Fertility & Pregnancy Flashcards by Emily Birch

What is the definition of infertility?

Lack of pregnancy

How well did you know this?

Not at all

Perfectly

__ in 7 UK couples have difficulty conceiving.

1 in 7

How well did you know this?

Not at all

Perfectly

List 3 factors involved in a successful conception

Release of a healthy, non-damaged oocyte
Production of sperm with adequate motility, DNA integrity, count and morphology
Adequate transport of sperm and egg to the fallopian tubes
Penetration of sperm into the oocyte
Implantation of the embryo into the healthy uterus lining
Normal development of the embryo into a foetus

How well did you know this?

Not at all

Perfectly

List 2 structural abnormalities that can affect female fertility

Cervical stenosis (narrow/closed cervix)
Uterine septum
Uterine fibroids/polyps
Fallopian tube obstruction
Pelvic inflammation
Endo/Adenomyosis
Ovarian cysts

How well did you know this?

Not at all

Perfectly

List 2 hormonal issues that may affect female fertility

PCOS
Hyper/hypothyroidism
Amenorrhea
Obesity/insulin resistance
Premature ovarian failure

How well did you know this?

Not at all

Perfectly

Which 3 organs are oestrogen and progesterone produced in?

Ovaries, adrenals, placenta

How well did you know this?

Not at all

Perfectly

List 5 signs/symptoms of oestrogen dominance

Fibroids / uterine polyps
Endo/Adenomyosis
PCOS
Heavy bleeding and clotting
Fibrocystic breasts
Tender and swollen breasts
PMS and irritability
Headaches
Shorter menstrual cycles
Poor memory
Brain fog
Hypothyroidism
Hair loss
Insomnia
Fatigue
Mood swings
Gallbladder disease
Swelling and bloating
Miscarriages

How well did you know this?

Not at all

Perfectly

List 3 signs/symptoms of progesterone dominance

Breast tenderness
Water retention
Bloating
Shortness of breath
Dizziness
Drowsiness / lack of concentration
Sense of physical instability
Long luteal phase
Discomfort or pain in the legs
Decreased libido
Anxiety/panic attacks
Weight gain
Insomnia
Light periods

How well did you know this?

Not at all

Perfectly

List 3 ways in which you can optimise oestrogen/progesterone ratio

Reduce stress
Optimise liver function
Avoid endocrine disruptors
Avoid alcohol
Reduce body weight if obese
Optimise digestion and elimination
Herbs (e.g., Vitex Agnus Castus)

How well did you know this?

Not at all

Perfectly

List 2 immunological factors that may cause foetal rejection.

Tissue type incompatibility (negative maternal response to paternal HLA proteins)
Blood clotting defects
High uterine NK cells
Autoimmunity (immune system rejects the embryo)
Anti-sperm antibodies
Thyroid antibodies
Ovarian antibodies
Antiphospholipid syndrome

How well did you know this?

Not at all

Perfectly

LIst 3 things that may affect male fertility

Congenital defect of testes / ejaculatory tract
Undescended testes
Testicular cancer
Surgery or injury to testes
Ischaemic damage to testes (i.e, sickle cell anaemia)
Infections (STI’s, mumps)
Hypogonadism (reduced sex hormone production)
Obesity (converts testosterone to oestrogen)
Cushings Syndrome
Diabetes mellitus
Haemochromotosis
Scrotal varicocele (increased temperature)
Acute & chronic illnesses
Medications / drugs / chemotherapy
Recreational drugs, alcohol, cigarettes, caffeine, marajuana
Pesticides / endocrine disruptors
Mobile phones
Heavy metals
Heat exposure
Lubricants
Poor diet
Periodontal disease
Ureaplasma infection
Seminal dysbiosis

How well did you know this?

Not at all

Perfectly

Which bacterial species should be most dominant in the vaginal and seminal microbiomes?

Lactobacillus

How well did you know this?

Not at all

Perfectly

List 3 things that can negatively impact the seminal microbiome

Antibiotics
Antifungals
STI’s
Prostatitis
Lubricants
Smoking
Alcohol
Obesity
Poor penile hygiene practices

How well did you know this?

Not at all

Perfectly

Cervical fluid is important as a fuel source to feed lactobacilli, as it is rich in _________

Glycogen

How well did you know this?

Not at all

Perfectly

List 3 things that can negatively impact the vaginal microbiome

STI’s
Alcohol
Smoking
Poor vaginal / oral health
Increased blood glucose levels
Copper IUD coil
Low antioxidant vitamin status

How well did you know this?

Not at all

Perfectly

List 3 ways in which you can positively impact the vaginal microbiome

Reduce infections
Improve blood glucose levels
Improve oestrogen balance
Support lactobacilli growth with pre/probiotics

How well did you know this?

Not at all

Perfectly

Why is intensive exercise deleterious for fertility?

It raises cortisol production, lowering progesterone
Excessive endorphin secretion interferes with FSH and LH production
Can reduce sperm production

How well did you know this?

Not at all

Perfectly

Under stress, the body will prioritise the production of cortisol, leading to reduced __________ production in women.

Progesterone

How well did you know this?

Not at all

Perfectly

How does stress influence FSH and LH?

It down regulates their production

How well did you know this?

Not at all

Perfectly

Chromosomal abnormalities, poor embryonic development, implantation failure and miscarriage risk increase with maternal _____

Age

How well did you know this?

Not at all

Perfectly

What is the C677T polymorphism associated with?

Decreased fertility in men

How well did you know this?

Not at all

Perfectly

List 4 orthodox fertility tests/investigations

Ultrasound scans (for structural abnormalities)
Serum FSH, progesterone, oestrogen
Thyroid function
Glucose levels
Anti-mullerian Hormone
Antral follicle count
Sperm sample
Testing for STIs and other infections

What is Anti-Mullerian Hormone (AMH?)

A serum protein used as a marker of ovarian reserve.

What is an antral follicle count (AFC)?

An ultrasound scan to check numbers of follicles in both ovaries

What 3 things does an orthodox sperm sample test for?

Sperm motility, morphology and semen volume

List 3 functional fertility tests/investigations

Toxic metal profile MTHFR and COMT variations Homocysteine Adrenal stress profile RBC minerals Oxidative stress markers Immune investigations (NK cells, HLA, etc) Amino acid testing (serum or urine) Vaginal ecology (microbiome) Comprehensive hormone panels DNA fragmentation (sperm)

Increased homocysteine levels can indicate an issue with _____________

Methylation

Name the 3 assisted reproductive technologies (ART)

Intrauterine insemination (IUI) Intracytoplasmic sperm injection (ICSI) In vitro fertilisation (IVF)

Explain intrauterine insemination (IUI)

Sperm is placed inside the uterus around ovulation to facilitate fertilisation

Explain Intracytoplasmic sperm injection (ICSI)

Sperm is injected into the egg in vitro (if fertility issue is due to sperm abnormalities)

Explain In vitro fertilisation (IVF)

Stimulation of ovaries, egg retrieval, fertilised in vitro with sperm, fertilised embryos transferred into uterus.

List 3 risks of IVF

Multiple births Premature delivery Low birth weight Ovarian hyperstimulation syndrome Egg retrieval procedure complications Ectopic pregnancy Cancer (from egg growth stimulation drugs)

How long does it take for an egg to prepare for ovulation?

About 100 days

How long does it take for sperm to mature?

72-76 days

Preconception preparation should start at least ___ months before planned conception

3 months

Why are organic eggs included in a fertility diet?

Contain cholesterol for sex hormone production and choline for neural development

Why do the NHS recommend no more than two portions of fish per week?

Mercury toxicity risk

Why might it be beneficial to consume organic liver 2 x month when on a fertility diet?

High in vitamin A, B, iron, copper, choline

Name 2 traditional foods to boost fertility

Fish Eggs Walnuts Maca Fresh figs Saffron (boosts libido, supports nervous system)

List 2 things you might do as part of a natural protocol to support fertility

1. Avoid poor food/lifestyle choices 2. Eat a broad, whole foods, nourishing diet 3. Optimise body composition (20-25% body fat) 4. Reduce stress 5. Minimise exposure to environmental toxins 6. Optimise sleep 7. Mindset work 8. Supportive holistic therapies 9. Castor oil packs

List 2 herbs that you might use for fertility

Vitex agnus castus Ashwagandha Shatavari

Foetal growth is divided into 3 stages. Name them.

Blastogenesis stage (2 weeks) Embryonic stage Foetal stage (3 months until term)

List 3 foods that should be avoided during pregnancy due to risk of toxins/infection.

Pate Soft & blue cheeses Raw eggs Raw fish Green or sprouting potatoes Undercooked meat Soft ice cream and 'squirty' fresh cream from dispensers

Dehydration in pregnancy can cause miscarriage and premature labour. True or false?

True

Where might you find toxoplasmosis?

Cat faeces Raw/undercooked meat Soil left on unwashed fruit and vegetables

Why should vitamin A be sourced solely from beta-carotene during pregnancy?

Because high dose Vit A in retinol form can be teratogenic.

Why should intake of fish oils / DHA & EPA be reduced 4 weeks before the baby's due date?

Because they have an anti-coagulant effect which could be detrimental / dangerous during childbirth

Excessive pre-pregnancy weight or excessive weight gain during pregnancy can lead to gut flora changes, predisposing the child to ________

Obesity

List 3 ways in which you might encourage optimal gut flora in infants

Probiotic supplementation during pregnancy Natural childbirth Breast feeding Avoidance of antibiotic use Pets in the home Avoidance of hyper clean environment Outdoor activities

List 2 possible contributors to morning sickness

Rising hCG levels High oestrogen Enhanced sense of smell Poor nutritional status Poor blood sugar control

Define pre-eclampsia

Pregnancy-induced hypertension associated with protein ion urine and oedema

List 2 signs/symptoms of pre-eclampsia

Water retention Severe headaches Vision problems Pain below ribs

What is the fourth trimester?

The 12 week period after giving birth

What causes postpartum mood instability / anxiety?

Huge sudden drop in progesterone Increase in prolactin