Infertility Flashcards
What is the definition of fertility?
The ability to conceive
What is the definition of Fertility rate?
Number of births per female
What is the definition of fecundability?
The probability of conception in a month or in a menstrual cycle
What is the definition of fecundity?
The probability of a live birth from one menstrual cycle
What is the definition of infertility?
Failure to achieve pregnancy following 12 months or more of unprotected sex
What is the definition of subfertility?
Reduction in fertility
What is the definition of sterility?
Permanent loss of fertility
What socioeconomic factors are causing increased infertility rates worldwide?
- Increased access to education.
- Lower child mortality rates (reducing the need for large families).
- Higher costs of raising children.
- Regional differences in fertility rates.
What has been the case in south Korea?
- Fertility rate dropped to 0.72 children per woman due to policies and economic pressures.
- Government now incentivizes childbirth due to concerns about an aging population.
What are the current clinical infertility trends?
- Increased prevalence in both males and females.
- Most noticeable in the 25–34 age group.
- May be due to better reporting and availability of treatments, rather than biological decline.
What has been found in terms of sperm count decline and what are the potential causes?
- Some studies suggest a decrease in sperm concentration (millions per mL).
Potential causes:
- Exposure to hormones and chemicals.
- Improved sperm analysis techniques may exaggerate trends.
What are the trends with age and fertility?
- Peak fertility at age 25 (probability of conception = 1.0).
- Still high at age 30 (p = 0.9).
- Dramatic decline by age 45
What does oligozoospermia mean?
Low sperm count (1 in 20 males, causes ~30% of infertility cases).
What does asthenozoospermia mean?
Low sperm motility (impaired movement prevents reaching the egg).
What does teratozoospermia mean?
Abnormal sperm shape affects fertilization.
What does azoospermia mean?
No sperm production (1 in 100 males).
What are some causes of sperm PRODUCTION issues?
- Varicoceles (40% of primary infertility cases): Increased retrograde blood flow to testes, inhibiting spermatogenesis.
- Undescended testes: Testes must be outside the body for optimal temperature regulation.
- Chromosomal abnormalities.
- Hormonal imbalances (e.g., hypogonadotropic hypogonadism, due to low pituitary action).
- Lifestyle factors: Stress, diet, alcohol, drug use, excessive heat.
What are some examples of sperm TRANSPORT issues?
- STIs (e.g., chlamydia): Can cause permanent tubal damage.
- Vasectomy (deliberate sterilization).
- Tumors affecting reproductive structures.
- Congenital absence of vas deferens (linked to cystic fibrosis—sperm is produced but not ejaculated).
What are some sexual dysfunction causes?
- Retrograde ejaculation (semen enters bladder instead of exiting through the penis).
- Spinal cord injuries affecting ejaculation.
What happens during varicocele pathophysiology?
Left testicular vein lacks a valve, leading to retrograde blood flow, which:
- Increases testicular temperature.
- Increases reactive oxygen species (ROS).
- Can contribute to infertility.
**Varicocele repair surgery can improve pregnancy rates, live births, and sperm retrieval.
What are some causes of oogenesis and ovulation disorders?
- Aging: Decline in ovarian reserve and oocyte quality.
- Hormonal imbalances (e.g., Polycystic Ovary Syndrome (PCOS)).
- Thyroid dysfunction (overactive or underactive).
- Premature ovarian failure.
- Genetic conditions (e.g., Turner Syndrome).
What are some oocyte/zygote transport and implantation issues?
- Tubal damage (e.g., from infections, ectopic pregnancies).
- Endometriosis: Uterine-like tissue grows outside the uterus, causing pain and implantation issues.
- Fibroids: Large growths that disrupt implantation.
- Pelvic inflammatory disease (PID): Chronic inflammation damages the uterine environment.
What are some causes of PREGNANCY issues?
- Chromosomal abnormalities.
- Structural defects of the uterus.
- Autoimmune conditions affecting implantation.
- Lifestyle factors: Smoking, alcohol, high BMI.
What are the symptoms of PCOS?
- Irregular cycles or anovulation.
- Acne, excessive hair growth.
Insulin resistance, weight gain, liver dysfunction.
What is the pathophysiology of PCOS?
- Multiple follicles develop but fail to ovulate, leading to ovarian cysts.
- Pituitary produces excess LH but insufficient FSH, leading to unbalanced follicle development.
- Increased testosterone disrupts sex hormone balance.
What are the key steps of infertility diagnosis in females?
- Full Patient History:
STIs, lifestyle factors, past oral contraceptive use.
- Family history of infertility. - Physical Examination:
- BMI, signs of pelvic infections. - Female Infertility Testing:
- Blood hormone tests (LH, FSH, estradiol, thyroid hormones).
- Chlamydia testing (major cause of tubal infertility).
What is the process of male infertility diagnosis?
- Semen analysis (sperm count, motility, morphology).
- Hormonal analysis if semen results are abnormal.
What are the current research areas in infertility?
- Investigating the global decline in fertility rates.
- Understanding environmental and lifestyle factors affecting sperm counts.
- Advances in ART (Assisted Reproductive Technologies).
- Studying PCOS mechanisms and treatment strategies.
