Fertility management Flashcards
What is infertility defined as?
The inability to conceive after 12 months of unprotected intercourse
The #1 reason for infertility is what?
Postponement of pregnancy until the later years
Besides postponement of pregnancy what is the other 40% of symptoms for infertility? 4
- Ovarian
- Uterine
- Cervical
- Immunologic
What are the two ovarian issues that cause infertility?
- Primary
- Secondary reasons
What is the reason for primary ovarian infertility?
Ovulatory dysfunction
What is the secondary reason for ovarian infertility?
Inability to transport ova/embryo- blocked fallopian tubes
What are uterine reason for infertility? 3
- Congenital abnormalities
- Fibroids
- Ashermans
What reasons for infertility in men? 3
- Varicocele
- Testicular failure
- Tubular obstruction
What are some reasons for testicular failure? 6
- Mumps
- Torsion
- Orchitis
- Testicular cancer
- Frequent marijuana use
- Undescended testes (cyptorchidism)
What is tubular obstructions in men?
Vas deferens not connecting to sperm
What is ART?
Assisted reproduction technology
What are four services in ART?
- Ovulation induction
- Intrauterine insemination
- In Vitro fertilization
- Intracytoplasmic sperm
What does IUI stand for?
Intrauterine insemination
What does In vitro fertilization stand for?
IVF
What does intracytoplasmic sperm insertion stand for?
ICSI
What does ultrasound do for ovulation induction? 4
Monitor the following
- Women with patent (open) fallopian tubes
- Ovulation impairment (no graafian follicle produced)
- Monitoring the cycle with ultrasound (trying to achieve only one graafian follicle)
- Fertility drugs are used to ensure ovulation occurs
What is the sonographic protocol for ovulation monitoring? 3
- Routine pelvic ultrasound
- Track the growth of follicles (3 dimensions of the 3 largest follicles for each ovary)
- Check the pouch of Douglas for FF
What are some things that we need to remember when using a EV when monitoring ART? 4
- Do not use a condom that has lubrication (may contain spermicidal lube)
- Only use non lubricated condoms or non latex probe covers
- Do not use gel or KY jelly on the outside of the condom
- Use water only
What does this represent?
How we should measure the ovary
What does this represent?
Ovary with Graafian follicle
IUI is usually done because of what reasons? 4
- Male infertility factors
- Unexplained infertility
- Donor insemination
- Same sex couples
Gynecology ultrasound is indicated or not indicated?
Usually not
IUI U/S may be asked to assess what?
Uterus for congenital abnormalities
What is Invitro fertilization?
- Fertilization in a glass or lab
- Egg and sperm are fertilized outside the body
What are some reasons for IVF? 4
- Blocked fallopian tubes
- Impaired eggs
- Impaired sperm
- Unexplained infertility
What are the steps in IVF? 6
- Initial lab and ultrasound investigation
- Ovarian suppression
- Ovarian stimulation
- Egg or oocyte retrival
- insemination
- Embryo Transfer
What does ovarian suppression mean?
Stopping the normal Ovulatory cycle
What does ovarian stimulation mean? 2
- Gonadotropins administered to hyperstimulate the ovaries
- More than one egg is produced
What do we do in a lab to investigate for patency of IVF? 2
- Bloodwork
- Ovarian reserve testing
What are some things that are done with ovarian reserve testing? 2
- FSH
- Insight into number of eggs left or ovarian age
What can ultrasound do for IVF? 3
- Assessing uterus
- Assessing Adnexa
- Assessing ovaries
What does ultrasound investigate for in the uterus? 2
- Fibroids
- Congenital uterine abnormalities
What does ultrasound investigate for in the adnexa?
Hydrosalpinx
What does ultrasound investigate for in terms of the ovaries? 3
- Cysts - PCOS
- Ovarian cysts
- Baseline antral follicle count (BAFC)
What is Baseline antral follicle count?
Number of small antral follicles observed at the beginning of the menstrual cycle
What is indicative of poor ovarian response in terms of BAFC?
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