Reproduction/Contraceptives/Infertility Flashcards
How does puberty occur?
Hypothalamic Pituitary cycle
Hypothalamic Pituitary cycle
Hypothalamus - gonadotropin-releasing hormone
Anterior pituitary = FSH and LH
Ovary and testes produce sex hormones = secondary sex hormones
The more sex hormones then the more
prominent secondary sex characteristics
The hypothalamus secretes what during puberty?
gonadotropin-releasing hormones
The anterior pituitary secretes what during puberty?
FSH
LH
FSH
follicle-stimulating hormone
LH
luteinizing hormones
Sex hormones aka
gametes
the genetic sex is determined at
conception
The reproductive system is similar for the first
6 weeks
The differentiation of external genitalia is complete at
12 weeks
Ovaries and testes secrete the
primary sex hormones
What weeks are you about to check the gender?
12-16 weeks
Boys would have male sex organs from an _____________ testosterone.
increase
Girls would develop female organs from an ________ testosterone.
no
During childhood, the sex glands are
inactive
Sexual maturation starts at
puberty (capable OF REPRODUCTION)
- reproductive organs functional
- primary/secondary sex characteristics
Male puberty starts at
13.5 y/o age
Male puberty is triggered by the production of
testosterone
What secondary sex characteristics are seen in male puberty?
Skeletal growth
Increase in body composition
Develop body hair- facial, axillary and pubic
Voice changes
Enlargement of testes and penis
Nocturnal emissions (wet dreams) – no mature sperm
Female puberty starts at
8-13 y/o
Female puberty is triggered by the production of
estrogen
Female secondary sex characteristics changes
Develop body hair – axillary, legs & pubic area
Body contours - widening of hips
Skeletal growth
Reproductive organs
Breast changes - mammary ducts & nipples erect
Menarche
1st menstrual period
2-2.5 years after puberty
Who is the quickest to mature puberty?
females
Can females get pregnant before their
1st period
What are the structures of the female reproductive system?
Ovaries
Fallopian tubes
Uterus
Cervix - Internal & External os
Vagina
Corpus luteum-
fluid fill mass on the ovary that makes your uterus a healthy place for the fetus to grow
What produces the hormones for the fetus before the placenta matures and makes the hormones?
corpus luteum
Anterior Pituitary glands produce what hormones
FSH
LH
The ovaries produce what hormones?
estrogen
progesterone
FSH function
helps control menstrual cycle and production eggs by ovaries
LH function
surge causes ovulation and results in formation of corpus luteum
Estrogen function
thickens uterine lining and regulates growth, development, and physiology of reproductive systems
Progesterone function
prepares the lining of the uterus to** implant and grow a fertilized egg
inhibits FSH and LH**
Menstrual cycle
Menstrual phase
Proliferative phase
Ovulatory phase
Luteal phase
Endometrial cycle
Menstrual phase
Proliferative phase
Secretory phase
Ischemic phase
Menstrual phase
change in mood swings
breast tenderness
cavings
irritable
anxious (emotionally high alert)
- period starts
vasoconstriction and sloughing off
Proliferative Phase
day 5 (after menstruation) to 14
Pituitary FSH makes the egg and LH for he egg
- start progesterone to ready lining
- depends on the estrogen starts the (thinning of the cervical mucus( _
Ovulatory Phase
hormone when LH increase
- one egg is taken and transported to the uterus whether impalantation or not
Secretory Phase
endometrial lining thickens
- implant then get thicker
- if no implantation start to shed again
Ischemic Phase
- vasoconstriction
What are the conditions of fertilization?
Live, motile, normal sperm present (no clumps or abnormal)
patent fallopian tubes
healthy progesterone and thickening endometrium of the uterus
60% of sperm move forward
What measures the sperm count and how healthy the sperm is?
postcoital test
Patent fallopian tubes prevent
ectopic pregnancy
Endometrial biopsy measures
adequate progesterone and thickening endometrium of the uterus
What percentage of sperm indicates health and fertility?
60% move forward and are healthy
Indications of Ovulation
Notable drop in temperature
Spinnbarket mucus
cervical os
mittelschmerz
saliva ferning
increased libido
what does the temperature do at ovulation?
notable drop occurs 1 day before ovulation and remains elevated 10-12 days
Spinnbarkeit mucus in ovulation
abundant, watery thin, clear, stretchy (egg white)
Cervical os for ovulation
dilates lightly
softens and rises in the vagina
Mittelschmerz occurs
localized abd pain (usually right-sided)
What does a fertile saliva ferning look like?
no space
What does the serum LH look like during ovulation?
too high
Infertility
Inability to conceive/maintain a pregnancy after 12 mos. of unprotected intercourse (6 mo. if > 35y/o)
- grouped with miscarriages before 20 weeks (age of viability)
Infertility after ____ months if > 35 y/o
6
Primary infertility
no children
Secondary infertility
have had 1 living child
Infertility can cause stress
Mentally- Inability to conceive
Financially- Expenses
Emotionally- Effect on couple’s relationship can be seen as crisis in relationship (each blames each other) – 1/3 woman, 1/3 male, 1/3 both
___/____ couples will have trouble getting pregnant or sustaining a pregnancy
1/8
Causes of Infertility in Men
abnormal erections, ejaculation
abnormalities of seminal fluid (inflammation)
- obstructions/infections in the genital tract
Abnormalities of the sperm
Retrograde ejaculation
goes into the bladder not the penis
Retrograde ejaculation causes
diabetes
neurologic disorders
antihypertensives and psychotropics
Azoospermia
absent sperm in semen
Oligospermia
decrease sperm in semen
Impairing sperm factors
Abnormal hormonal stimulation
Acute or chronic illness (mumps, cirrhosis, or renal failure)
Infections of the genital tract (inflammation and clump of the sperm)
Anatomic abnormalities such as varicocele (enlarged vein in the back of the testes)
Exposure to toxins such as lead, pesticides, or other chemicals
Antineoplastic drugs, chemo, or radiation
Excessive alcohol intake; use of illicit drugs
Elevated scrotal temperature (febrile illness, use of saunas or hot tubs, or sitting for prolonged periods)
Immunologic factors produced by man or woman
Monchidism
1 testicle
Causes of infertility in women
- disorders in ovulation
Hypothalamus or pituitary gland dysfunction
Failure of ovaries to respond to follicle-stimulating hormone (FSH) or luteinizing hormone (LH)
PCOS – most common
Cranial tumors
Stress (same with dad)
Obesity or anorexia
Systemic disease
Abnormalities in ovaries or other endocrine glands (polypos or increase of cervical mucus)
Causes of women’s infertility due to abnormalities of the fallopian tubes
endometriosis - tissue lining going outward
Causes of women’s infertility due to abnormal cervix
Estrogen levels decreased preventing development of spinnbarkeit
Causes of infertility in women
- recurrent pregnancy loss
Abnormalities of fetal chromosomes
Abnormalities of the cervix or uterus
Endocrine abnormalities
Immunologic and thrombotic factors – increase of miscarriage and loss of the baby
Environmental agents
Infections (implantation not able to)
Evaulation of Infertility from a H&P
- REPRODUCTIVE MEDICAL HX
Menstrual history
Any pregnancies, complications and outcomes (BMI)
Contraceptive methods-past and present
Fertility with other partners
Pattern of intercourse
Exposure to toxins
Medications- Rx or OTC
Family history of pregnancy loss
Home tests/other methods used
Who is usually tested first due to cheap and quick?
men
Men Dx Test for fertility
Semen analysis-collection after 2-3 days of abstinence
Ultrasonography
Hormone analysis
FSH, LH, Testosterone, & Prolactin
Testicular Biopsy – environment
Sperm Penetration Assay “hamster test”
Mix to test for penetration
Women Dx Tests
Ovulation Prediction
X-ray of uterus & fallopian tubes to determine patency
Hysterosalpenogrpahy – patency of the fallopian
Hysterot
Laparoscopy – observing for
Hormone analysis
Progesterone, FSH, Estrogen, Luteinizing hormone & Prolactin
Nonmedical Therapy for facilitating pregnancy
Nutritional and Dietary Changes
Exercise, Yoga, and Stress Management
Lifestyle changes- No smoking/drinking
Ovulation Predictor
Use water-soluble lubricant for intercourse
Do not use spermicides as it can misread the ovulation by thinning the mucus
A loss of ____% body weight if obese can restore ovulation
5
Medication Therapy for Fertility
Clomiphene citrate and Letrozole
Clomiphene citrate and Letrozole purpose is to
stimulates pituitary gland to increase secretion of luteinizing hormone (LH) & follicle-stimulating hormone (FSH), can cause ovarian hyperstimulation syndrome
Clomiphene citrate and Letrozole have a risk of
Risk of multiple gestations (use responsibly)
Clomiphene citrate and Letrozole side effects
include hot flashes, blurred vision, nausea, vomiting, pain in pelvis, bloating, and headache
Clomiphene citrate and Letrozole contraindications
bleeding disorders or liver disease
What medication is also given along with Clomiphene citrate and Letrozole for PCOS patients?
Metformin
Clomiphene citrate and Letrozole can cause
ovarian hyperstimulation syndrome
In-vitro fertilization (IVF)
fertilization-embryo transfer (IVF-ET)-Eggs are collected from ovaries, and fertilized in the laboratory with sperm; the embryo is then transferred to the uterus (fertilized outside the body)
Timing is important to be put in
Intrauterine insemination (IUI)
Places prepared sperm in the uterus at the time of ovulation
Makes the journey to fallopian tubes much shorter
Gestational surrogacy
couple goes through IVF and the embryo is placed in another woman with no genetic ties to the embryo
Traditional surrogacy
woman inseminated with semen; carries fetus to birth
IUI is used for
cervical scarring
male partner not long-distance swimmers
premature ejaculation
What fertilization is done outside of the body?
Intracytoplasmic sperm injection
Zygote Intrafallopian transfer (ZIFT)
In vitro fertilization-embryo transfer (IVF-ET)
Intracytoplasmic sperm injection
Single sperm selected and injected directly into mature oocyte in laboratory
What fertilization is done inside of the body?
Gamete intrafallopian transfer (GIFT)
Intrauterine insemination (IUI)
Gamete intrafallopian transfer (GIFT)-
Oocytes retrieved; placed with prepared motile sperm; then placed in fallopian tubes
Religions-
Zygote Intrafallopian transfer (ZIFT)-
Zygote is placed in fallopian tube instead of uterus
Intrauterine insemination (IUI)
Places prepared sperm in uterus at time of ovulation
In vitro fertilization-embryo transfer (IVF-ET)
Eggs are collected from ovaries, fertilized in laboratory with sperm; embryo then transferred to uterus
Fertility Nursing Interventions
Educate on available options for reproductive assistance and encourage couples to discuss feelings about infertility
Educate the couple on roles of specialists they will see
Monitor for adverse effects associated with infertility treatments
Teach that infertility medications that can increase risk of multiple births
Refer for psychosocial counseling if needed
Educate regarding assisted reproductive therapies and available options such as surrogacy and adoption
Placenta if formed by
fetal and maternal tissue
The placenta exchanges
substances between the mother an fetus occurring in the intervillous spaces
The placental membrane prevents
maternal and fetal blood mixing; gasses, nutrients, and electrolytes are exchanged via the umbilical cord
What can cross the placental membrane and enter the fetal circulation?
viruses and drugs
rubella and cytomegalovirus
Degenerative placenta
: Infarcts & calcifications that interfere with uterine-placental-fetal oxygen exchange
Degenerative placenta is more likely in
severe preeclampsia, smokers, drug abuse and post dates
What are the two membranes forming the amniotic sac?
Amnion = next to fluid for baby (urine)
Chorion = next to placenta
Membranes stretch to accommodate
growth of developing fetus and increasing amount of amniotic fluid
Amniotic fluid is made from
from fetal urine and fluid transported from maternal blood
Amniotic fluid purpose
Cushions Impact to maternal abdomen
Prevents adherence of fetus to amniotic membranes
Allows freedom of fetal movement
Provides a consistent thermal environment
Essential for fetal lung development
Allows symmetric development as major body surfaces fold to midline
Oligohydramnios
Abnormally small quantity of fluid (< 50% of amount expected for gestation or < 400 ml at term)
Oligohydramnios causes
Poor placental blood flow (increased risk of umbilical cord compression
PPROM
Failure of kidney development
Blocked urinary tract
Fetal effects
Poor fetal lung development
Malformations such as skeletal abnormalities
Polyhydramnios
Quantity of fluid may exceed 2000 mL
Polyhydramnios causes
Poorly controlled maternal diabetes mellitus resulting in large quantities of fetal urine excretion having elevated glucose level
Malformations of the CNS, cardiovascular system, or GI tract
Chromosomal abnormalities
Multifetal gestation
Sometimes no known cause
Umbilical Cord is the ____________ between fetus and placenta.
lifeline