L07: Fertility And Infertility Diagnosis And Causes Flashcards by selcan icli

What do you need to do to be fertile (to in males and females)

Produce sperm 
Produce egg 
Sperm should transverse female tract
Sperm has to penetrate and fertilise the egg
Implantation of embryo into uterus 
Normal pregnancy i.e no miscarriage

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What is the definition of fertility

Measure of actual outcome of the reproductive process- number of children born

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What is the definition of fecundability

Probability of pregnancy each month of an individual or population.

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What is the definition of fecundity

Measure to conceive AND produce a live birth

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What is the definition of infertility

Inability to conceive after a period of unprotected intercourse or inability to carry a pregnancy to term

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What does NICE say the definition of infertility is

Failing to get pregnant after 2 years of regular unprotected sex

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What is the definition of sub fertility

A state of reduced fertility

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What causes increase the risk of infertility

Age
Smoking
Obesity
STI’s

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Name and STI

Chlamydia

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What are the groups of diseases that can cause fertility problem in females

Ovulatory disorder
Tubal damage
Endometriosis
Uterine abnormalities

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What investigations can be carried out for a female patient presenting with fertility problems

LH/FSH ratio
Day 21 progesterone
Laparoscopy
Hysterosalpingogram (HSG)

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What does looking at FSH/LH ratio help us to look at

Ovarian reserve

PCOS

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What does day 21 progesterone help us to look at

If ovulation is occurring

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What is laparoscopy

Key hole surgery that allows to view the uterus

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What is hysterosalpingogram

Dye is inserted into the uterus and viewed with X-RAY

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What does hysterosalpingoram allow to detect

Blockage of tubes

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If there is no tubal blockage what happen to the dye

Spills into the pelvic cavity

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What can ovulation disorders present as

Ammenorhhea
Secondary ammenorhhea
Oligomenorrhea

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What are possible disorders that cause ovulation disorders

Idiopathic ovarian failure
PCOS
Luteinesed unruptured follicle syndrome
Abbreviated luteal phase

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What does the idiopathic ovarian failure result in

Oestrogen levels do not rise and follicles to not mature this results in small follicles

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What are the hormones like in PCOS

High FSH
High androgen
No oestrogen deficiency

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What is the abbreviated luteal phase hormone Satus like

Decreased progesterone

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What does decreased progesterone result in

Poor luteinisation

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What are the disorders that can occur in the female tract

Tubal obstruction

Endometriosis

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What can tubal obstruction occur as a result of

Infection

If the tube is blocked what becomes affected

The release of the egg The transport of sperm to the egg Due to loss of cilia and intraluminal cells and scarring that cause adhesion

What is endometriosis

When the endometrium of the uterus increases in ectopic sizes such as oviduct, ovary, peritoneal cavity

What are the maternal problems that can occur that affects fertility

Cervical incompetence Implantation defects Autoimmune Immunological incompatible in terms of ABO or rhesus blood group loci

What increases the risk of tubal infection

STD, eg gonorrhoea, chlamydia, tuberculosis

What is the biochemical test for testing for pregnancy

HCG in blood or urine

At what day do we test for HCG after the last period

18-30 days

How do we test for clinical pregnancy

Ultrasound at week 5 as a foetal sac

If we do an ultrasound at week 7 what would be visible

Foetal heart

What is the main cause of spontaneous pregnancy loos

Chromosomal abnormalities

What are the 3 categories that result in chromosomal abnormality

Translocation Errors of ploidy Errors of chromosome number or somy

What is errors of ploidy

Deletion or duplication of a complete set of haploid chromosome i.e from diploid to tetraploid

What are the errors of chromosome or somy about

Loss or gain of a single chromosome

What does aneuploidy mean

Having one or more chromosome above or below the normal chromosome number

What happens to the risk of aneuploidy as maternal age increases

Risk increases

Why is there an increased risk of aneuploidy with increased age

Egg quality decreases as egg can become damaged

What can be the causes of male disorders for fertility

``` Production of sperm Transport of sperm Motility of sperm Sperm function in female tract Fertilisation and events after ```

What tests should be done for a male with fertility issues

Semen analysis | Blood test

If a male has a sperm production of less than 5 million per ml what is required

Endocrine evaluation

What does normozoospermic mean

Normal sperm with: - more than 15 million spermatozoa - more than 32% motility - more than 4% normal morphology

What does oligozoospermic mean

Less than 15 million spermatozoa per ml

What does asthenozoospermic

Less than 32% of rapid and medium forward progressive motility

What does tetrazoospermic mean

Less than 4% of sperm with normal morphology

What does azoospermic mean

No sperm

Why can a patient be azoospermic

Congenital testicular deficiency e.g klinefelters syndrome XXY Maldescent testis i.e cyrptorchidism Acquired via trauma or mumps Endocrine disorder

What are the congenital acquired testicular deficiency that lead to azoospermic

``` Klinefelters syndrome (XXY) Y chromosome deletion ```

What can be the acquired causes of azoospermic

Trauma | Orchitis (MUMPs)

Apart from the basic analysis of sperm what other tests can we do on semen

``` Leukocytes Sperm viability test Sperm vitality Antisperm antibodies CASA ```

At what leukocyte level indicates infection

More than 1 million per ml

What does sperm viability test look at

Even though the sperm is not moving, is it still alive

What are the causes for failure of transmission of sperm to the female tract

Erectile dysfunction | Ejacgulatory dysfunction

What are the 2 forms of ejaculatory dysfunction

Retrograde | Defects of accessory sex glands

Describe the normal process that occurs in normal ejaculation

1) prostate, seminal vesical and vas deferens contracts under the influence of SNS 2) seminal fluid and sperm enter the urethra 3) urethral and pelvic floor muscles contract and ejaculation occurs 4) vesicular urethral spinchter closes bladder neck

What is retrograde ejaculation

1) the urethral spinchter at the bladder neck does not close 2) ejculaton is into the bladder 3) so the sperm is low or nil

What are the associated conditions with retrograde ejaculation

Diabetes Post traumatic paraplegia Post bladder neck surgery

How is retrograde ejaculation confirmed

Semen in urine

What are the causes of total failure in transport of sperm

Infections | Congenital bilateral absences of vas deferens (CBAVD)

What is CBVAD linked to

Cystic fibrosis

What occurs in CVAD

Improper development of the vas deferens

It there is no obstruction in the male tract but patient is azoospermic or oligozoospermia what need to be tested

Genetic testing for chromosomal abnormality

What is the definition of unexplained infertility

- normal frequency of unprotected intercourse - no obstruction or malformation of female/male tract - normal follicle growth and ovulation and no signs of inflammatory reactions in female - normal motile sperm and no signs of inflammatory reactions in males

What does high levels of FSH/LH indicate

Low ovary reserve as there is no negative feedback

What does low levels of LH/FSH indicate

Pituitary and hypothalamus pathology

In PCOS why is there higher levels of LH

LH stimulates theca cells to produce testosterone

Why are there normal levels of oestrogen in PCOS

1) there is normal levels of FSH | 2) FSH acts on granulosa cells to produce aromatase which converts the testosterone into oestrogen