Infertility Flashcards
How is infertility defined? how does this vary by age and risk factors? what’s the first step in helping couples with fertility issues?
Inability for a couple to conceive after 12 consecutive months of trying without contraception in women under 35.
6 months 35-40
earlier if 40+
Earlier if known risk factors POF, endometriosis. Male impotence, sub fertility with another partner.
First step lifestyle: timed intercourse with the ovulation kit, stress reduction.
When is a woman most fertile? How might the woman’s cervical mucus indicate fertility?
5 days prior to and the day of ovulation
Mucus will be clear and slippery
How would you advice couples to time their intercourse based on ovulation predictor kits, high sperm count etc?
Sex every other day will keep the sperm count high and intercourse 2-3x week after woman period ends will insure that intercourse will happen during the 6 day window of fertility associated with ovulation.
What lube do you use?
mineral oil based not KY or Astroglide b/c inhibit sperm motility
What’s the optimal BMI for woman to conceive and how much weight should a “normal” weight woman gain in a pregnancy?
18-28 BMI
27+ BMI 3x increased risk of anovulation
High BMI=high estrogen which inhibits GnRH and ovulation is affected.
25-35lbs
What’s unexplained infertility defined as? What are some potential explanations to this?
Absence of cause for infertility after 12 months of attempting conception despite a thorough eval.
Hostile cervical mucous Celiac disease implantation failure low sperm count etc
How do you manage unexplained infertility for women
How come a 16 BMI woman has trouble getting pregnant? What are some other consequences of low BMI? How do they relate to fertility?
Inadequate support for a fetus, not smart for the body to be pregnant in suboptimal conditions. Leptin is a hormone that can signal hypothalamus to secrete GnRH and FSH/LH directly; it’s found in adipose tissue. This signal will decrease in thin women.
Consequences- osteoporosis (esp caucasian women), b/c decreased estrogen; also Amenorrhea.
How do you council a woman with a BMI of 30 in maters of fertility? How might hormone therapy play into a woman obesity? How does this same BMI affect men?
Loose weight and likely fertility will return. Hormone therapy will also be more likely to succeed in a woman that’s not obese. May use metformin, or clomed
Men BMI 30 decrease testosterone. Increase peripheral conversion to estrogen
Which of the following is a bad choice for fertility?
1) 1 glass ETOH a day
2) 1 coffee a day
3) Hydrogenated oils
4) McDonalds Big Mac
hydrogenated oils
Drinking less than 2 cups of ETOH and coffee has not been shown to decrease fertility. Big Mac depends on BMI
Which of the following will decrease GnRH?
obesity PCOS stress Adrenal tumor all of the above
All of the above
obesity=leptin resistance
PCOS=leptin suppression by androgens
stress
Adrenal tumor=same as PCOS; suppression
What is insulins role in PCOS, and how does that interplay with androgens and obesity?
PCOS patients are often insulin resistant or diabetic. Insulin directly stimulates ovaries, stimulates SHBG decrease binding of testosterone; increasing free T, and stimulates pituitary to secrete LH which affects ovarian production of adrosteindione in theca cells. Increases in androgens cause increased peripheral conversion to estrone, and increased free T from SHBG. Estrone increases will increase their risk for endometrial carcinoma, and MI, but also causes neg feedback on the pituitary decreasing FSH, such that follicles in the ovary grow, but don’t produce estrogen and become atretic, cystic, and immature. Finally obesity stimulates leptin which stimulates GnRH and FSH/LH.
How do OCP help with PCOS, isn’t it strange to give this to an infertile woman?
Estrogen will increase Leptin which can stimulate hypothalamus and pituitary and progesterone will help stimulate ovulation.
How would the pituitary respond to damage to sertoli cells, or leydig cells?
Increase FSH-sertoli cell damage spermatogenesis prob
Increase LH-leydig cell damage testosterone prob
You notice one of your patients testicles is unusually small, he also has ED and decreased libido. What could you reasonably assume is impaired within the testicle?
Spermatogenesis b/c 80% if testicular size is related to sperm production
Most male infertility is due to what three things?
Testicular dysfunction
post testicular defects
and HPO axis: pituitary infarction, portal circulation interruption, inhibition of GnRH. Surgical therapy of macro adenoma or craniopharyngioma, psychotropic drugs, and GnRH agonists.
What hormonal excess can cause hypogonadism in men?
hyperprolactinemia, hypercortisolism, excess estrogen or androgens (leptin suppression), from steroids or adrenal tumors
You have a masculine looking man come in c/o infertility. He works out at the gym regularly has a hot wife and is in his late 20s. His sperm count is low and LH levels are low also. What are you suspicious of?
Testosterone supplimentation/steroids, or tumor
Serum free testosterone is inversely related to what?
BMI
