Infertility Flashcards
definition of infertility by insurance companies
inability to achieve pregnancy after one year of unprotected intercourse
infertility statistics
- 8 mil couples in the US affected
- 1 in 8
- 12% of reproductive age pop
what causes infertility? in a general sense
-disruption of any of the developmental steps between gametogenesis and implantation
ratio of male to female infertility problems
1:1
causes of ovulation defects 5
- changes in GnRH from the hypothalamus
- reduced FSH and LH from the anterior pituitary
- stress and extreme athletic activity
- eating disorders
- thyroid and adrenal hormonal imblances
Polysistic Ovary Syndrome
- symptoms
- problems
- statistics
- excessive growth of face and body hair due to increased androgen hormones
- irregular ovulation and involution
- increased LH relative to FSH
- most common hormonal disturbance in women of child bearing age (1 in 10 in this age group)
abnormalities of the female reproductive tract
- anatomical abnormalities can interfere with transport of the gametes or embryos or blastocyst implantation
- common examples include: endometriosis, chronic pelvic inflammatory disease, tubal obstruction, uterine abnormalities, usually fibroids
types of uterine abnormalities
- uterine fibroids (leiomyomas)
- congenital uterine developmental anomalies (mayer-rokitansky-kutser-hauser syndrome)
- excessive scar tissue (ashermans syndrome)
- excessive scar tissue from STI’s
most male infertility causes
- azoospermia: no sperm cells
- oligospermia: few sperm cells
causes of abnormally low sperm number and low sperm function
- hormonal abnormalities (HPT axis)
- abnormally high testis temperature caused by varicocele in the scrotum (dilated internal spermatic veins)
Aging and infertility in women
- advanced age is the leading risk for infertility in women in the US (over 35)
- by age 40, over half of the ovulated oocytes are aneuploid and unable to support normal embryonic development
- in some women, these losses occur earlier and cause premature ovarian failure (menopause before age 40)
aging and infertility in men
-recent data suggests that men over 50 are more likely to have children with autism and certain other conditions
success rate of IVf is
similair to normal fertile population until mid 30’s
unexplained infertility
-approximately one third of couples go through infertility treatment and are diagnosed with this
first step in treating/diagnosing infertility
-determining whether it is explained or unexplained
when do you do surgery?
- endodetriosis
- ashermann’s
- fibroids
- fallopian tube defects
- varicoceles in males
when do you prescribe FSH?
-if its PCOS
if the sperm are immotile, what do you do?
IVF using ICSI
if the couple has no trouble getting pregnant but the woman has miscarriages, what do you do?
-prescribe progesterone
When do you prescribe GnRH therapy?
-if a defect in GnRH production is found
-if the woman has gone throuhg menopause, what do you do?
-donor egg IVF and adoption
if the infertility is unexplained…
- consider the age of the women first
- if she is young, you would ideally start with clomiphene treatment, probably with IUI, and go on from there to add in more complex, expensive, and invasive treatments if it does not work
- if she is over 35 then going straight to IVF would be the best choice as the fertility of your patient will rapidly decline with time
fertility drugs
- colmiphene citrate
- human menopausal gonadotropins (FSH and LH)
- FSH
- GnRH
- hCG (LH mimetic)
clomiphene citrate
- inexpensive, orally administered
- blocks estrogen receptors in the hypothalamus
- used to regulate ovulation or induce ovulation in women who are anovulatory
