Lecture 16 - Infertility in women

Question 1

Women have two different types of infertility. What are the two different ways?

Answer 1

1. Anovulatory- Can’t ovulate properly = no pregnancy
2. Ovuatory- Ovulation happens but no preganancy because of implantation problems and block of fertilization.

Question 2

Women infertility: Anovulatory

PCOS

What is it?

Answer 2

• Polycystic ovarian syndrome: a set of symptoms
• Elevated LH levels; elevated androgens → Cause amenorrhea (abnormal absence of menstruation); hyperandrogenism(high levels of androgens); polycystic ovaries (prolonged menstruation)
• Obesity can be a factor

Question 3

If we get no estrogen, we do not get an LH surge for ovulation.

Not enough LH = No ovulation

So how do we get estrogen levels to rise?

Answer 3

Increase FSH, to get granulosa cells to make aromtase, then they make estrogen.

Question 4

To increase FSH levels where do we want to shut off estrogen receptors?

Answer 4

Want to shut off estrogen receptors in the arcuate nucleus(function: inhibits the release of kisspeptin→ reduction of GNRH, FSH, LH) with the use of clomiphene. Because the Central nervous system doesn’t think we are getting estrogen so it releases more GNRH→ more FSH and LH → more estrogen.

Question 5

What is a treatment for anovualtory (not ovulating): PCOS?

Answer 5

The goal is to increase FSH so we can get follicular growth and ovulation.

Clomiphene: It is a estrogen receptor inhibitor so that means we are getting less/no estrogen → more GNRH→ more FSH from granulosa cells→ more LH→ more estrogen.

• Downside: since we are blocking estrogen receptors everywhere, endometrium is thinner

Question 6

What is the first example of ovulatory infertility (can ovulate but still infertile) in women?

Answer 6

Block of fertilization because of tubual problems. This is often a result of (STDs); chlamydia being the most common cause of infertility in females.

Question 7

What is the second example of ovulatory infertility (can ovulate but still infertile) in women?

Answer 7

Implantation problems:

• This depends on embryo quality and endometrial thickness
• Issues with endometrial lining occcur when basal endometrium is compromised in its response to estrogen (not enough of estrogen)
• Implantation rates decline with female age

Question 8

What is the third example of ovulatory infertility (can ovulate but still infertile) in women?

Answer 8

Repetitive pregnancy loss:

When you suffer a pregnancy loss you are left with scar tissue. The scar tissue makes it harder to make another child.

Question 9

Another treatment for anovulatory infertile women that is often used with a IUI:

Answer 9

• FSH injections to stimulate more follicles.
• Leads to more estrogen and progesterone
• Often used with intrauterine insemination aka IUI (this is when semen is injected in the uterus near the oviducts)

Question 10

What treatment are we going to use if we have ovulatory infertilization?

Answer 10

In vitro fertilzation

Question 11

What is in virtro fertilization(IVF)?

Answer 11

Someone goes in through the vagina and gets to the ovaries in the oviduct→ manually stimulates the ovaries with FSH to produce many mature follicules→ then removes the ovaries from the person body→puts them on a dish with sperm so that the ovaries are fertilized→ them the embryo is put back into the uterus.

Question 12

Another type of in virto fertilization is called Intracytoplasmic sperm injection (ICSI).

What is it?

Answer 12

It’s for people with low sperm production.

Inject a single sperm into a ooctye.

Question 13

Other options for ovulatory infertillity:

Surrogacy and Gestational carrier

What are they?

Answer 13

• Surrogacy: another person (carrier) egg, partners sperm
• Gestational carrier: female user uses her own egg and partner’s sperm, but another person gestates the embryo/fetus