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Medical Physiology > Infertility > Flashcards

Infertility Flashcards

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USMLE® Step 1 flashcards
1
Q

Whose health issue is Male infertility?

A

Women’s.

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2
Q

What is needed associated with male infertility?

A

Research.

Clinical evaluation.

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3
Q

How many people does infertility affect?

A

15% of couples globally.

48.5 million couples.

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4
Q

Where does the weight of treatment always dall?

A

On women.

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5
Q

Why is the weight of treatment of male infertility always fall on women?

A

Because of the loss of diagnostic options for men.

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6
Q

How much of infertility lies on male?

A

50% of cases.

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7
Q

What do we have to understand in order to achieve new diagnostics and treatment options in male infertility?

A

Physiology of males and females.

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8
Q

Why is infertility a greater problem in women?

A

Because, of the need to understand the process of egg production.
How sperm behaves in tract.
How successful pregnancy happens.

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9
Q

When did the first observation of human sperm occur?

A

In the 17th century.

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10
Q

When was artificial insemination conducted?

A

In the 18th century.

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11
Q

To who did artificial insemination occur first?

A

In dogs.

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12
Q

To who did artificial insemination conducted after dogs?

A

In humans.

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13
Q

In what did artificial insemination result in humans?

A

In a live birth in 1793.

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14
Q

When did succefful fertilisation occur in vitro?

A

Late 20th century.

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15
Q

Why was successful fertilisation late?

A

Because it wasn’t appreciated that the sperm must undergo biochemical changes in order to be fertilised competent.

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16
Q

When was the term capacitation used?

A

In 1951.

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17
Q

As what did the term capacitation used to describe?

A

Changes for over 8 million babies to be born thanks to IVF.

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18
Q

What does Intracytoplasmic sperm injection bypass?

A

All natural selection steps.

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19
Q

Why does intracytoplasmic sperm injection bypass all natural selection steps?

A

Because of the sperm head which contains nucleus –> injected directly in the egg.

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20
Q

What is the definition of infertility?

A

Inability of a couple to conceive after 1 year of unprotected sexual intercourse.

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21
Q

What does Primary infertility mean?

A

Inability to conceive.

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22
Q

What does Secondary infertility mean?

A

Inability to conceive but has previous pregnancy.

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23
Q

When is the lowest prevalence of infertility and help request in women?

A

In the lowest age.

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24
Q

When does infertility and help ask peak in women?

A

At age 35-44.

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25
Q

What is the age 35-44 in women?

A

The top end of a woman natural fertility.

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26
Q

Until what age women still seek for treatment?

A

Until advanced age.

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27
Q

Do male have a longer fertile lifespan than women?

A

YES.

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28
Q

When is the beginning of subfertility in women?

A

At age of 21.

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29
Q

When is the beginning of sterility in women?

A

At age of 31.

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30
Q

When is the beginning of irregular menstrual cycle in women?

A

At age of 41.

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31
Q

When is the beginning of menopause in women?

A

At age of 51.

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32
Q

What are the factors that impact the ability to reproduce?

A 
Physiological = menstrual cycle stage.
Patho = infections, genetic mutation, PCOS.
Economic = can't afford children, poor living impacts health.
Psychological = stress.
Abortion = choosing no child.
Contraception = Use prevents.
ART access = economic and geographical.
Social.
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33
Q

What are the social factors that impact infertility?

A 
Cigarette smoking.
Marijuana smoking.
Anabolic steroids.
Alcohol.
Emotional stress.
Excessive heat exposure.
Tight underwear/clothing. 
Prolonged sitting.
Prolonged cycling.
Environmental exposure.
Exposure to Pesticides and toxins.
Exposure to radiation/cytotoxic drugs.
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34
Q

What are some pathophysiological factors that impact male?

A 
Cystic fibrosis.
High frequency of CFTR mutations.
Cryptochordism.
Obesity.
Varicocele.
Azoospermia.
Globozoospermia.
Asthenozoospermia.
Infections.
Pollutants. 
Impotence = inability.
Idiopathic = unexplained.
KS syndrome.
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35
Q

What is Cystic fibrosis?

A

The primary cause of infertility in 95% of affected men.

Congenital bilateral absence of vas deferens.

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36
Q

Where is high frequency of CFTR mutations found?

A

In non-CBAVD males.

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37
Q

With what is the high frequency of CFTR mutations associated?

A

With spermatogenesis defects.

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38
Q

What is Crypochordism?

A

The name given to undescended testes.

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39
Q

Where does Crypochordism result?

A

In impaired spermatogenesis.

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40
Q

Why does Crypochordism result in impaired spermatogenesis?

A

Because internal body temperature prevents spermatogenesis.

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41
Q

How can obesity effect sperm production?

A

If it is associated with elevated estrogen production.

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42
Q

What happens in obesity that affects fertility?

A

Testosterone –> converted to –> estrogen by fat cells.

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43
Q

What is Varicocele?

A

A varicose vein in scrotum.

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44
Q

What is the function of Varicocele in infertility?

A

Helps keep heat exchange and testis cooler than body temperature , but it doesn’t work efficiently.

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45
Q

Which factors suffer from stress and affect fertility?

A

Nutrient and waste exchange.

46
Q

What happens to nutrient and waste exchange and testis duffer stress and affect spermatogenesis?

A

They are impaired.

47
Q

What is Azoospermia?

A

The failure to produce viable sperm.

48
Q

What is Globozoospermia?

A

The production of sperm with abnormal heads and no acrosome.

Sperms –> cannot fertile.

49
Q

What is Asthenozoospermia?

A

Sperm with poor motility.

50
Q

What do infections cause and affect fertility?

A

Inflammation.

Immune response –> damages –> sperm and spermatogenesis.

51
Q

What can pollutants affect?

A

Testosterone production.
Spermatogenesis.
Sperm function.

52
Q

What is Impotence?

A

A cause o infertility.

53
Q

Why is impotence a cause of infertility?

A

Because the man cannot naturally inseminate the women.

54
Q

What happens in KS syndrome condition in men that affects fertility?

A

Man has an extra X chromosome.
Affects puberty.
Men –> infertile.

55
Q

How does Idiopathic/unexplained infertility affect men?

A

75& of infertility.

Huge demand of progress.

56
Q

In what does Cystic fibrosis result?

A

In blocked fallopian tubes.

57
Q

When does Primary ovarian insufficiency occur?

A

When a woman’s ovaries stop working normally.

58
Q

When does Primary ovarian insufficiency occur?

A

Before woman is 40.

59
Q

What can PCOS syndrome affect?

A

Ovulation.

60
Q

Which factors can result in woman getting pregnant?

A

Treatment.
Surgery.
IVF.

61
Q

What can Endometriosis cause?

A

Infertility.

62
Q

When does Endometriosis cause infertility?

A

If there is damage to uterus or fallopian tubes.

63
Q

What is chlamydia?

A

An infections that can cause damage and scarring to reproductive tissues.

64
Q

What are the unexplained causes of female infertility?

A

Prevalent.

65
Q

How much was the global population growth since 1950?

A

From 2.6 billion - 7.6 billion.

66
Q

What is the estimation of future world population growth?

A

World’s population will expand before declining back to todays level.

67
Q

What should be made for fertility?

A

Mindful research of projected population changes.
Research against demands of medical disciplines.
Example = cancer research.

68
Q

What is important to emphasise in terms of infertility research?

A

Is not about increasing the number of people per se.

It is about bringing new life into the world.

69
Q

What can an economic argument show us in terms of infertility?

A

The interests of every country to ensure youthful population remains at light levels.

70
Q

What do researchers say about human fertility?

A

It could be getting worse.

71
Q

What do some NHS trusts do?

A

They are cutting back on free IVF services.

72
Q

What does research and development require in terms of infertility?

A

Huge sums of money.

73
Q

What do we have to understand in terms of infertility research?

A

The molecular regulation of fertility.

74
Q

Why should we understand molecular regulation of fertility?

A

To help in development of contraceptive.

75
Q

What is ‘planned parenting’?

A

Part of WHO 17 sustainable development goals.

76
Q

What does ‘WHO 17 sustainable development goals’ say?

A

By 2030 countries should aim to ensure universal access to sexual and reproductive health-care services.

77
Q

What ‘WHO goals’ includes?

A

Family planning.
Information.
Education.
Reproductive health into strategies and programmes.

78
Q

What is the current contraceptive strategy doing?

A

Failing.

79
Q

What do unplanned pregnancies present?

A

Significant health.

Social problems.

80
Q

How many pregnancies were unintended and aborted in 2008, out of 208 million pregnancies, respectively?

A

86 million = unintended (42%).

41 million = aborted (19.7%).

81
Q

How many were born over the past 20 years, out of 10M cycles?

A

2M babies.

82
Q

What do the figures of born babies in the past 20 years show?

A

There is a lot of progress to be made –> increase effectiveness of treatment.

83
Q

How much is the mean pregnancy rate for IVF and ICSI treatments?

A

Around 25% only.

84
Q

How much is the cost for people using private clinics?

A

A huge financial cost.

85
Q

How much is one 3 cycle IVF package from UK?

A

10K.

86
Q

How much is one 1 cycle IVF package in USA.

A

$12K, without including medication.

87
Q

What do some people still consider for the current treatment methods?

A

They are sufficient.

88
Q

When was the huge breakthrough with the first live birth from IVF?

A

In 1978.

89
Q

What is IVF along with ICSI?

A

Still the only treatment options.

90
Q

What does the fact that IVF and ICSI are still the only treatment options for infertility since 1978?

A

There has been no progress for 40 years.

91
Q

About what are some scientists concerned?

A

About the increasing and routine use of ICSI.

92
Q

Why are some scientists concerned abut the increasing and routine use of ICSI?

A

Because it removes all the barriers of natural selection.

93
Q

What option solves everything?

A

ART.

94
Q

When was Louise Brown born?

A

In 1978.

95
Q

How does ART solve everything?

A

It contributes to 1-4% live births.

96
Q

What happened in 2017?

A

Nearly 55K people undertook > 75K treatment cycles.

97
Q

Which country had the largest majority of infertility treatment in 2017?

A

England.

98
Q

What does the NHS provide in Scotland?

A

Three free cycles.

99
Q

What do recent updated guidelines fail to find?

A

The benefit of ICSI in non-male factor treatment.

100
Q

What do recent guidelines advise?

A

Against ICSI routine use.

101
Q

What happened in pregnancy rates since 1997 until 2011?

A

Little progress in improving rates.

102
Q

What does an increasing number of studies suggest?

A

That children born using reproductive technologies –> increased risk of certain conditions.

103
Q

Is the fact that ‘children born using reproductive technologies have increased risk of certain conditions’ proved?

A

No.

It remains unproved.

104
Q

What is certain about IVF and ICSI?

A

They both are far removed from natural selection.

105
Q

What do scientists think is better about restoring natural fertility?

A

A significant treatment milestone would be routinely restore natural fertility.

106
Q

What is infertility?

A

A disease of the reproductive system.

107
Q

Who does infertility impact?

A

Individuals.

108
Q

How does infertility impact individuals?

A

Physically through treatment.
Mentally.
Financially.

109
Q

What is a fact about ART using in infertility?

A

It is increasingly used.

Increasingly invasive.

110
Q

What does understanding of molecular causes of infertility serve?

A

A medical and a contraceptive discovery agenda.

Medical Physiology (12 decks)

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