Reproduction Lectures 2021 - Contraception & Infertility

Question 1

How is contraception increased throughout the world?

Answer 1

Population control

Lifestyle choices

Question 2

In the US ~ half of all women will have an unplanned pregnancy between

Answer 2

15 and 44

Question 3

Approximately 50% of unintended pregnancies in the US occur…

Answer 3

even when contraceptives are used

Question 4

Tubual ligation in females is typically…

Answer 4

reversible

Question 5

Vasectomy in males is…

Answer 5

not so easy to reserve but can

- normally have storage of sperm in case

Question 6

Combination Pill

Answer 6

~ 30 different brands available in North America all contain synthetic estrogen and progesterone

Typically 2 estrogen types: mestranol or ethinyl estradiol
and one of 8 progesterones: ethynodiol diacetate, norethidrone, norethindrone acetate, norethynodrel, norgestrel, desogestral, gestodene or norgestimate

The combination pill blocks ovulation, conception and implantation

Mild and serious side effects as well as benefits independent of their intended use. Delay in fertility when women come off the pill

Question 7

Ppl on the combo pill have…

Answer 7

elevated levels of constant concen. of E & P

- these will (-) feedback & limit appro. prod. of a viable egg

Question 8

Even if fertilization does occur when on pill, the…

Answer 8

imbalance can prevent appro. dev. of endometrial lining & implantation but with inappro. use it can fail

Question 9

Why do some females use P only pills that are not as effective as P & E ones?

Answer 9

nursing moms normally - they don’t want to get pregnant at that time, so P only pill is used b/c of the complications that elevated levels of E’s might have in terms of supporting & breastfeeding a child

Question 10

What are the mild & severe side effects of the combo pill as well as the benefits?

Answer 10

mild - nausea, weight gain, fluid retention

serious - possible increase for breast or cervical cancer

benefits - decrease in risk of ovarian cancer

Question 11

Hormone delivery

Answer 11

• Progesterone implants (intradermal) - slow release method
• Injectable hormones
• Contraceptive patch - slow release method
• Vaginal ring - can deliver concen’s. of hormones within lower part of FRT, making a v. unfav. envir. for sperm to survive

Question 12

“Morning after pill”

Answer 12

• Again progesterone and estrogen based
• Success rates are highly variable
• Usually requires more than a single pill (1- 5)

Question 13

Physical contraception

Answer 13

• IUD’s–T-shaped flexible plastic sometimes impregnated with progestogens
– Reduces sperm motility and viability, influences development and maturation of the ovum, blocks implantation

• Diaphragm, sponge and cervical caps (physical barrier to the movement of sperm through FRT)– Used in combination with spermicide (stops sperm ability to swim)
– Easily reversible

Question 14

Male contraception

Answer 14

• Condom
– Limits STI’s and STD’s eg: HIV

• Coitus interuptus

• The male “pill”
– Why is this not a reality?
– Testosterone derivatives have undergone clinical trials but success rates are low in regard to creating infertility (>40% in caucasian males)
– Androgens alone have significant side effects
– Why not an androgen in combination with an estrogen?
– Specific calcium channels in sperm tails

Question 15

Why not an androgen in combination with an estrogen?

Answer 15

male psyche

• males have potential to repro. until they die - taking what is perceived to be a female sex steroid to limit their repro. potential
• hard to market

Question 16

Surgical contraception/sterilisation

Answer 16

Much more common in females than males
• Tubal ligation - tying FT’s (reversible)
• Hysterectomy - removal of ovaries (NOT reversible)
• Vasectomy - destruction of vas deferens
• Orchidectomy - removal of testes (NOT reversible)

Question 17

When is an orchidectomy normally conducted?

Answer 17

if there’s underline issues with male (prostate cancer for ex)

Question 18

Infertility

Answer 18

• Considered infertile if after a year there is no pregnancy Can be from male (35%), female (35%) or both (20%) (& 10% unknown)

Question 19

Infertility in males:

Answer 19

reduced sperm count (<20million.ml-1) or abnormally high defective sperm. Autoimmune disorders

Question 20

Infertility in females:

Answer 20

production of antibodies against sperm or failure to implant developing zygote, blockage, ciliary dysfunction or endocrine basis

Question 21

Endometriosis

Answer 21

endometrial lining blocks FT as it joins the uterus & now sperm has no way to get to it & fertilize that egg

Question 22

Oligospermia

Answer 22

• Low sperm count, oligospermia, is the leading cause;

Possible reasons:
– Endocrine dysfunction
– Varicocele (varicous veins in the scrotal sac - has increase temp.)
– Retrograde ejaculation (things go backwards)
– Orchitis - infected testicles
– Cryptorchidism - testis fail to descend
– Impotence - erectile dysfunction

Question 23

In vitro fertilisation

Answer 23

• First “test-tube baby” born in Bristol, England in 1978

Ovarian stimulation and egg retrieval:
Fertility drugs (gonadotropins) are administered to the woman to stimulate the maturation of several large follicles followed by hCG.
Prior to ovulation 10-12 eggs are removed from the ovary (typically 3 are implanted)

Fertilisation and embryo transfer:
Sperm obtained from the male and placed in a fluid that nourishes and CAPACITATES the sperm

The fertilised egg is cultured to ensure normal embryonic development and then inserted into the woman’s uterus.

Robert Edwards (1st to do this) - Nobel Prize in Med in 2010

Question 24

In Vitro Fertilization (IVF)

Answer 24

external fertilization in petri disk and transfered as pre-embryos

Question 25

Gamete Intrafallopian Transfer (GIFT)

Answer 25

ova surgically implanted into FT

- Artificial Insemination Husband (AIH) b/c of timing you have to do it artificially instead of naturally

Question 26

Zygote Intrafallopian Transfer (ZIFT)

Answer 26

external fertilization and transfered as zygotes (implanted at an earlier stage than IVF)

Question 27

Egg Donation

Answer 27

external fertilization and transfered into uterus as pre-embryos
- female is incapable of producing viable eggs, so there is a donor (complication happen)

Question 28

Gestational Carrier

Answer 28

external fertilization by a diff. woman that will carry it in her uterus and transfered as pre-embryos into uterus

Question 29

Surrogate Pregnancy

Answer 29

ovum transfered to fallopian tube

• AIH or natural
• male has intercourse with a diff. woman who will give birth to that child & then couple takes that child

Question 30

Suleman Octuplets

Answer 30

Nadya Suleman is mother
- made it to 31 weeks gestation –> C-section

2 sets of mono
2 sets of dizy (sometimes 1 might not make it to full term)

Normally, for IVF the gynocologist implants 3 blastocysts into mom, in hopes of 1 making it to term
- she requested 6 blastocyts be implanted, doctor implanted 12!