Infertilities maternal Flashcards
Inability conceives a child or sustains a pregnancy to childbirth.
Exist when a pregnancy has not occurred after at least 1 year of engaging in unprotected coitus.
Infertility
the term more often used today that can unable to produce a baby
Subfertility
the inability to conceive because of a known condition such as the absence of a uterus
Sterility
Types of subfertility
PRIMARY SUBFERTILITY
SECONDARY SUBFERTILITY
There have been no previous conception
PRIMARY SUBFERTILITY
There has been a previous viable pregnancy but the couple is unable to conceive at present
SECONDARY SUBFERTILITY
percent of couples are infertile after TWO yrs
10 percent
As a rule these are the limitations set by some health care settings before evaluation:
if a woman is younger than 35 years of age, it is usually suggested she have an evaluation after 1 year of subfertility
If a woman is older than 35 years, she should be seen after 6 months
if the couple is extremely apprehensive or knows of a specific problem that could be causing their difficulty in conceiving, studies should never be delayed, regardless of the couple’s age
Fertility Assessment
is the medical condition of a man whose semen contains no sperm.
Azoospermia
Failure to deposit Sperms
ED (formerly known as Impotence)
Premature ejaculation
Retrograde ejaculation
Use of Tricyclic antidepressants (TCA’s)
Inadequate Sperm Count
Sperm Count
Number of sperm in a single ejaculation or milliliter of semen
Normal: ranges from 15 million sperm to more than 200 million sperm per mL of semen
Factors that can affect sperm count:
Any condition that significantly increases body temperature
Congenital abnormalities (cryptorchidism)
Twisted spermatic cord
Varicocele
Obstruction or Impaired Motility
Occur at any point along the pathway that spermatozoa must travel to reach the outside.
Causes:
Mumps orchitis
Epididymitis
Tubal infections (gonorrhea or ascending urethral infection)
Congenital stricture of the spermatic duct
4 causes of male infertility
- failure to produce sperm
- failure to deposit sperm
- Inadequate sperm count
- obstructions or impaired mobility
Test for semen
Semen Analysis
tests for the following:
number of sperm (volume)
shape of sperm
movement of sperm, or “sperm motility”
Semen analysis
Done 2 – 4 days of sexual abstinence and/or abstinence from ejaculation
Spermatozoa are examined under a microscope within 2 hours of collection noting appearance and motility
Repeated in 2 – 3 months
Semen Analysis
days of sexual abstinence and/or abstinence from ejaculation for semen analysis
2-4 days
are examined under a microscope within 2 hours of collection noting appearance and motility
Spermatozoa
Semen Analysis is repeated in…
2 -3 months
Primary pathologies of the male reproductive system can cause oxidative stress to sperm and can cause spermatozoal dysfunction and leads to infertility.
- Male accessory gland infection
- Immature/Abnormal spermatozoa
- Prolonged stasis of spermatozoa in the epididymis or in transit.
Environmental factors that cause male infertility
- Drugs
- Smoking
- Pollution and radiation
Systemic pathologies for male infertility
- Diabetes
- Cancer
- Systemic Infection
total sperm count in ejaculation
39-928 million
Female Infertility causes…
- Ovarian factors
- Tubal transport problems
- Uterine Problems
- Cervical problems
The ovarian factors affecting female infertility
PCOS
Hyperprolactinemia
Hypothyroidism
Premature ovarian failure
Luteal phase defect
Usually due to scarring of the fallopian tubes
PID
Infection of pelvic organs is usually caused by chlamydia and gonorrhea
Ruptured AP
Abdominal surgery involving infection
Tubal Transport Problems
- Tumors block the entrance of the fallopian tubes OR Limit space available for effective implantation
- Uterine deviations
3, Poor secretions of estrogen and progesterone - Endometriosis
Uterine Problems
Infection and inflammation of the cervix
Stenotic cervical os
Congenital
Scarring from D&C and/or cervical surgeries.
Obstruction of the cervix (e.g. Polyp)
Cervical Problems
Types of Fertility testing
- Hysterosalpingography
- Laparoscopy
- Uterine Endometrial Biopsy
- Hysteroscopy
Radiologic examination of the fallopian tubes using a radio-opaque medium
Hysterosalpingography
opaque water soluble dye is injected into the cervix and noted
Radio
Introduction of a thin, flexible lighted tube (laparoscope) through a small incision in the abdomen just above the umbilicus to examine the position and state of the fallopian tubes and ovaries.
Done during the follicular phase of the menstrual cycle and done under general anesthesia
Used to view the proximity of the ovaries to the fallopian tubes.
Laparoscopy
Used as a test for ovulation or to reveal an endometrial problem such as a luteal phase defect.
A catheter is inserted into the uterus through the vagina to remove cells from the uterine lining for examination.
Uterine Endometrial
Biopsy
Visual inspection of the uterus through the insertion of a hysteroscope through the cervix
Helpful in discovering uterine adhesions
Hysteroscopy
Man is advised to abstain from coitus 7 – 10 days to increase the amount
Ligation of a varicocele
Lifestyle changes
Wearing loose clothing
Avoiding long periods of sitting
Avoid prolonged hot baths
Low Sperm Count
Hormone Therapy for fertility management
- Clomiphene citrate
- Human Menopausal Gonadotrophin
- Bromocriptine
- Conjugated Estrogen
- Progesterone vaginal suppositories
Surgery for Infertility management
- myomectomy
- Lysis of uterine adhesions
- Diathermy
- Cannulation of the fallopian tubes
Done if myoma is interfering with fertility
myomectomy
If the problem is tubal insufficiency
Diathermy and Cannulation of the fallopian tubes
