damage / depletion of oocytes.
3) Antipsychotic medicines — increase prolactin levels leading to anovulation and amenorrhoea.
4) Corticosteroids — suppress immune function, affect gut microbiome, elevate blood pressure and blood sugar levels.
5) Antihistamines — dry the mucous membranes.
3 environmental factors that may affect female fertility?
1) Excessive radiation (mobile phones, x-rays and radiotherapy, frequent flying) — damages oocytes.
2) Environmental toxin exposure (e.g., mercury, lead, phthalates, solvents)
3) Chronic alcohol consumption — diminished ovarian reserve and ovulatory dysfunction.
4) Caffeine — increases cortisol production, slows COMT (oestrogen dominance).
5) Xenoestrogens, pesticides and endocrine disruptors (e.g., plastics, cans, detergents, candles, flame retardants, cosmetics).
Which immunological
events must occur to prevent foetal rejection?
1) Tissue type compatibility — if mother’s immune system responds negatively to paternal HLA proteins, this can affect implantation / pregnancy outcome.
2) Blood clotting defects — ↑ risk of early / late term loss, risk of maternal embolism / stroke, placental blood flow restriction.
3) High uterine NK cells — can trigger ↑ TNF-alpha, cytokines- early pregnancy loss. High BPA exposure linked to NK cell activity.
4) Autoimmunity — immune system rejects the embryo.
5 structural reasons that may contribute to male infertility?
1) Congenital defect of testes or ejaculatory tract.
2) Undescended testes ― ↓ sperm count and quality due to heat.
3) Testicular cancer ― caused by the disease or treatment that damages sperm
4) Surgery or injury to testes such as testicular torsion, being kicked; bicycle injury.
5) Infections (STIs and post-pubertal mumps) cause permanent damage to the testes, vas deferens or epididymis. Impacts transport of semen to ejaculatory ducts.
Name 6 hormonal or health conditions affecting male fertility?
Hormonal:
1) Hypogonadism ― ↓ function of gonads and ↓ production of sex hormones. Causes: tumour, illegal drugs, or Klinefelter syndrome (a genetic condition where an additional X chromosome interferes with male sexual development and ↓ testosterone)
2) Obesity-Increased peripheral conversion of testosterone to oestrogen (aromatisation) and decreased luteinising hormone.
3) Cushing syndrome- Increased cortisol results in low sperm count.
Other health conditions:
1) Diabetes mellitus ― neuropathy, neurogenic impotence, and retrograde ejaculation (= semen in bladder).
2) Haemochromatosis ― systemic inflammation- hypogonadism and androgen deficiency.
3) Scrotal varicocele ― blocked / enlarged veins scrotal temperature = ↓sperm production.
What are 3 drugs that could impact male fertility?
Sulfasalazine — (DMARD) (RA, UC and Crohn’s) ↓ sperm count whilst taking the drug.
* Anabolic steroids — increase levels of testosterone but impairs body’s own production ↓ sperm count / sperm mobility.
* Chemotherapy — severely reduces sperm production.
* Medical drugs, alcohol, cigarettes, caffeine and marijuana reduces sperm count, concentration and motility.
3 environmental factors affecting male fertility?
Environmental:
* Pesticides and endocrine disruptors.
* Mobiles ― interfere with spermatogenesis- heat, radiation, EMFs, ↑ oxidative stress.
* Heavy metals (e.g., lead and mercury) and chemical toxins (e.g., BPA, phthalates) have been shown to damage sperm.
* Heat exposure to the testicles compromises sperm production
hot baths, cycling, tight underwear, mobile phone in pocket.
* Excessive oxidation (poor diet, smoking, obesity, alcohol etc.) can cause DNA fragmentation and reduced sperm morphology).
How can peridontal disease affect fertility?
(mother) ― lengthens the time to conceive by approx. 2 months:
* It can prevent ovulation — increases inflammatory markers (IL-1). IL-1 inhibits GnRH production.
* Metabolic waste products from oral bacteria and can cross the placenta and affect the foetus.
* Fusobacterium nucleatum has been isolated from the amniotic fluid and placenta of women delivering prematurely.
(father):
* Causal links exist between oral infections and infertility. Treatment of oral infections = 20% improvement in spermatic parameters.
Describe the seminal microbiome?
comes from the GIT, mouth, vagina (sexual partner and mother).
* aids conception, supports health of offspring and modulates immune responses.
*more diverse but has lower bacterial concentrations than the vagina. diversity is thought to help expose and train the VMB and immune system to aid pregnancy and conception.
* The SMB should be lactobacillus dominant (like the VMB) — it has
been shown that these bacteria prevent sperm damage by ROS.
Sex during IVF increases implantation
; the semen (with the SMB) prompts the cervix to release immune signalling molecules such as regulatory T-cells.
* The SMB is negatively impacted by antibiotics, antifungals, STIs, prostatitis, lubricants, smoking, alcohol, obesity and poor penile hygiene practices.
* Ureaplasma urealyticum is a frequent causes of male infertility, E.coli, prevotella,chlamydia, gonorrhoea, bacteroidetes and firmicutes also implicated
Which bacteria species positively and negatively impact the vaginal microbiome?
healthy fertile VMB is normally associated with: dominance of the lactobacilli species, low diversity of other species. Creates an acidic, inhospitable environment which prevents the overgrowth of potential pathogens.
* Lactobacillus crispatus is associated with a higher implantation rate in IVF if it is in high abundance
* The presence of bacterial vaginosis, such as ureaplasma and gardnerella, when coupled with low lactobacilli species and a higher pH, can increase the chance of miscarriage.
* Mycoplasma, ureaplasma and chlamydia trachomatis are examples of bacteria that have been negatively associated with fertility.
How can you negatively and positively impact the vaginal microbiome?
The vaginal microbiota can be negatively impacted by STIs, alcohol, smoking, poor vaginal or oral
hygiene, increased blood glucose levels, copper
IUD coil, a low vitamin A, D, C and E status etc.
* A low oestrogen environment can impact the
growth of the VM. Cervical fluid is important as a
fuel source to feed lactobacilli as it is rich in glycogen.
* You can positively impact the vaginal microbiota by reducing
infections, improving blood glucose levels, improving oestrogen
levels, and supporting lactobacilli growth with pre and probiotics.
Describe how exercise can affect fertility
Moderate exercise improves circulation and insulin resistance which increases the likelihood of conception:
* Intensive exercise is deleterious for fertility,it raises cortisol production = ↓ progesterone.
* Excessive secretion of endorphins interferes with production of FSH and LH, in turn inducing ovulatory disorders and luteal phase dysfunction, which accounts for lack of embryo implantation and first-trimester miscarriages.
* In males, excessive exercise has been associated with oligospermia
How can stress affect fertility?
The release of cortisol, adrenaline and noradrenaline inhibits the release of GnRH (downregulates LH and FSH)- disrupts steroidogenesis in testes/ ovaries
* Under stress, the body will prioritise cortisol, leading to reduced progesterone production.
