SM186 Female Infertility Flashcards
Definition of female infertility
Inability to conceive after one year of unprotected intercourse
Infertility DDx
Common: male factor, oocyte factor/decreased, ovarian reserve, tubal/transport factor, ovulatory dysfunction
Uncommon: uterine abnormalities (usually congenital), endometrial abnormalities, endometriosis, sexual dysfunction, unexplained
Cycle fecundability
Probability that a cycle will result in pregnancy
Cycle fecundity
Probability that a cycle will result in live birth (avg. 20%)
When is peak fertility? When does it start to decline?
20-24, declines around 30-32
Miscarriage rate also starts to rise around that time
Abnormalities of the uterine cavity
Congenital: mullerian duct abnormalities
Acquired: fibroids, polyps, Asherman’s syndrome
Abnormalities of the fallopian tubes
Related to ascending infection or pelvic surgery
Age and uterus
No significant changes with age
No adverse effects on endometrial development or function in response to steroid stimulation
Male factor infertility
Hypothalamic-pitutiary disorders
Primary gonadal disorders
Disorders of sperm transport
Idiopathic
Anovulation
PCOS, hypothalamic amenorrhea, hyperprolactinemia, thyroid disease, premature ovarian failure
Decreased ovarian reserve
Result of aging, lose eggs as you get older
Endometriosis
Presence of endometrial glands and stroma outside of the uterus, associated with pelvic pain and infertility
Usually located in the pelvis, but can appear anywhere in the body
Retrograde menstruation currently-accepted pathophysiology
Infertility mechanism: distorted adnexal anatomy inhibits ovum capture after ovulation and excess production of prostaglandins and other proteins results in chronic inflammation
Postcoital test: what is it, do we still do it?
Tests cervical mucus after intercourse for pH, clarity, cellularity, viscosity, and presence of sperm
No longer recommended
Cervical abnormalities
Cervicitis and stenosis
Most common cause is conization or other treatments
Can impair sperm-mucus interaction
