Fertility Management Flashcards
week 9
What are the surgical contraceptive methods?
Vasectomy
Tubual ligation
What are the advantages and disadvantages of a vasectomy?
Advantages
No sex interruption
Continuous protection
Disadvanatges
3 month wait to be sterile
Expensive
Irreversible
No STI protection
What are the advantages and disadvantages of Tubal ligation
Advantages
No sex interruption
Continuous protection
Decreased risk of ovarian cancer
Disadvantages
Expensive
Irreversible
No STI protection
What are the hormonal contraceptive methods?
COC (combined)
POC (progesterone only)
What is POC (hormnal contraceptive)
Progesterone Only Hormone
thickens cervical mucous
What are the contracindications of POC?
stroke
breast cancer
What is COC
Combined Estrogen and Progesterone
What is the action of COC?
Supresses follicle stimulation, ovulation and CL formation
Thickens cervical mucous
Disrupts oviduct transport and creates hostile endometrium
Adv and disAvd of COC
Adv
Works at 3 levels
Decreases risk of ovarian cancer
Regular and lighter menses
DisAdv
Prescription
Daily use
No STI protection
Nausea, breast tenderness and headaches
Contrainindication of COC
CV complications
Breast cancer
Postpartum breastfeeding (blocks PRL)
Adv and DisAdv of Condoms
Adv
STI protection
Nonprescription
DisAdv
Interrupts sex
Single-use
What is a Diaphragm used for and what are the disadvantages of it?
Prevents movement of sperm in female repro tract
DisAdv
Prescription
Requires fitting
Timing
What is spermicide and what are its Adv and DisAvds
What
Prevents movement of sperm through female repro tract
Adv
Some STI protection
Nonprescription
DisAdv
Unpleasant for some
Time-sensitive
What is the action of an IUD and what are its Adv and DisAdvs
Prevents implantation of blastocyst
Adv
Effective for years
No sex interruption
DisAdv
Prescription
Painful
What are the natural methods for contraception?
Withdrawal
Rhythm method
Breast feeding
What are the barrier/chemical contraceptive methods of contraception?
Condom
Diaphragm
Spermicide
IUD
Compare the failure rates of the contraceptive methods.
Surgical - lowest failure
hormonal = relatively effective
barrier = high failure
natural = least reliable
What hormones can be targeted for male contraception
inhibin: suppresses FSH (unsupported Sertoli cells and no ADP)
ABP: -revent sequestration of testosterone to sertoli cells )
FSH:
What precautions must be made when consideration hormonal targets for males
Must avoid disrupting endogenous testosterone levels
What techniques of contractception are used before fertilisation?
Male
vasectomy
Abstinence
Condom
Coitus Interruptus
Female
COC, monthly injection, vaginal ring
Abstinence
feae condom
tubal ligation
spermicides, diaphragm
What contraceptive methods are used during transport down the male duct?
Abstinence (male and female)
condom (male and female)
coitus interruptus
Clinical infertility vs Sterility
Clinical infertility = inability to conceive after 12months of freq unprotected intercourse
Sterility = cannot conceive
Fecundability vs fecundity
Fecundability = probability of achieving pregnancy in 1 menstrual cycle
Fecundity = Probability of achieving pregnancy resulting in live birth in 1 menstural cycle.
What are the (5) main causes of male infertilty?
Poor sperm number/motility/ morphology
Tetes and accessory gland dysfunction
Blocked ejaculatory tracts
Retrograde/ neurological ejaculation disorders
Anti-sperm antibodies
What are the 5 main causes of female infertility?
Ovulation and ovarian failure
Implantation failure
Failed sperm transport
Blocked oviducts
Anti-sperm antibodies
What can cause ovulation and ovarian failure?
hormone imbalance, PCOS and hypoplasia
What can cause implantation failure?
Abnormal endometrium, fibroids/polyps and hormone imbalance
What can cause failed sperm transport
Vaginal avid and abnormal cervical shape
What can cause poor sperm number/motility/ morphology?
hormone imbalance and hypogonadism
What can cause tetes and Accessory gland dysfunction?
Cryptorchidism (a condition in which one or both of the testes fail to descend), varicocele (englagement of veins inside scrotum) and drugs/toxins
How is the cause of infertility determined?
Primary analysis
Hormone assays
Ultrasound
Test tubual patency
Semen analysis
Blood tests
Secondary analysis
Laparoscopy and endoscopy
Endometrial/ testicular biopsy
Hormone assays
– detects cycying, ovulation and spermatogenesis
Ultrasound use in testing infertility
presence of follicles or cysts and endometrial thickness
What is looked for in a test of tubal patency?
blockages and occlusions (hidden or obscured)
what is looked for in a semen analysis?
number and morphology of sperm
What is looked for in a blood test during the primary analysis of infertilty?
anti-sperm antibodies
What does a laparoscopy or endoscopy in the secondary analysis of infertility look for?
Laparoscopy and endoscopy – uterine and oviduct blockage
What terms are used to refer to sperm count?
Aspermia
Azoospermia
Oligozoospermia
Normospermia
Aspermia
NO ejaculate
(accessory gland affected)
Azoospermia
No Sperm
Oligozoospermia
Less than 15million/ mL
Normospermia
Greater than 15million/ mL
What are the main types of Assistive Repro Technologies?
Artificial insemination (AI)
In Vitro Fertilization (IVF)
Intracytoplasmic sperm injections (ICSI)
Zygote intrafallopian transfer (ZIFT)
Gamete intrafallopian transfer (GIFT)
Cryopreservation of sperm, oocytes or embryo
Describe Artificial insemination
Most motile/functional perm isolated
Intrauterine insemination by catheter
Synchronised with natural or induced ovulation
IVF
Oocyte retrieved from ovary
Sperm is capacitated
Natural penetration, fusion and fertilization IN VITRO
Embryo cultured in vitro
Blastocyst transferred to uterus
Describe the process of intracytiplasmic sperm injections
Fertilization incompetent sperm directly injected into oocyte
Injected oocyte is chemically activated with Ca
Describe the process of
Zygote intrafallopian transfer (ZIFT)
Like IVF however transferred into oviduct
Describe the process of
Gamete intrafallopian transfer (GIFT)
Oocyte transferred to oviduct to bypass blockage
Suggest the best methods for males with:
a) Suboptimal motility or count
b) Very poor motility or count
c) Immotility
a- AI
B- IVF
C- ICSI (directly into oocyte)
Suggest the best ART methods for females with:
a) Tubual blockage
b) Tubual blockage AND very poor sperm motility/ count
a= GIFT
b= IVF or ZIFT
Adv and DisAdv of POC
Adv
Don’t get the contraindications associated with Estrogen (COC)
DisAdv
prescription
daily use
decreased protection compred to COC
When do most make contraception methods occur?
BEFORE fertilisation
(women can do after)
Why is there a higher risk of having a child with down syndrome in older mothers rather than older fathers?
Cohesive proteins keep sister chromatids apart. These weaken with age =
-incorrect microtubule-centromere attachment
-non-disjunction
What is the formula for sperm concentration?
mean sperm number X square multiplication factor X dilution
Square multiplication factor = 10^4 (large) or 5x10^4 (small)
dilution factor = 2 for a dilution factor of 1/2
What is the formula for the total number of ejaculated sperm?
= sperm conc x total ejaculate volume
