infertility Flashcards
what Is the requirement for fertility?
- production of normal sperm
- production of normal eggs
- sperm traverse the female tract to reach the egg (capacitation)
- sperm penetrate and fertilise the oocyte
what Is the clinical definition of infertility?
- failure to conceive after regular unprotected sexual intercourse for 2 years in absence of unknown reproductive pathology
what are the factors which affect females?
- ovulatory disorders
- disorders of the female tract
- implantation, growth and development
list some disorders of the female tract
- tubal obstruction–> consequence of pellucida;vic infection (STIs)–> scarring and adhesions in uterine tubes
- endometriosis –> ectopic growth go endometrial tissue in sites such as uterine tubes, ovaries or peritoneal cavity
how can these female tract disorders be diagnosed?
- HSC , HyCOsy and laparoscopy imaging techniques
what is a bicornate uterus?
- congenital anomaly
- uterus is divided
- partial or incomplete
- surgical removal
what are uterine leiomyomas?
- these are benign smooth muscle tumours driven bu estrogen production -> common in obese people and during the menopause
- develop within the uterine wall
which processes can male disorders affect?
- production of spermatozoa
- transport of spermatozoa through the male tract
- transmission to the female tract
- sperm function in female tract
how are male problems diagnosed?
- through semen analysis or some via blood analysis to look at T, FSH and LH levels
- if no sperm levels –> genetic screening for Klinefelter syndrome
if a patient is azoospermic ?
- there is no sperm in the ejaculate
list some disorders affecting sperm production
- genetic disorders –> Y chromosome deletions
- deletion of AZF region (severity depends on deletion)
- cryptorchidism -> reduced spermatogenesis and increased risk of testicular cancer
what prevents transport of sperm into the male tract?
- obstructive azoospermia (stops sperm reaching ejaculate) vs non-obstructive (sperm can reach
- post infection
- bilateral or vas deferens occlusion
- congenital absence of the VD (CBAVD)
what is CBAVD?
- improper development of the VD
- thick mucus production
- impairs sperm transport in male tract
- linked to CFTR mutations
how can failures in transmission of sperm occur?
- erectile dysfunction (1 in 10)
- ejaculatory dysfunction (retrograde ejaculation and defects in accessory glands)
what happens during a normal ejaculation?
- Contraction of musculature of prostate, seminal vesicles and vas deferens => seminal fluid and sperm => urethra = emission
- Contraction of urethral and pelvic floor musculature => ejaculation
- Urethral sphincter closes bladder neck –> prevents urine ejaculation –> diabetes
what occurs during retrograde ejaculation?
· Incompetence of urethral sphincter
• Ejaculation into the bladder
• Ejaculate volume nil or low
• Confirmation in urine sample–> sperm presence
what is assisted conception?
- any technique which assists conception but does not cure the infertility
why give clomiphene:?
- is an oral anti- estrogen
- removal of inhibition on HPG axis
- ## allows for increased FSH Levels
what is IUI?
- injection of prepared sperm into uterine cavity
- must be washed as seminal plasma contains pGs which causes contractions
why have IUI?
- if unable to have sexual intercourse
- need sperm washing
- in a same sex relationship
- allows bypassing of cervical mucus
- perfect timing stimulated or natural
- non-invasive
when do patients undergo IVF? (in vitro fertilisation)
- major
- failed ovulation induction
- failed IUI
- tubal obstruction
- unexplained infertility
what is ICSI
intracytoplasmic sperm injection –> injection of sperm into oocyte
- 50,100,000 sperm added and left to F
why can we use both GnRH agonists and antagonists ?
- agonist there is initially a stimulatory flare followed by down regulation of GnRHR –> suppression of gonadotrophin release (take longer as there’s a flare first)
- antagonists -> immediate suppression of G release (are immediate acting)
what are the risks associated with IVF and ICSI?
• Multiple pregnancies
• Very invasive for woman
• Ovarian Hyperstimulation Syndrome (OHSS)
○ excessive response to fertility drugs
○ multiple follicles produce VEGF – vascular
permeability – fluid accumulation in the
peritoneal/thoracic cavity
○ occasionally fatal
• Risk of congenital abnormalities/long-term maternal risks, imprinting disorders
• Inheritance of male infertility
when do we have to use donated sperm/oocytes?
• Severe male factor infertility
• Premature ovarian failure, surgical loss of ovaries, poor
oocyte quality (maternal age)
Either/both partner carrier of heritable disease
what is PGD used for?
- preimplantation genetic testing
- removal of one or two cells from early embryo for genetic analysis
- sex -linked diseases, translocations and single gene disorders such as Huntington’s
