Infertility Flashcards
What is the definition of infertility?
- Inability of a couple to achieve a clinical pregnancy within 12 months of beginning regular unprotected sexual intercourse
What is primary infertility?
No previous pregnancies
What is secondary infertility?
A couple have previously had a child but now can not
What is fecundability?
The percentage of women exposed to the risk of pregnancy for one menstrual cycle who will subsequently produce a live born infant (Normal 15-28%)
At what age do fecundity rates begin to decrease?
- Small but noticeable decrease at age 31, more pronounced at age 36 and very steep at 40
What are the main categories for the causes of infertility?
- Ovulation disorders (25%)
- Male factors (25%)
- Tubal factors (15%)
Different book says
- Female (65%)
- Male (20%)
- Other (15)
In men who have had infection to the testis or epididymis or who have had reversed vasectomies what may you be more concerned about regarding fertility?
- Antisperm antibodies
What is the chromosomal abnormality found in Turner syndrome?
- 45,XO
What is the pathophysiology behind weight-related anovulation
a) low weight
b) high weight
a) A minimum percentage of body fat is required to maintain ovulatory cycles (typically 22%ish)
- weight reduction leads to disappearance of normal 24h secretory pattern of GnRH resulting in anovulation
b) Overweight - likely due to excess androgen from adipose tissue converting androgens.
- Interferes with normal feedback mechanism in pituitary
What is luteinized unruptured follicle syndrome?
- occurs when the oocyte is retained following the luteinizing hormone surge
- No studies have been done longitudinally to show if this is longstanding or recurring or if affects fertility
What are some symptoms that would make you concerned about hyperprolactinemia?
- Galactorrhea (10-15%)
- Bitemporal hemianopia (if pituitary adenoma)
What are the gonadotrophins?
- Luteinizing hormone
- Follicle stimulating hormone
What is the mechanism behind anovulation in hyperprolactinemia?
- High levels of prolactin inhibit the release of gonadotrophins (LH and FSH) which are required for ovulation to occur
Name 3 methods of determining if ovulation is occuring in a female
1) History: over 90% of women with regular menstrual cycles will ovulate spontaneously
2) Urine LH kit: Urine test which can pick up the mid-cycle LH surge that leads to ovulation
3) Mid-luteal (7-10 days before next cycle) progesterone level: Progesterone is produced by corpus luteum. Therefore levels over 28
Explain how basal body temperature can be used to test for ovulation? What temperature change are you expecting?
- After ovulation the corpus luteum produces progesterone
- Progesterone is pyrogenic and increases body temperature which can be monitored
- 0.5 degree Celsius change after ovulation and during luteal phase