Lecture 75 - Fertility and Preg D/o Flashcards
what is the defintion of infertility
what is normal fecundability rate
unprotected intercourse for one year w/o becoming pregnant
fecundability (probability) of 25% to achieve a pregnancy within one menstrual cycle.
Causes of infertility
Male factor - 35%
Tubal and Pelvic = 35%
Ovaulartory Dysfunction = 15%
Unexplained = 10%
Other/Unusual = 5%
4 categories of basic evaluation of an infertile couple:
Ovulation
Tubal and Uterine Factors
Sperm Function
Cervical Factors
Methods for evaluation of ovulation
hormone levels
basal body temperature charting
home urine ovulation detection kits
endometrial biopsy
hormone levels
at what day do you check FSH, and what should that level be?
when do you check progesterone? what level should it be?
what other hormones should be checked that lead to more indirect infertility problems?
Day 3 FSH – should be low; if it is high, there is no negative feedback from the ovaries = premature menopause
Day 21 - progesterone should be high
Other hormones: TSH and Prolactin
what would be a high FSH and low estradiol be indicative of?
premature reproductive aging
predicting ovulation:
2 methods for home testing
Increased basal body temperature (.6 degrees)
Rising LH levels
Anovulation Infertility –
Treatment:
clomiphene citrate
Human Menopausal Gonadotropin or Recombinant FSH
mechanism of Clomiphene
when is it given
what is the most common complication?
Given on days 5-10 of the cycle
Blocks negative feedback (estrogen receptors) on the hypothalamus.
therefore overproductive of GnRH –> high LH/FSH –> more recruitment of follicles
Complication: higher rates of twins (release two eggs)
methods of evaluation of uterine factors
Hysterosalpingogram
Ultrasound
Laparoscopy
Hysteroscopy
Hysterosalpingogram
when is this given in regards to the menstural cycle
Ultrasound
Lapropscopy
Hysteroscopy
inject dye into the fallopian tubes; should be some leakage out of the fimbriae – visualized on Xray
Given after menstrual bleeding. Done on days 7-10
US: detect abn of endometrium
Lapro - direct visulization of the tubes
Hysteroscopy – direct visualization of inside the tubes;
What is the main cause of tubal infertility
PID due to chlamydia
three categories of causes of male infertility; name a few of each
Pretesticular – chromosomal, hormonal
Testicular – congenital, infection, vascular issues, gonadotoxins
Post-testicular problems – obsturitve (epididymal), accessory gland, erectile dysfunction, ejaculatory dysfunction
what is the only test for male infertiltiy ?
when?
what are you evaluating?
Semenalysis
best to do after 2-5 days of abstinence.
Quantity of sperm
Motility of sperm
Vitality of sperm
Morphology (only 4% have to be normal)
treatment of infertility for men
surgical treatment for obstruction
Hormonal therapy for gonadotropin deficinecy
Treatment of ED of retrograde ejactulation
Cryopreservation of sperm
