Lecture 8: Infertility Flashcards
Define Infertility
Failure to conceive after 12 months of
unprotected intercourse
What assessments do you do for Males with Infertility?
1) Semen analysis (count, motility, volume, total number and morphology)
What basic assessments do we do for females with infertility?
1) Ovulation (regularity of periods around 28 days, E2, P4, FSH, AMH)
2) Timing (not frequency) of intercourse (having time around ovulation)
3) Sexually Transmitted Infections
Describe the treatment and drugs given to women who have infertility due to anovulation
Problem: Anovulation
Treatment: Weight gain or loss
Drugs:
1) GnRH (stimulate the prodction of pituitary hormones)
2) C_lomiphene citrate_ (Given to women who don’t ovulate regularly. Selective estrogen receptor modulator- works on receptors and tricsk the brain into thinking that there isn’t much estrogen so it produces more estrogen).- cause multiple-follicular growth
3) Letrazole (Cause Mono-follicular growth- aromatase inhibitor- prevents converseion of androgens to estrogen)
4) FSH
What is the name of the drug given to women who don’t ovulate regularly?
How does it work?
Clomiphene citrate (Given to women who don’t ovulate regularly.
Selective estrogen receptor modulator- works on receptors and tricsk the brain into thinking that there isn’t much estrogen so it produces more estrogen).
What are some drug treatments to women with infertility due to anovulation?
1) GnRH (stimulate the prodction of pituitary hormones)
2) Clomiphene citrate (Given to women who don’t ovulate regularly. Selective estrogen receptor modulator- works on receptors and tricsk the brain into thinking that there isn’t much estrogen so it produces more estrogen).- cause multiple-follicular growth
3) Letrazole (Cause Mono-follicular growth- aromatase inhibitor- prevents converseion of androgens to estrogen)
4) FSH
What are some causes of infertility in women?
- Anovluation
- PCOS
- Tubal Disease
- Cervical problems
- Nedometriosis
- Premature menopause
- No uterus
Describe the treatment and dtugs given to women with infertility due to PCOS
Polycystic Ovarian Syndrome (up to 10% of women)
Treatment:
Weight loss
Letrozole
Meformin- insulin sensitizer
IVF
What are the symptoms of women with PCOS?
1) Infrequent or no periods
2) Metabolic syndrome- overweight
3) Increased androgens
Describe the tratment options for women with infertility due to Tubal Disease
Tubal diease- either a tubal pregnancy or cyst, or more commonly an adhesion that blocks off the access of the sperm to the eggs.
Treatment:
- Surgery
- IV
Describe the treatment options for women with infertility due to Cervical Problems
Aren’t very common
Treatment:
-IUI intrauterine insemination
Intrauterine insemination (IUI) is a fertility treatment that involves placing sperm inside a woman’s uterus to facilitate fertilization. The goal of IUI is to increase the number of sperm that reach the fallopian tubes and subsequently increase the chance of fertilization.
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Describe the treatment options for women with infertility due to Endometriosis
10% of women
Hormonal contraceptive ablation- surgery
Describe the treatment options for women with infertility due to Premature menopause (pr rising FSH and decreasing AMH with age)
Donor egg (IVF)
Describe the treatment options for women with infertility due to No uterus
Surogacy
Briefly Describe the 6 steps of IVF
1) Produce lots of eggs
- By stimulating the ovaries with hormones
2) Eggs retrieved from Ovary
- Aspirate and get the egg from most follicles
3) Serm sample provided
4) Egg and sperm combined to allow ferilization
- Put in a drop of sperm into each egg
- Then put into an incubator
- Culture the embryo
5) Fertilized eggs (best ones) introduced into uterus
6) Embryo freezing
Describe the 1st step of IVF
1) Ovarian stimulation
-
Stimulation
- FSH
-
Control
- Prevent ovulation
- We don’t want anything to happen that is unplanned
- GnRH antagonists
-
Trigger
- Stimulate ovulation once we know the follicles are of a decent size
- HCG or GnRH agonist
-
Luteal support (after the eggs have been retrieved)
- progesterone- essential because all of the fertility drugs that stimulate the ovaries have a negative effect on the endometrium and advances the endometrium so we need to balance this out.
How do we track the IVF cycle to trigger and OPU?
1) Transvaginal Ultrasound scans
- Measure size of each follicle
- Goes through wall of vagina
2) Blood tests
- Estrogen ~1000U/follicle
- Progesterone (don’t want this to rise)
Describe the in-vivo fertilisation and development phase in IVF
Basically looking at the growth of the embryo as if it is going down the fallopian tube
Monitor the development every couple of days and grade the eggs
What is an alternative to implanting a fresh embryo?
- Freezing the embryo first, and then wait for the woman’s natural hormonal cycle to occur before implanting the emrbyo.
- The woman may have hyper-excitable ovaries which can be deadly with all of the hormones
What are some causes of Male Infertility?
1) Oligospermia (low sperm count)
2) OATS (oligoasthenoteratospermia)
3) Azoospermia
Describe the treatment options for male infertility due to Oligospermia
- ICSI (intra-cytoplasmimc sperm injection)- take a single sperm and inject it straight into an egg
- Donor sperm
Describe the treatment options for male infertility due to OATS
Oligoasthenoteratospermia
Oligo= low concentration
Astheno = slow motility
Terato = Abnormal form
(this is a triple defect)
Treatment
- ICSI (intra-cytoplasmic sperm injection)
- Donor sperm
What is ICSI?
(intra-cytoplasmic sperm injection)
When a single sperm is injected directly into the egg
Describe the treatment options for male infertility due to Azoospermia
No sperm at all
due to…
1) Kallman’s Snydrome (no GnRH- FSH/LH)
2) Obstructive/vastectomy
3) No spermatogenesis
4) Congenital absnece of the vas
Treatment
- Donor insemination
- TESA/TESE
(testicular sperm aspiration/extraction + ICSI)
Describe testicular sperm aspiration/extraction
Surgical retrieval of sperm
Lots of approaches
1) PESA Stick a needle into the epididymis and take some fluid (hope there’s sperm in there)
2) TESA If no sperm is found in the epididymis, go do fine needle aspiration in the testes and suck out testicular tissue
3) TESE If none are found in the small testicular tissue, you have to take out a chunk of testicular tissue.
What are some causes of unexplained infertility and what are the treatment options?
Problem
1) Unknown aetiology (Sperm is fine, fallopian tube is fine, know when they’re ovulating but cannot get pregnant after 3 years)
2) Fertilisation issue (something wrong with egg or sperm- won’t know until you try IVF
3) Age
Treatment
1) Mild ovarian stimulation with Intrauterine insemination IUI (low tech and not too expensive- few thousand)
or
2) IVF (10-12 thousand dollars)
What is AMH?
What can it predict?
Women are born with their lifetime supply of eggs, and these gradually decrease in both quality and quantity with age. Anti-Mullerian Hormone (AMH) is a hormone secreted by cells in developing egg sacs (follicles). The level of AMH in a woman’s blood is generally a good indicator of her ovarian reserve.
It can help predict how many eggs you are likely to obtain in an IVF cycle. It may also identify women who may undergo early menopause, and therefore who may lose their fertility earlier than average
What is Preimplantation Genetic Screening?
recent innovation
1) Take 3 embryo and make a little hole in the zona pellucida using a lazer (this is because, as the embryo keeps growing, we are hoping that it will herniate out some cells and we can biopsy it)
2) We freeze the cells
3) Genetic sequencing
What is Intrauterine Insemination?
Intrauterine insemination (IUI) is a fertility treatment that involves placing sperm inside a woman’s uterus to facilitate fertilization.
The goal of IUI is to increase the number of sperm that reach the fallopian tubes and subsequently increase the chance of fertilization.
