Lecture 2 Flashcards
What is fecundity ?
Biological ability to bear children
-able to do it
What is fertility?
Actual production of children
-you are doing it, you are fertile
What is infecundity?
Biological inability o bear children after 1 year of unprotected intercourse
What is infertility?
Involuntary absence of production of children
-no timeline
What is sub fertility?
Decreased level of fertility
- > 12 months to conception or repeated early losses
- applies to people who have had multiple miscarriages
what us a miscarriage?
Spontaneous abortion
-up to 20 wks, anything after is a still birth
How many couples experience infecundity in canid?
1 in 6 fail to conceive within 1 year of attempting pregnancy
-doubled since 80’s
Do couples who can conceive in one year use fertility treatments?
44% of couples who qualify as infertility will go on to conceive without fertility treatment
healthy couples have 20-25% chance go pregnancy within given menstrual cycle
What are the reasons for infertility?
Males and females separately but if there is a couple and both have problems then there is an issue
What is the fertility rate equation?
#births/per 1000 females of childbearing age -age 15-44
What is the trend in fertility rates over the years in canada?
High when the men came back from the war (Boomers) and slowly decreasing since then
Why are we seeing fewer children and older moms?
- Women going to school
- Divorce in previous generation makes current generation more cautious
- Desire to be financially stable before having a child
What are the symptoms of miscarriage?
- Vaginal bleeding
- Passing clots and tissue
- Abdominal pain
- Pregnancy symptoms disappear
Who do you go to if you have a miscarriage before and after 20wks?
Before: Emergency room
After: OBGYN
What can arise as a side affect of a miscarriage?
Infertility
Emotional and physical strain
If you have a miscarriage when should you wait to become pregnant?
3-6 months to become pregnant again
-because you lost a lot of blood and Fe stores
What are some of the causes of miscarriages?
- Severe defect in fetus (most frequent, eggs or sperm of low quality)
- Maternal infection (UTI, influenza)
- Structural abnormality of uterus (tilted)
- Endocrine or immunological disturbances (progesterone surge doesn’t happen/Thyroid too high/low)
- Other unknown random events (dehydration/flying)
What is a stilbrith?
Death before complete expulsion from the mother >20 weeks gestation
- fetus doesn’t breath or have a heartbeat
- baby passes away inside of mom or during birth
What do we tell women to limit to decrease their chances of miscarriage?
Bath
Activities that raise the core temperature
What is an abortion?
Termination of pregnancy <500g or <20weeks pregnancy
What is the abortion rate equation?
abortion/1000females of childbearing age
What is the reproduction physiology at birth for male and female?
Female: Immature ova (primordial follicle) eggs produced and stored in ovaries
Male: Sperm producing capabilities but not actually starts until puberty
What happens at puberty interns of reproduction physiology?
Capacity of reproduction established
-hormonal changes lead to maturation of reproductive system
What is the purpose of the menstrual cycle?
Prepare ovum for fertilization
Uterus for implantation
What are the 2 phases of the menstrual cycle?
Phase 1: follicular cycle
Phase 2: Luteal
In the follicular phase what happens to estrogen?
Stimulates hypothalamus to secrete GnRH
What does GnRH do?
Causes pituitary gland to release:
- FSH: increases estrogen production by follicle and stimulates maturation
- LH: Stimulates release of ovum and progesterone by follicle
- -estrogen and progesterone stimulate preparation of uterus
In the luteal phase, what happens after ovulation?
Follicle left a corpus lute which secretes progesterone and estrogen to decrease GnRH, thus FSH and LH; increase endometrium development
What happens if the ovum is or is not fertilized?
Not: There is a decrease in corpus lute secretions which leads to menstruation
Yes: Egg signals corpus lute to increase estrogen and progesterone secretions
What is the reproductive system like in males?
Hypothalamus secretes GnRH which releases FSH and LH by pituitary
- LH triggers secretion of testosterone by testes
- Testostreone and FSH stimulate maturation of spem
- Sperm stored in epididymis
Is sperm more important at the time you are trying to get pregnant or 3 months prior?
3 months prior
What are sources of disruption in fertility?
- Hormones regulating fertility (GnRH, FSH, LH)
- Presence/length of luteal phase (miss the window)
- Sperm production
- Implantation
- Tubular passageways for ova/sperm to travel are blocked
What does the government fund in terms of fertility?
drugs that stimulate ovaries to stimulate more follicles
IVF covers 1 live birth
What are the factors related to impaired fertility?
- Endocrine abnormality (Mostly female- hypothyroidism)
- Unknown causes (1/2 of cases)
- Adverse nutritional/environmental exposures
- Contrceptive use
- Severe stree
- Infection
- Structural problems: tubal damage
- Chromosomal Abnormalities
- Underweight
- Sexually transmitted infections
- Endometreosis
What are nutrition related disruptions in fertility?
Decrease fertility is related to nutritional status:
- undernutrition
- Wt loss (too fast or genetic predeposition)
- High activity levels
- Intake of dietary components modifying hormone levels
- Obesity
Generally, temporary decrease in fertility
Amenorrhea
What is amenorrhea?
Absences of >3or more consecutive menstrual cycles
What is the different between acute and chronic undernutrition?
Acute
- clearly decrease fertility
- Famine period associated decrease birth rate
- decrease hormones regulating fertility
Chronic
- Primary effect= small/frail infants increase likelihood of death
- Small decrease fertility
In terms of body Wt, fertility is lower in…?
UnderWt: BMI <18.5
Obese: BMI >30
What in terms of body Wt may result in fertility decline?
Decrease body fat content may play a role in fertility decline because:
- Fat produces estrogen
- Estrogen stimulates hypothalamus to secrete GnRH
What happens to infertility in women when there is a Wt loss of 10-15% of usual Wt?
Decrease estrogen concentrations in normal wt women
What are the consequences of rapid wt loss?
Hypothalamic amenorrhea
Anovulatory cycles
Short/Absent luteal phase
What are 30% of infertility cases related to?
Simple wt loss
How do you treat wt loss?
Increase wt within 95% of previous wt
-hormonal concentration return to normal
Hormonal therapy
-increases risk of small for gestational age infant compared to underweigtht women who gain wt
what kind of physical activity has an adverse effect on fertility?
Intense physical activity
Why are competitive female athletes more infertile?
Menarch delayed 2-4 years
40% have abnormal cycles
What is the likely cause of hormone and metabolic changes?
Overal calorie deficit
What is the female athlete triad?
Disordered eating
- low BW
- inadequate caloric intake and high PA
Mentrual irregulatieis
-low estrogen levels causes decrease GnRH
Low bone mass
- low estrogen levels cause decrease in bone Ca retention
- increase risk of stunting/osteoperosis
What is the triad?
Amenorrhea
Eating disorder
Osteoperosis
Do you need to have an eating disorder to have the triad?
No, just non regular eating that is unbalanced qualifies
What should you do interns of your diet to prepare for pregnancy?
Requires establishing healthy habits
Maintain healthy body weight
Healthy eating habits prior to pregnancy support health pregnancy
What does pre pregnancy body weight influence?
Maternal health
Fetal development
What problems do over and under weight moms and newborns face?
Greater risk of health problems
Underweight
- low BW
- Premature birth
Overweight
- Large BW
- Pregnancy complications
What are maternal complication of having a high BMI?
Reduced fertility Impaired glucose tolerance and gestational diabetes Thromboembolism Hypertensive disorders of pregnancy Increased risk of miscarriage
What are fetal complications of high BMI?
Fetal congenital abnormalities
Fetal growth restricftion
Stillbirth
Increased risk of morbidity in later life
Can you exercise during pregnancy ?
Can continue exercising like you used to do but do not begin strenuous activity or anything new or that can hurt the baby
-make sure getting extra extra calories
What can physical activity do for your pregnancy?
Ensure appropriate weight gain
Improve muscle tone and strength
Build stamina for labour and delivery
Speed recovery
What do doctors say about smoking while pregnant?
Baby could have wuthfral symptoms if you stop so maybe not to quite complete but greatly reduce the amount
What dietary components indirectly impair fertility?
Soy isoflavanoids (hormone levels) Menstrual cycle irregularities Increase time it takes to conceive Probably interrelated effect Lack of antioxidants Alcohol, caffeine, heavy metals
Does soy effect everyone?
Can effect hormones in men and women and can either be beneficial or negative impacts
-also depends on the life stage as well
What things do women have to be mindful when eating?
Vegetarian diets
- decrease estrogen levels in N, under and overweight
- lengthens menstrual cycles
Low fat intake (less than 20% cals)
-lengthens menstrucal cycle
Caffeine
-300mg/day or 2 cups
Fe
-Poor Fe status may be associated with infertility
Alcohol
- May decrease estrogen by disrupting cycle
- age and genetics play a role
What are nutrients that affect fertility in males?
Zn Antioxidants Alcohol Intake Smoking Heat Steroid abuse Lead Mercury Cadmium Maganese Boron Colbalt Copper Nickle Silver Tin
Why is Zn status important in men?
Decreases semen volume and abnormal sperm shape
Decrease testosterone levels
Hypogonadism: decrease growth penis and development of testes
*not proven if supplements helps in absence of deficiency
Why are antioxidants important for males?
Helps protect sperm DNA from oxidative damage
Why is lead bad for men?
It can be inhale for ingested
- Affects pituitary gland
- decrease testosterone as well as sperm production and motility
What does mercury do for men fertility?
Decrease sperm count
How does heat affect fertility in men?
Increased temperature of scrotum and testes can decrease sperm count
How do steroids affect fertility in meant?
Multiple adverse effects of high doses
- testicle atrophy
- absence of sperm
- decreased libido
Does wt loss in males affect fertility?
Wt loss of 10-15% below normal weight will decrease sperm viability and motility
Wt loss >25% below normal weight, sperm production will ceases
and overall decrease in sex drive
What happens to male fertility if the lost weight is regained?
Sperm production and libiddo returns to normal
What can obesity in men lead to in terms of fertility?
- Increase erectile disfunction and scrotal temp
- Increase sleep apnea
- increase estrogen, insulin and leptin
- Decrease testosterone
- OOgliozoospermia
- Increase DFI (DNA fragmentation index)
What are the nutrition related side effects of oral contraceptives?
Increase:
- cholesterol, HDL, TG
- Risk of venous thromboembolism
- Blood copper
- Risk of cervical cancer
- CVD
Decrease:
-Blood concentrations of copper, folate, Vit B6/12
What are the nutrition related side effects of injection contraceptives?
Wt Gain (water)
Irregular period
Fatigue, Headache and and pain
Increase:
Blood LDL and insulin
Decrease:
Blood HD:
Bone density
What are the nutrition related side effects of contraceptive implants??
Erratic bleeding
Wt gain
Headache
*depends on place in body
What are the nutrition related side effects of contraceptive patches?
Increase:
- blood cholesterol and TGs
- Risk of blood clot formation
- HDL concentrations
Headache
Abdominal pain
what is the importance of optimal health and nutritional status before conception?
Within the first months of pregnancy:
- embryos basic organ structures form
- female do not know they are pregnant
- if mom is exposed baby is too
What % of pregnancies are unplanned?
50%
What are critical periods?
When there is an increase in cell size and number at the same time
-exposure to non-beneficial things at this time can have negative side effects
If you are underweight female what are your additional risks?
Increased:
- risk of complicated pregnancy
- risk of small and early born
If you are overweight female what are your additional risks?
Increased:
- risk of complicated pregnancy
- risk neural tube defects, excessive body fat
Babies can get used to a high glucose environment
what happens when you have too much vitamin a?
Too much intake of retinol and increase risk of facial and heart abnormalities
-teratogenic
What can high blood lead lead to in baby?
Increased risk of mental retardation
What can iodine deficiency result in?
hypothyroidism: reduced metabolic rate, fatigue, wt gain
Deficiency in pregnancy and result in cretinism in offspring
-developmental delay, deafness and growth failure
What can Fe deficiency lead to?
- Increased risk of really delivery and Fe deficiency in mom and baby
- Preterm labour
- Morning sickness
What happens when there is insufficiency folate intake?
Increased risk of neural tube defects (spina bifida and anencephaly)
-Defects develop very early, first 0-21 days (tube closes 21-28days)
If you take folate before pregnancy, how much does it reduce neural tube defects?
By 46%
-government mandatory fortification in 1998
What are the folic acid intake recommendations?
400micrograms before pregnancy
600 during
400-1000 during the remainder
What is fetal alcohol syndrome?
Alcohol related birth defects
Malformations (physical)
Mental and behavioural abnormalities
What is fetal alcohol effects?
Alcohol related neurodevelopment disorders
Mental and behavioural abnormalities abnormalities but no malformations
What increases your risk of diabetes?
High blood glucose levels early in pregnancy
How can diabetes affect pregnancy?!
Fetal malformations
Excessive size (macrosomia)
Offspring can have diabetes late in life
Decrease fertility is uncontrolled
What is the best preconception diet?
Diet adequate in nutrients
-Folate and Fe
Follow food guide
No access Vitamin A
What is the Ca RDA for women when pregnant, not pregnant and lactation?
1000mg/day
What is the RDA for folate?
19-50 400microgram
Pregnancy 600
Lactation 500
How much folate do we get from fortified foods?
200micrograms
What is the RDA for Fe?
19-50 18miligrams
Pregnant 27
Lactation 9
-assuming normal levels
Why is lactation Fe requirements lower than pregnancy?
While breastfeeding you arent menstruating, so no blood loss so our recommendations are similar to men
○ When bresfteeeding bodys hormones fluctuatee a lot and tell the body not to ovulate (when baby is feeding often
○ When introducing solid foods, baby starts to breastfeed less and the body thinks it can then support another babay and then ovulation starts again
Can beocme pregnant before the first menstruation
When does baby get its Fe stores form mom?
3rdT
-enough for up to 4 months
What happens if baby doesn’t get enough Fe?
cant come back from Fe deficiency as a baby during this time in utero, leads to neurological development delays
*Mom Fe deficiency is linked to preterm labour
What time of day produces the biggest signals for producing milk?
12-5 am biggest signals for producing milk, and. This is the time where women start to menstruate again
What is PCOS?
Polycyclic ovary syndrome
-leading cause of infertility
What are the symptoms of PCOS?
Insulin resistance
Increase blood insulin and testosterone levels
Obesity
Menstrual dysfunction, amenorrhea, infertility
Hirsutism
Acne
Why is PCOS bad?
Increases risk of:
- hypertension
- gestational and type 2 diabetes
- CVD
- Spontaneous abortion
What is the treatment for PCOS?
Weight loss and medicaition (metformin) to:
- -decrease insulin resistance, blood insulin, testosterone and BP
- Increase fertility
- Diet and exercise
How do you know If you have DM before pregnancy?
Increased glucose concentrations
-Teratogenic during first 2 months of pregnancy
Why is DM bad for pregnancy?
Increase risk of maternal and fetal complications
Increase rate of congenital abnormalities (birth defect)
- structural and functional
- metabolism
Why are eating disorders bad?
Low body fat leads to:
- irregular release of GnRH
- decrease estrogen
What is CPNP?
Canada prenatal nutrition program
- comprehensive program for women most at risk to provide:
- -Food supplementation
- -Nutriton Counseling
- -Support education
Why did CPNP start?
People with low SES more likely to have malnutrition which leads to LBW babies
- 10% of birth are at risk due to poor health and malnutrition of mom
- determining factor in 2/3 of newborn deaths
What is the target population for CPNP?
Pregnant in violent situations First nations Refugees Living in isolation No access to services Youth in poverty Adolescents Abuse
