Reproduction 16

Question 1

Of 100 couples trying to conceive naturally how many will get pregnancy?

Answer 1

20 will conceive within one month 85 will conceive in year 95 will conceive within two years

Question 2

Describe disorders of the female tract leading to infertility

Answer 2

Ovulatory disorders

Disorders of the female tract

Tubal disorders- secondary to pelvic inflammatory disease due to STDs

Scaring and adhesions in the uterine tubes- impaired oocyte and sperm transport

Diagnosed by HysteroSalpingoGram

Endometriosis- endometrial tissue growth in ectopic sites causing scarring hand adhesion

Uterine disorders- Separate or bicornate uterus leading to miscarriage, premature birth and mallee sensation can be removed surgically

Uterine leiomyomas (fibroids)- benign tumours (oestrogen and obesity) common in menopause, develop in the uterine wall leads to menorrhagia, sub fertility, miscarriage Treated with hormone therapy (Mirena), surgery

_Problems with implantation, growth amd developmen_t

25% pregnancies fail before week 6, 9% pregnancies fail between weeks 6-13, 1-2% pregnancies fail before weeks 13-24, 0.5% pregnancies and in stillbirth

Question 3

Describe male infertility disorders

Answer 3

Production of spermatozoa transport of spermatozoa through male tract, transmission of sperm to the female tract, sperm funciton in the female tract

Semen analysis:

Normozospermia= >15 million sperm/ml

>32% rapid forward motility

>4 normal morphology

Can also get oligozoospermic (low sperm count), Asthenozoospermic (poor motility), Teratozoospermic (dont look good enough), Azoospermic (no sperm in ejaculate)

Question 4

Describe Production of spermatozoa, transport of spermatozoa through male tract, transmission of sperm to the female tract, sperm funciton in the female tract problems

Answer 4

Production of spermatozoa = can be genetic, aquired from trauma, lifestyle etc

Transport of spermatozoa through male tract = Obstructive tracs, post infection, congenital bilateral absence of vas deferens (improper development of vas deferens)

Failure in transmision = Erectile dysfunction (incompetance of urethral sphincter, ejaculation volume nil or low, confomation in urine

Unexplained infertility = no obstructions or anything, inferliety just happens which we dont know why

Question 5

What is the effect of age on fertility?

Answer 5

Bigger factor on women, decline after 20s, sharp decline after 35

Makes mainly due to other age related causes

Quality of eggs decrease over time

Question 6

Describe assisted conception

Answer 6

To circumvent infertility, assist conception

Clomiophene for anovulation (ovulation induction with times intercourse) - antioestrogen to increase FSH. Also need to monitor number of follicles

IUI- intrauterine insemination (injection of sperm into uterus) by passes cervical mucous, paired with ovulation induction- low success rate 5-10% with 10% multiple pregnancy

IVF- egg + 100000 sperm in petri dish- failed previous fertility treatment, tubal obstruction or unexplained infertility

ICSI (intra cytoplasmic sperm injection)- sperm injected directly into egg after failed IVF and male factor infertility

USse donated sperm/egg/embryos if severe male inferlity , permature ovariun failure, both partners carry heritable disease

Preimplantation Genetic Diagnosis (PGD) - Removal of 1/2 cells from early embryo for genetic analysis

Question 7

Describe the process of ovarian stimulation

Answer 7

1. Pituitary stimulation (GnRH agonist/antagonist)
2. Ovarian stimulation (recombinant FSH)- multi follicular development)
3. Monitoring of follicular growth
4. hCG triggering (longer half life than LH)- final egg maturation
5. Egg collection
6. Insemination/injection
7. Embryo culture (day 2/3 or 5/6)
8. Embryo transport
9. Luteal support (progesterone)

Question 8

Describe blastocyst

Answer 8

Culture in vitro for 5-6 days-

switching on of embryonic genome, p

ast stages of totipotency to first differentiation

Question 9

What are the risks of IVF/ICSI?

Answer 9

Multiple pregnancies

Invasive for women

Ovarian hyper stimulation syndrome- excessive response to fertility drugs- multiple follicles produce VEGF- vascular permeability leading too fluid accumulation in peritoneal cavity

Risk of congenital abnormalities, imprinting disorder Oocyte damage

Inheritence of male infertility