Module 1.2.1 (Management of Infertility) Flashcards
What is primary infertility?
infertility: indicates that the ability to become pregnant maybe diminished or absent.
subfertility: delay to conceiving
1 in 6 couples have trouble conceiving (15%) with 50% of these requiring medical assistance
Defined as failure to achieve a pregnancy after 12 months of regular, unprotected intercourse (2-3 per week)
> 85% of couples are likely to conceive in 12 months and upto 95% in 24 months
What is seconday infertility?
Defined as failure to achieve a second pregnancy after a couple has already had a pregnancy or child.
What are examples of ovulation disorders that can cause female infertility?
Decreased ability to release a viable egg for fertilisation, can be due to hormone deficiency
- Ovary damage
- Infrequent periods (oligomenorrhoea)
- Absence of periods (amenorrhoea)
How can blocked/damaged fallopian tubes cause female infertility
- Blocked tubes – hysterosalpingogram (HSG) –> do to see if tubes are blocked
- Damage due to previous surgery – results in scar tissue deposits
- Limited egg flow and sperm access
- Pelvic inflammatory disease (PID) due to sexually transmitted diseases e.g chlamydia, gonorrhoea is a significant cause of tube damage
How can endometriosis cause female infertility?
- Significant cause of infertility
- Uterine tissue grows outside the uterus and can affect the ovaries, fallopian tubes, bowel, bladder and rectum
- Development of scar tissue in the uterus that can impair embryo attachment
Why does fibrioids cause female infertility?
- Can occur in 70-80% of women
- Non-cancerous growth of muscle in the uterus that may affect fertility/implantation
Why can PCOS cause female infertility?
Polycystic ovarian syndrome – ovaries are enlarged and have a thicker outer layer covered by small cysts – can be harmless but affect period regularity and result infertility
How does cervical problems cause female infertility?
Cervical secretions
> production, consistency and resistance
Causes of male infertility?
- Damage to sperm production – oligospermia/azoospermia
- Obstruction to the vas deferens
- Testosterone production
- Sperm genetics
- Sperm abnormalities / mobility problems n Damage due to cancer therapy
What are some lifestyle factors that can cause infertility?
Smoking
- Women – increased risk of ovulation problems and miscarriage
- Men- may affect development, quality and volume of sperm
Alcohol
- Excessive alcohol intake can be damaging to general health
- Australian standard alcohol rules apply to men
- Recommended that women restrict alcohol use when trying to conceive
Recreational Drugs
- Cocaine, methamphetamine and marijuana can affect menstrual cycle and ovulation processes
- Sperm count is affected by marijuana intake
- All recreational drugs should be avoided
Caffeine
- Reduction of caffeine intake
- Mixed studies –1-2 standards cups of coffee is recommended / others suggest no caffeine
Weight Management
- both male and female fertility can be affected by being overweight or underweight
Balanced diet
- Ensure a well balanced diet is maintained
Fertilitity and age?
Female fertility is known to decrease with age
Women are most fertile between the ages of 15-25 years
From 35 years of age – the quantity and quality of viable eggs will begin to decrease
By 50/60 years of age, the total number of eggs available will have usually depleted
n In contrast – male fertility can persist into old age – some evidence to suggest a reduction of sperm quantity and quality at 45 years of age
Describe the
A) menstrual phase
B) follicle phase
C) ovulation phase
D) luteal phase
A)
- • Days 1-5 •
- Menstrual bleed •
- Break down of endometrium – endometrial lining
B)
- Day 5-14 •
- Pituitary Hormone/ Gonadotrophin Release •
- FSH release to stimulate follicle development •
- Follicle development increases Oestrogen release from the ovaries
C)
- Day 14-16
- Release of mature egg from ovary
- Ovulation is triggered by the release of LH
- Ovulation/fertile window
D)
- •Day 17-28
- Follicle develops into a corpus luteum - Initiates release of progesterone – increase in endometrium thickness
- Fertilised egg will embed in lining and release HCG – positive pregnancy
- •If no pregnancy, corpus luteum demise/ decreased progesterone
- Endometrial lining breakdown - menstrual phase
What are the FOUR stages of fertility treatment?
- Lifestle modifications –> fertility tracking
- Ovulation Induction –> hormonal therapy
- Assisted reproductive technology (ART) –> Artificial Insemination (AI) and Intrauterine Insemination (IUI)
- In Virtro Fertilisation (IVF). IVD with intra-cytoplasmic sperm injection (ICSI).
How to modify lifsetyle?
- Balanced diet
- No smoking
- No alcohol
- Weight management
- No drugs
- Include physical actvities
- Regular and adequate sleep
- Multivtiamins and folic acid
For fertility tacking which is part of lifestyle modifications, describe the following types:
A) Cycle tracking
B) Basal body temperature
C) Changes in cervical mucus
D) Ovulation Kits
A)
- Also known as the calendar method
- Calculating possible ovulation day based on menstrual cycle
- Ovulation expected to be 14 days before your menstrual bleed
- Timed intercourse to increase likelihood of becoming pregnant 3 days prior to and day of ovulation
B)
- Following ovulation – temperature is expected to rise significantly due to the increase in progesterone levels
- Monitor daily temperature throughout cycle and record days where body temperature has risen
C)
- Early in the cycle , cervical mucus is sparse, cloudy and dense
- Ovulation results increased clear fluid to allow for sperm to easily pass
- Monitoring mucus consistency and amount during tracking
D)
- Ovulation predictor kits available from pharmacies
- 2 types: urine & saliva test
- Urine Test – detects amount of leutinising hormone in the urine. LH surge will occur 24- 36 hours prior to the release of a mature egg
- Saliva Test – saliva appearance demonstrates a distinctive ‘fern=like’ pattern when oestrogen levels rise before ovulation
NB: these kits may work for some women although women with PCOS or ovarian failure cannot use them
