Infertility Flashcards
Define infertility?
Failure to conceive after 12 months of unprotected sex
What is a normal (lower limit) ejaculate made of?
15 million/ml 1.5 ml 40% good motility sperm 39 million in ejaculate 4% normal sperm.
What would you look at for women fertility?
1) Ovulation: Regularity of period. Progesterone levels at day 21 and estrogen at day 12 FSH at days 2-4 anti-mullerian hormone
Timing of intercourse
STIs
Causes of anovulation and what are some treatments to stimulate ovulation?
Obestiy or annorexia.
Treatment:
Weight gain or loss.
GnRH
FSH
Clomiphene citrate - selective estrogen modulation (makes brain think there is less estrogen)
Letrazole - aromatase inhibitor (prevents the conversion of androgens to estrogen = brain produce more FSH)
What is Polysystic ovarian syndrome and who does it affect?
Has many follicles in the ovary, medium size follicles an large ovaries.
Affects 10% of women.
Infrequent or no periods
Metabolic syndrome - overweight
Increased androgens - alters apearance
Treatment: Weightloss Letrazole Metformin IVF
What tubual disease can cause infertility?
Cyst, tumour, adhesions that block the fallopian tube.
Treat: IVF, surgery to fix the tube
What is the treatment for infertility caused by cervical problems?
Treatment: Intrauterine insemination
Treatment and symptoms of edometriosis
10% affected (30% infertile)
Painful
Treatment: hormonal contraceptives, ablation surgery
How would you makes someone with premature menopause or rising FSH and decreasing AMH pregnant?
Treat with donor egg (IVF)
Time lapse photography?
Takes a photo every 10 minutes of the embryo. Can follow development to determine if it is normal.
What is oligospermia and how do you treat?
Low sperm count
Treat by taking a single sperm and inseminating an egg (intracytoplasmic sperm injection [ICSI]) or donor sperm
What is Oligoasthenoteratosperima (OATS)?
Low concentran, slow moving, abnormal form (3 defect)
Treat with intracytoplasmic sperm injection (ICSI) or donor sperm
What is azoospermiaand how do you treat?
No sperm
Causes: No GnRH - no FSH/LH. No spermatogenesis. Obstructive - vasectomy Congenital vas deferens absence.
Treatment:
Donor sperm
Testicle aspiration of sperm then intracytoplasmic sperm injection [ICSI]
Surgical removal of sperm
Fine needle taking fluid from the epididymis (1st try) or tissue from testis (2nd attempt).
Take a larger chunk if that doesn’t work.
Milk the seminephrous tubules.
What are the steps involved in intracytoplasmic sperm injection?
Select sperm with normal motility and morphology Immobilize sperm Aspirate sperm tail first Position sperm in needle. Suction pipette Insert needle into egg Rupture egg cytoplasm by aspiration Expel the sperm
What are some treatments for unexplained infertility?
Usually associated with age or a problem at the sperm and ovary level.
Mild ovarian stimulation and intrauterine insemination
IVF
What can you check to see implatation rate for IVF?
AMH - high means polysystic ovaries and high ovarian reserve
Preimplantation genetic screen analysis of embryos at day 3. Cut hole in zona and allow the cells to herniate out the hole. Take 4-5 cells and do gen seq.
Why is age associated with infertility?
Eggs age. Associated with an increased aneuploidy (number of eggs with chromosomal abnormalities) and the implantation rates decrease.
What are the steps of IVF?
1) Stimulate follicle production with hormone therapy.
- FSH stimulates the ovary and GnRH antagonists prevent ovulation.
Measure the size of the follices with ultrasound, looking for 3 lead follicles of 18 mm. When follicles have grown sufficiently then want to trigger maturation of the follicles with HCG or GnRH.
2) Remove the eggs from the ovary
- Vaginal ultrasound with an attached needle. It goes through the wall of the vagina and into the ovary. Acquire follicle liquid.
Clean up the sperm sample
Combine for fertilization (just add together) and incubate
Culture and monitor the division before implantation.
Fertilized eggs placed in uterus.
Progesterone is provided for luteal support, which is essential. Prevents the advancing of the endometrium which can be caused by all the drugs required for follicle stimulation.
Embryo freezing
