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Repro 313 > Lecture 12; Infertility and Assisted Reproductive technologies > Flashcards

Lecture 12; Infertility and Assisted Reproductive technologies Flashcards

1
Q

How many couples are affected by infertility?

A

1 in 6

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2
Q

Define infertility;

A

WHO;

- Failure to concieve following one year of unprotected intercourse

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3
Q

Define subfertility

A

Failure to conceive after 6 months of unprotected intercourse

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4
Q

Define fertility and fecundity;

A

Fertility: Production of offspring

Fecundity; Ability to concieve

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5
Q

What are the male factors of infertility?

A
  • Semen analysis
  • Blood, hormones
  • Physical exam (testis)
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6
Q

What is examined in semen analysis?

A

WHO analysis

Volume
Density
Motility
Forward progression
Morphology
Leucocytes
Agglutination
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7
Q

What do studies of men considered fertile vs general population show?

A

That some men who according to WHO definition are infertile, are perfectly fertile in reality, i.e low count, volume, etc

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8
Q

What can affect spermatogenesis?

A

Endocrine imbalances

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9
Q

What are some endocrine imbalances that can affect spermatogenesis?

A

Kallmann syndrome (Hypogonadotrophic hypogonadism)

Hyperprolactinemia (also inhibits spermatogenesis)

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10
Q

Write some short notes on Kallmann syndrome;

A

Kallmann syndrome (Hypogonadotrophic hypogonadism) ;

  • delayed puberty and lack of sense of smell (anosmia)
  • Fix with administration of GnRH (hypothalamic defect)
  • 1 in 10,000 males
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11
Q

How can the immune system affect male fertility?

A

Mumps orchitis affects fertility as immune response damages structures

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12
Q

Write some short notes on mumps orchitis;

A
  • Mumps orchitis only occurs after puberty
  • Bilateral in 25% of affected men
  • The inflammatory response results in swelling and oedema which can cause vascular occlusion leading to ischemia and loss of spermatogenic potential. (b/c tunica albuginea doesnt distend)
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13
Q

Does male age influence fertility?

A

Nope

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14
Q

Does female age influence fertility?

A

Yes, 37+ there is significant decline in fertility rates.

Female age matters, designed to be most fertile in young 20s

Societal info shows maternal age increasing but this is problematic as fertility for females declines with age

IVF age increasing too

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15
Q

What is a current prevalent cause of anovulation?

A

Exercise induced oligiomenorrhea

Estimated that 22% body fat is required for female fertility. When it drops below this = ologiomenorrhoea

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16
Q

What percent body fat is suggested to be necessary for pregnancy?

A

22% body fat is required to support pregnancy so women with less body fat than this may have an evolutionary disadvantage.

17
Q

Why does low body fat result in anovulation?

A

Adipose tissue contributes to 1/3 of womens oestrogen.

Thus a reduction in body fat, may lead to reduced oestrogen, which can reduce the first oestrogen peak and thus LH surge.

Obesity is also associated with anovulation especially those with PCOS

18
Q

Write some short notes on PCOS and anovulation;

A

PCOS

  • Major cause of anovulation
  • Ovarian cysts
  • Elevated LH / LH:FSH ratio
  • Elevated androgen levels
  • hirsutism / acne / obesity
19
Q

Does BMI influence fertility?

A

Pregnancy outcomes decline with increasing BMI

i.e fat = increased still births, miscarriages etc, not just PCOS

20
Q

What are some anatomical characteristics that can affect fertility?

A

Tubal Blockage

Endometriosis

21
Q

Write some short notes on fertility and tubal blockage

A

Tubal blockage = reduced fertility
- Impaired sperm and ooctyte transport

Causes i.e

  • Salpingitis (inflammation of uterine tubes)
  • This could result in permanent fluid filled blockage (hydosalphinx)
22
Q

What can be used to image the uterine tubes?

A

Hysterosalpingogram (HSG)

23
Q

How can HSG actually be a therapy?

A

HSG
- The lipiodol dye used was found to actually enhance fertility by altering murine uterine dendritic cell populations (immune response, important for implantation)

24
Q

Write some short notes on endometriosis?

A

Endometriosis
- Expansion of endometrium outside of the uterus into the tubes, ovaries or peritoneal cavity

  • Idiopathic
  • retrograde mensturation?
  • Infertility as adhesions of tubes
25
Q

What is endometriosis associated with?

A

Painful periods, adhesions and sub fertility

26
Q

Whats a immune response that could reduce fertility?

A

Antisperm antibodies

Found in males and females

27
Q

Why are antisperm antibodies found in males?

A
  • Normally sperm is separated from the male immune system by the blood-testis barrier
  • Immune exposure may occur following testicular trauma or vasectomy, sperm are considered antigens and antisperm antibodies are produced.

90% have antibodies following vasectomy

28
Q

Describe female antisperm antibodies;

A

Most women do not produce antisperm antibodies even following vaginal exposure

Some do though, and this may reduce fertility.

29
Q

What particular antibody in famales affects sperm?

A

IgA antisperm antibodies in particular have been shown to inhibit the ability of sperm to penetrate cervical mucous

30
Q

Whats the incidence of antisperm antibodies and infertility?

A

up to 15% of infertile couples have antisperm antibodies as do 5% of fertile couples

Thus it is unknown if antisperm antibodies are actually problematic. A problem is the tests used to diagnose the antibodies

31
Q

What is the problem with antisperm antibody tests?

A

Most common test;

  • MAR mixed agglutination test
  • IBT immunobead test
  • Both detect agglutination, showing antibodies ON sperm
  • Do not detect the antigens the antibodies bind to
  • Thus it is possbile that some epitopes (antigens) on sperm may have no affect on fertility or if i.e ZP3 may have their action blocked by antisperm antibodies thus infertility

Repro 313 (20 decks)

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