Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

RED > Infertility > Flashcards

Infertility Flashcards

1
Q

Meanings

Fertility

A

measure of the actual outcome of the reproductive process

  • number of children born to an individual/couple.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Meaning

Fecundity

A

measure of the ability to conceive AND produce a live birth.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Meanings

Fecundability

A

probability of conceiving each month - the monthly chance of pregnancy, or monthly fertility rate

-either for an individual (measured over time)
-or for a population (the number of conceptions occurring in one month).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Meaning

Infertility

A

The inability to conceive after a period of unprotected intercourse or the inability to carry a pregnancy to term.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Meaning

How does NICE define infertlity

A

defined as failing to get pregnant after two years of regular unprotected sex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Meanings

Subfertility

A

A state of reduced fertility.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

When do people typically advice medically

A

one year -> subfertlity

most couples are unaware of fertility status until trying for child

Of 100 couples without a fertility issue trying to conceive naturally:
20 will conceive within one month
70 will conceive within six months
85 will conceive within a year
90 will conceive within 18 months
95 will conceive within two years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How many couples have difficulty concieving?

A

1 in 6

Infertility commonest reason for women aged 20-45 to see their GP

majority may become naturally pregnant down the line (if you try early enough)

Only 20% of these cases arise through actual sterility

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What factors can affect fertility

A
  • Age
  • Smoking status
  • Obesity
  • Increasing prevalence of STIs such as chlamydia

chlamydia: are damaging the reproductive tract and so reduce fertility

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

If a couple turn up and ask about concieving what is the first you should do

A
  • ASK: how long have you been trying
  • family history
    • is there lots of miscarriages
  • current sexual history
    • do they know they are ovulating,
    • are they are trying correctly
  • past sexual history
    • whats its like with other partners
    • may not always say things in front of their other partners
    • if a female says they got pregnant, its smth you can rely on it, whereas men may say they have fathered pregnancy … (???)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What females factors can affect conception

like physiologically

A
  • Ovulatory disorders
  • Tubal damage
  • Endometriosis
  • Uterine abnormalities
  • Implantation, growth and development
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Female

What tests would be conducted

A
  • via blood analysis
    • FSH, LH (day 2-4) -> check ovarian reserve
    • day 21 progesterone -> to investigate ovulation
  • via ultrasound (laparoscopy, or radiogram)
    • hysterosalpingogram
    • dye spill means the fallopian tube is clear, the egg can go down, and sperm can go up
    • Laparoscopy
    • involves looking inside the abdomen to visualize the uterus, fallopian tubes and ovaries
    • to check they have normal appearance.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the causes of infertlity in women

A

Ovulation disorders (40%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Meanings

Primary amenorrhoea

A

No cycles ever happened

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Secondary amenorrhoea

A

occurs when a patient who has passed menarche goes six months or longer without menses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is oligomenorrhoea

A

Irregular cycles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How would check for an anvoluatry cycle

A

take a day-21 progestorone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What other factors can ovulation disorders be associated with

things outside the body

A

ovulation disorders can be associated with stress, obesity, strenuous exercise, anorexia nervosa and drug use

stress axis is important

around 30% of cases, treatment with placebo is affective in getting cycles to resume and restoring fertility

Possible failure of maturation of neuroendocrine system at puberty can also cause annovulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What disorders can cause annovulation

A

**Idiopathic ovarian failure
**
- Gonadotrophin secretion is normal but is insufficient to support a normal cycle → end organ insensitivity
- oestrogen levels fail to rise and follicles fail to mature (many small follicles)

**Polycystic ovarian syndrome (PCOS)
**
- Associated with LH and usually increases androgens (mild increase in follicular phase)

**Anovulatory cycles – endocrinologically normal
**
- Luteinised unruptured follicle syndrome (LUF) – eggs ‘deficient’

**Abbreviated luteal phase
**
- decreased Progesterone →poor luteinization
- you don’t maintain endometrium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What disorders of the female tract can impact conception

A

**Tubal obstruction
**- can be due to
- secondary consequence of pelvic infection
- increase the incidence of STDs, e.g gonorrhoea, chlamydia and tuberculosis
- Post-abortal or post-pregnancy sepsis
- scarring may affect surface of fallopian rube, can affect sperm going up, or egg going down
- infection → impaired oocyte and sperm transport due to loss of cilia on intraluminal cells and scarring => adhesions

  • Endometriosis
    • endometrial tissue growth escalates in ectopic sites – oviduct, ovary or peritoneal cavity => scarring/adhesions
    • pain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

female

Apart from ovulation and tubal disorders what other factors can affect pregnancy

A
  • cervical incompetence
  • implantation defects
  • autoimmune (lupusP
  • immunological incompatibly
    • rhesus, ABO

Basically, can get prgenant but something downstream is affecting it

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

How do we detect a pregnancy biochemically and clinically

A

**- biochemical pregnancy
** - tested with the presence of hCG in blood and urine after 18-30 days start of last period
**- clinical pregnancy
** - ultrasound at 5 weeks
- foetal heart at 7 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are the two types of loss

A

-sponetanous
-abnormal conceptus

22
Q

How does a sponetnous loss occur after a clinical pregancy

after 5-7 weeks

A
  • 4/5 cycles involving unprotected intercourse don’t cause pregnancy
    • when sperm meets egg it may not always implant

  • flushing of the human uterus revealed that at day 4/5 only 20% of embryos recovered where blastocysts
  • 15-25% of clinical pregnancies fail (1st trimester)
23
Q

What percentages of pregnancies end up in a live birth

A

15-25% have a live birth

24
Q

Why does pregnancy loss due to abnormal conceptus happen

A

60% of the time, have sponetonus abortion because the sperm or egg gave the wrong amount of chromosomes

Chromosomal abonromalities types
-Translocations
-Errors of ploidy
-Deletions or duplications of a complete set of haploid chromosomes
Errors of chromosome number or ‘somy’

25
Q

How can age affect conception

A
  • as females gets older
    • chance of miscarriage goes up
    • live birth goes down
    • aneuploidy in oocyte is more common
    • this is related to egg quality, not he uterus, or endometrium

if we give a lady of 44 a donor egg, she will have same chance of pregnancy and no increased risk of miscarriage.
I.e. as you age, egg quality decreases -> aneuplodiy point

26
Q

What are the effects of delayed reproduction

causes

A
  • caused by age-related factors
    • diabetes
    • hypertension
  • increase in miscarriage and imprinting disorders go beyond 45 years
  • increase of autism increases as men get older
27
Q

What happens with egg and sperm as they both get older

A

as eggs get older, the eggs struggle to deal with problems older sperm brings them

-miscarriages

28
Q

How can male disorders about sperm

so what about sperm can it affect

A
  • Production of spermatozoa
  • Transport of spermatozoa
  • Transmission of spermatozoa
  • Sperm function in the female tract
  • Fertilization and events afte
29
Q

What could be causing male infertitiy

A
  • dentify potentially correctable conditions
    • Ductal obstruction or hypogonadotropic hypogonadism
      • can you give gondotrophins and spermtagonsis may start
  • Identify potentially irreversible conditions requiring assisted reproductive technique using the sperm of the male partner.
    • like he’s doesn’t have a VAS and you can use a technqiye to get a around that
  • Identify irreversible conditions for which donor insemination or adoption are the possible options
  • identify life-threatening conditions
    • testicular cancer, pituitary tumours
  • identify genetic abnormalities that may affect the health of offspring if assisted reproductive techniques should be employed
30
Q

What tests do you need to do intially for men

A
  • reproductive history
  • semen analysis
    • one semen analysis
    • if it comes with abodnomal result
      • if he gives a reason, like i had the flu, or smth then do a repeat
  • additional blood analysis
31
Q

male infertility

What examinnations

A

Examine male

  • General weight, BP, urinalysis
  • Secondary sexual characteristics
    • does he loo like he’s gone through puberty
  • Signs of endocrine disease
  • Gynaecomastia
  • Abdominal examination
  • Genital examination
  • Digital PR
    • unusual in UK
    • you would check for prostatitis
32
Q

What endocrine evaluation would you do

A
  • abnormally low sperm count (5 million)
  • if he says he has impaired sexual function you would do bloods as soon as possible
  • other clinical findings
33
Q

Definitions

normozoospermic

A

normal semen sample
>16 million spermatozoa/ml; >30% rapid forward progressive motility and >4% normal morphology

34
Q

Defintions

Oligozoospermic

A

low sperm count

<16 million spermatozoa/ml

35
Q

Defintions

Asthenozoospermic

A

about sperm motlity -> reduced motlity
< 42% rapid and normal forward progressive motility

36
Q

Teratozoospermic

A

a condition in which a man has a high amount of abnormal shaped sperm

< 4% spermatozoa with normal morphology

37
Q

azoospermic

A

means no sperm in ejaculate

38
Q

what does zoospermic mean

A

to do with sperm

39
Q

if there is a problem with the ejaculate

A

spermia

40
Q

What are the causes of failure in sperm production

A

Congenital testicular deficiency
- Klinefelter (47, XXY)
- Y Chromosome deletions

Maldescended testes - cryptorchidism
- didn’t get normal testicular decent
- Reduced spermatogenesis
- Increased risk for testicular cancer

Acquired
- Trauma - testis torsion
- may have cut off the blood supply
- hit with cricket bat or smth
- Orchitis (mumps)
- Endocrine disorders

41
Q

What clinical tests can you do for sperm

A
  • leucocytes in semen over 1 million per ml
    • tells you man have some kind of infection
  • sperm viability tests
    • to test if sperm or dead or nah
  • sperm vitality tests
    • if sperm are alive, but they aren’t moving suggests, that sperm does not move
  • anti-sperm antibodies
  • computer aided sperm analysis
42
Q

What are non standard sperm tests

A
  • DNA damage (TUNEL / SCSA / SDFA / Comet assays)
  • Aneuploidy (usually chromosomes 13, 18, 21, X and Y)
  • OxidaAve Stress Tests (MiOxsys, Luminol, TOS, TAC)
  • Cervical mucus penetraAon(CMT) and the post coital test (PCT)
  • Hemizona assay
  • Acrosome reacAon (AR)
  • Zona free hamster egg sperm penetraAon (SPA)

(most people do non-standard tests are ripping them off)

43
Q

What can cause sperm to fail to transmit themselves

tranmsit: from penis to vagina

A
  • erectile dysfunction
    • will affect delivery of sperm to female tract
  • ejaculatory dysfunction
    • retrograde
    • defects of accessory sex glands
44
Q

Descirbe how ejaculations usually happens

A
  • Contraction of musculature of prostate
    • seminal vesicles and vas deferens => seminal fluid and sperm => move out through urethra
  • Under sympathetic nerve control
  • Contraction of urethral and pelvic floor musculature => ejaculation
  • the vesicular urethral sphincter closes bladder neck
    • need to close this
45
Q

What is reterograde ejaculation

A
  • Incompetence of urethral sphincter
  • Ejaculation into the bladder (retrograde)the path of least resistance
46
Q

What conditions are associated with reterograde ejaculation

A
  • Diabetes
  • post traumatic paraplegia
  • post bladder neck surgery
47
Q

What are the signs of reterograde ejaculatiomn

tests

A

Ejaculate volume nil or low
Confirmation in urine – see if sperm in urine.

48
Q

Why would you do a post ejaculatory urine analysis

A

low volume ejaculate
Absent ejaculate (Aspermia)

Avoid if CBAVD / hypogonadism features

49
Q

What are the causes of low volume / no ejaculate:

A
  • retrograde ejaculation
  • Lack of emission
  • Ejaculatory duct obstruction
50
Q

sperm

What can cause a total failure in transport

A
  • post-infection
    • bilateral epididymal/ vas occlusion
      • can be injury or by an STI
  • congenital bilateral absence of vas defferns
    • CBAVD
    • ejaculate he thinks is normal, but there’s no sperm in ejauclate
  • Azoospermic semen samples – obstructive azoospermia
51
Q

What are the indications for genetic testing

A
  • genetic abnormalities may cause infertility
    • they can affect sperm production or transport
    • Chromosomal abnormalities resulting in impaired testicular function. Klinefelter’s or translocations or inversions.
  • men with non obstructive azoospermia, or oligozoospermia
52
Q

What do 10-15% of men with severe oligo or azoospermia have

A

Y chromosome microdeletion

if the man goes onto have a son, the son may have the same phenotype or worse

53
Q

What is CNAVD

what is it associated with causes etc

A
  • Linked to CFTR gene (causes Cystic Fibrosis)
  • CFTR gene mutation on chromosome 7
  • CF associated with CBAVD.
  • It is an improper development of vas deferens (c.f. vasectomy)
  • > 95% of men with CF have CBAVD

85% of men with CBAVD have only one severely mutated allele => no other CF symptoms… In this situation you can take sperm for testes or epididymis and perform assisted reproduction.

  • Check female partner when relevant
    • but if she has a CF mutation, there’s a 25% chance they would make a baby with CF
54
Q

What is the sperms role in fertilisation

A

– Centriole function (spindle formation)

– Chromatin decondensation

– Protamine exchange

– Pronuclear fusion

– Activation of genes for placenta formation

if you can select the sperm, you can skew the odds of things workings

55
Q

What is the unexplained infertility …

A

it is when - Normal frequency and distribution of unprotected intercourse
- No obstructions of malformations in female or male genital tracts
- Normal follicle growth, maturation and ovulation; no signs of ongoing inflammatory reactions
- Normal concentration of motile spermatozoa, no anti-sperm antibodies or other signs of ongoing inflammatory reaction is …

RED (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions