Infertility Flashcards
Chances of natural conception decline with increasing what?
Female age
What are the chances of conception per cycle?
20% at peak
What is there a predetermined number of in women?
Pre determined number of eggs-no new egg production following egg numbers which the female is born with
What happens as the ovarian reserve is exhausted?
Cycle irregularity begins to start by age 45 & then over the next 5-7 years menopause is reached
What is associated with the decline in egg number?
Decline in the quality of the eggs where the capacity of the egg to perform well in terms of nuclear and genetic material division also declines (important feature required to achieve a conception)
Can a decline in fertility be predicted?
NO, to date there is no fertility test that can tell whether a woman can get pregnant and have a baby
What are 4 key important factors for conception?
Ovulation=egg production cyclically
Sperm production=Good & swimming well to fertilise egg
Fertilisation=Sperm & egg to meet-happens in fallopian tube (patent & functioning well), no ejaculatory or projectile problems (sexual dysfunction) to allow adequate sperm into the female repro tract
Implantation=Uterus has to be normal
What parts are crucial for ovulation to happen?
Functioning of the hypothalamus & pituitary gland & ovaries along with the hormones has to be normal for ovulation to happen
What is the diagnostic test for ovulation?
Measure progesterone to show whether ovulation did happen in that cycle or not
What happens to the hormone levels in ovulation?
LH surge mid cycle and after ovulation progesterone goes up
What cycles are coordinated in a cyclical fashion?
Ovarian & menstrual cycles
What uterine changes occur each month?
Generate an endometrium each month which is capable of having an implantation & pregnancy
Endometrial development under the effect of ovarian hormones
Fertilisation-oestrogen plays a role and also along with progesterone plays a role in tubal transport and implantation. How does the embryo get into the uterine cavity?
Once the egg is fertilised it starts dividing into embryo
Muscular spasms drive the embryo into the uterine cavity where it implants
Endometrium is prepared under influence of hormones in order to receive the embryo & drive the process of implantation
What 6 things does natural conception rely on?
Functioning hormonal axis and gonads
Ovarian reserve
Regular ovulation
Normal sperm production
Fertilization- egg and sperm interaction patent fallopian tubes
Normal uterine cavity for implantation
What lifestyle factors can affect fertility?
Age
BMI
Smoking-can accelerate the decline in ovarian reserve
Alcohol
Recreational drug use
Stress
What is the WHO clinical definition of infertility?
Inability to conceive over a 12 month period despite exposure to regular , unprotected intercourse. Represents a prognosis based approach and provides practical guidance on when to initiate investigations.
Why are global infertility trends often unreliable?
Many different definitions (WHO (clinical), epidemiological, demographic definitions)-used inconsistently when calculating prevalence
When should people be referred for fertility issues?
No conception after one year of regular unprotected intercourse
Referral earlier if-
- Age>35 years
- Known cause for infertility