Fertility & Pregnancy Flashcards
What is the definition of infertility?
Lack of pregnancy
__ in 7 UK couples have difficulty conceiving.
1 in 7
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
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
List 2 hormonal issues that may affect female fertility
PCOS
Hyper/hypothyroidism
Amenorrhea
Obesity/insulin resistance
Premature ovarian failure
Which 3 organs are oestrogen and progesterone produced in?
Ovaries, adrenals, placenta
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
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
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)
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
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
Which bacterial species should be most dominant in the vaginal and seminal microbiomes?
Lactobacillus
List 3 things that can negatively impact the seminal microbiome
Antibiotics
Antifungals
STI’s
Prostatitis
Lubricants
Smoking
Alcohol
Obesity
Poor penile hygiene practices
Cervical fluid is important as a fuel source to feed lactobacilli, as it is rich in _________
Glycogen
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
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
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
Under stress, the body will prioritise the production of cortisol, leading to reduced __________ production in women.
Progesterone
How does stress influence FSH and LH?
It down regulates their production
Chromosomal abnormalities, poor embryonic development, implantation failure and miscarriage risk increase with maternal _____
Age
What is the C677T polymorphism associated with?
Decreased fertility in men
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
- Avoid poor food/lifestyle choices
- Eat a broad, whole foods, nourishing diet
- Optimise body composition (20-25% body fat)
- Reduce stress
- Minimise exposure to environmental toxins
- Optimise sleep
- Mindset work
- Supportive holistic therapies
- 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
