Reproduction 16 Flashcards
Of 100 couples trying to conceive naturally how many will get pregnancy?
20 will conceive within one month 85 will conceive in year 95 will conceive within two years
Describe disorders of the female tract leading to infertility
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
Describe male infertility disorders
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)
Describe Production of spermatozoa, transport of spermatozoa through male tract, transmission of sperm to the female tract, sperm funciton in the female tract problems
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
What is the effect of age on fertility?
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
Describe assisted conception
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
Describe the process of ovarian stimulation
- Pituitary stimulation (GnRH agonist/antagonist)
- Ovarian stimulation (recombinant FSH)- multi follicular development)
- Monitoring of follicular growth
- hCG triggering (longer half life than LH)- final egg maturation
- Egg collection
- Insemination/injection
- Embryo culture (day 2/3 or 5/6)
- Embryo transport
- Luteal support (progesterone)
Describe blastocyst
Culture in vitro for 5-6 days-
switching on of embryonic genome, p
ast stages of totipotency to first differentiation
What are the risks of IVF/ICSI?
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