INFERTILITY Flashcards
definition of infertility
failure to conceive (regardless of cause) after 1 year of unprotected intercourse in women less than 35 years of age, and after 6 months in women 35 years and older
Infertility = failure to conceive (regardless of cause) after ______ of unprotected intercourse in women less than _________ of age, and after _______ in women older than _____
1 year in women < 35 years
6 months in women 35+
the probability of achieving a pregnancy in one menstrual cycle
fecundability
Studies demonstrate that the large majority (80 to 90 percent) of apparently normal couples will conceive within the
first year of attempted conception
LIFESTYLE FACTORS ASSOCIATED WITH INCREASED RISK OF INFERTILITY
- Environmental and occupational (radiation, exposure to heavy metals)
- Toxic effects of
⦁ Tobacco
⦁ Marijuana - Excessive exercise
- Inadequate diet
- Extreme weight loss or gain – increased BMI
- Advanced age
- also with work shift fluctuations
FACTORS ASSOCIATED WITH FERTILITY
⦁ Male factor—26% ⦁ Ovulatory dysfunction—21% ⦁ Tubal damage—14% ⦁ Endometriosis—6% ⦁ Coital problems—6% ⦁ Cervical factor—3% ⦁ Unexplained—28%***
most common factor associated with fertility
unexplained**
then male factor….
⦁ Fecundability rates ________ in younger women
⦁ Fecundability rates _______ in older women
higher in younger women
lower in older women
Counseling a 40 y/o women to wait a year before seeking fertility services is inappropriate
she already doesn’t have much time; don’t waste more time by telling her to try another few months to a year…go ahead and refer to fertility clinic
FEMALE FACTORS CAUSING INFERTILITY
- Cervical: stenosis, scarring or abnormality of mucus-sperm interaction
- Uterine: congenital or acquired defects may affect the endometrium or myometrium
- Ovarian: ovulatory dysfunction = an alteration in frequency & duration of menstrual cycle
- Tubal: abnormalities or damage to fallopian tube; congenital or acquired
- Peritoneal: anatomic defects or physiologic dysfunctions (ex: infection, adhesions, adnexal masses)
oligoovulation =
anovulation =
infrequent ovulation
absent ovulation
Infrequent ovulation (oligoovulation) or absent ovulation (anovulation) results in infertility because an oocyte is not available every month for fertilization.
WHO CLASS I
low FSH & low estradiol
due to decreased hypothalamic secretion of GnRH or pituitary unresponsiveness to GnRH
WHO CLASS II
normogonadotropic normoestrogenic anovulation = normal amounts of GnRH and estrogen, but FSH secretion is subnormal.
PCOS is class II - some ovulate occasionally
WHO CLASS III
hypergonadotropic hypoestrogenic anovulation = premature ovarian failure - either due to early menopause –> absence of ovarian follicles, or ovarian resistance. GnRH is high, estrogen is low
Hyperprolactinemic Anovulation
hyperprolactinemia inhibits GnRH and therefore estrogen secretion is inhibited.
age & ovaries
- female age = important factor in infertility; as the quantity & quality of oocytes decreases with age
- females are born with 1-2 million viable ovarian follicles. These follicles decrease with age; by puberty, about 300,000 follicles remain
- as the woman ages, the remaining oocytes left are of poorer quality
primary cause of tubal factor infertility
PID**
