Infertility Flashcards
Clinical definition of Infertility
inability to achieve a pregnancy after 1 year of normal relations.
sperm problems
low sperm count, Poor sperm movement, odd sperm shape
Low sperm count causes
Decreased since 1930s due to environmental estrogens.
Blockage of ducts (Male)
Prevent sperm transport and addition of seminal fluid
Hormonal disorders
Low hormonal levels, high levels of fertility suppressing hormones
Reproductive blockages (Female)
thick cervical mucus, scarring in uterine tubes
Seminal evaluation
testing qualities of semen to evaluate number/mobility/morphology of sperm
Ovulation induction
A chemical is used to stimulate ovulation
Intrauterine insemination (IUI)
introduction of semen into female’s uterus.
Success of IUI
Twice as successful as normal intercourse, has impregnated single women and lesbians
In vitro fertilization (IVF) steps
- Stimulation of oocyte production
- Removal of multiple oocytes
- Collection of sperm
- Combining sperm and oocytes
- Embryo preservation
- Embryo transfer
Stimulation of oocyte production
multiple oocytes are stimulated to develop
removal of multiple oocytes
ovulation is suppressed, oocytes are removed
collection of sperm
usually occurs through masturbation. Sperm (and oocytes) can be stored and frozen for multiple years. Sperm are “washed” and capacitated.
Washing of sperm
seminal fluid, abnormal sperm, pathogens removed
combining sperm and oocytes
sperm deposited in general area of oocytes. Sometimes injected with ICSI. Many oocytes are fertilized.
Intracytoplasmic sperm injection (ICSI)
injection of sperm into cytoplasm of oocyte.
Embryo preservation
Embryos develop until 8-cell stage, best are used, excess are frozen :(
Preimplantation Genetic Diagnosis (PGD)
removal of blastomere for genetic testing, Increases embryo death risk.
Embryo transfer
Movement of embryos to the uterine cavity. If one implants, IVF is successful
Surrogacy
transfer to a woman who did not contribute gametes
Gamete intrafallopian transfer (GIFT)
introduction of sperm and oocyte into fallopian tubes
Zygote intrafallopian transfer
introduction of a zygote in to the fallopian tube. Zygote is created using IVF. Transferred without testing
ART success rates
implantation is ~35% successful, so 3 deaths for each life. Not more successful than 30 year old surgery treatments.
ART Risks and limitations
multiple babies, premature birth, low birth weight, selective reduction, OHSS, preeclampsia, birth defects, ectopic pregnancy, does not reveal underlying reason for infertility.
selective reduction
abortion of conceptuses when multiples result from IVF
Ovarian Hyperstimulation Syndrome (OHSS)
Ovary is hyper stimulated. occurs due the ovulation drugs used.
Preeclampsia
high blood pressure in a pregnancy