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ginecologia > Sterilità di coppia e procreazione assistita > Flashcards

Sterilità di coppia e procreazione assistita Flashcards

1
Q

Definition of sterility, infertility

A

We define Infertility
INFERTILITY - the inability to bring
continue a pregnancy up to an age of vitality
It defines STERILITY instead the complete inability
to conceive for obstacle to fertilization, for both causes male and female:
•The sterility I: To never had a pregnancy
•Infertility II: There was a pregnancy even if not
completed

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2
Q

Sterility

A

Sterility = lack of fertility after years of relationships intentionally not protected.

Male, female, couple

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3
Q

Female sterility

A

FEMALE STERILITY
L ‘endocrine female infertility is characterized by a
women is characterized by a
disorder of the physiological process of development and maturation
follicle, which leads to ovulation in women and thus to the corpus luteum formation
While recognizing multiple causes is explained by three main syndromes

  • Anovulation
  • Luteinized unruptured follicle syndrome
  • Deficit luteal phase
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4
Q

CAUSES AND FEMALE STERILITY

hypothalamic pituitary anovulation. Causesorganic and (dis)functional

A

FEMALE STERILITY
Hypothalamic pituitary AND CAUSES OF
Anovulation

Organic

  • hypothalamic tumors
  • outcomes truami cranial
  • pituitary adenomas
  • Sindr. Sheehan
  • Empty saddle syndrome
  • Iatrogenic (radiotherapy, etc)

Disfunzionali

  • malnutrition
  • Associated with heavy exercise
  • Isolated deficiency of gonadotripine
  • prolactin dysfunctional
  • Iatrogenic (drugs)
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5
Q

Causes endocrine Extragenital

nutritional causes

pharmacologic causes

A

Causes endocrine Extragenital
-Tiroidee (Hyperthyroidism, hypothyroidism)
-Surrene (Hyperadrenal, iposurreanalizmo)
-Pancreas (Diabetes)
nutritional causes
-Obesità
-Malnutrizione
causes drug
steroids gonadichi
drugs psichotropi

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6
Q

FEMALE STERILITY
Anovulation BY ALTERATION OF SYSTEMS FEEDBACK

A

FEMALE STERILITY
Anovulation BY ALTERATION OF SYSTEMS
FEEDBACK

  • Polycystic ovary disease of
  • Associated with states of hyperandrogenism
  • Associated with states of the hyper hypothyroidism
  • Associated with hyper and hypoadrenalism
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7
Q

CAUSES OF OVARIAN anovulation

A

FEMALE STERILITY
CAUSES OF OVARIAN anovulation
PRIMITIVE

Gonadal dysgenesis

SECONDARY
Sindr. Resistant ovary
Premature menopause
Ovarian tumors
Iatrogenic

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8
Q

Luteinized unruptured follicle syndrome

A

LUF syndrome
Failure to eject the oocyte from the follicle that is not to be
rupture, but it must be at a meeting
transformation with luteal progesterone production
ROBABLE CAUSES

  • Alteration of the biochemical mechanisms responsible intraovarici
  • the checking of the mature follicle
  • Peak LH defective
  • Dissociation between endocrine function and oocyte maturation
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9
Q

FEMALE STERILITY

luteal phase DEFICIT

inadequate folliculogenesis in detail

A

Inadequate folliculogenesis
•Reduced production of FSH
•Altered LH pulsatility in follicular phase
•Reduced peak preovulatory LH

Inadequate progesterone production by the corpus luteum
•Reduced secretion of the hormone daily
•Normal hormone secretion, but for a reduced time compared to the physiological duration of the life of the corpus luteum (about 14 days)
•Alteration of LH secretion in the luteal phase (hyperprolactinemia)
•Specific defects inherent in the luteal cells

Alteration of endometrial response to progesterone
•Abnormal endometrial response to progesterone

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10
Q

FEMALE STERILITY
DEFICIT luteal phase

A

Altered function of the corpus luteum
-> Insufficient production of progesterone

Inadequate endometrium maturation -> Abortion

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11
Q

UTERINE FACTOR

Obstacles to the system (Infertility)

Obstacles to the evolution of pregnancy (Infertility)

A

UTERINE FACTOR
Obstacle to the system (Infertility)

  • Endometritis
  • Atrophic endometrium
  • Hyperplastic endometrium
  • Synechiae
  • Intracavitary fibroids

Obstacle to the evolution of pregnancy (Infertility)
Abortion and / or premature paro

  • Mullerian malformations
  • Cervical insufficiency
  • Failure cervico - isthmic
  • isthmus
  • Fibroids
  • Synechiae
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12
Q

FEMALE STERILITY

Tubal factor

A

Pelvic inflammatory disease
Salpingitis
Endometriosis
—->
Ectopic pregnancy
Pelvic adhesions following surgery
Malformations tubal

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13
Q

Female sterility
FACTOR PELVIC

A

FACTOR PELVIC
Impediments of a physical, chemical or mechanical
realized inside the peritoneal cavity pelvic (that of
normally not detectable by the ISG)

ADHESIOns(later)

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14
Q

FEMALE STERILITY
factor pelvic. Adhesions

A

FEMALE STERILITY
FACTOR PELVIC
Adhesions:
•Endometriosis
•MIP gonorrhea, TB, etc
•Post - partum
•Post - abortion
•Undiagnosed ectopic pregnancies
•Rupture of the luteal cysts
•Excessive bleeding ovulation
•Previous surgery
•Use of IUDs
Endometriosis

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15
Q

FEMALE STERILITY
FACTOR NECK - VAGINAL, cervical factor

A

Impediment anatomical and / or functional deposit the sperm in the vagina, the cervical canal and lifts interaction between pathological secretion and spz, with alteration sperm motility and survival.
Factor vaginal
• Vaginitis
• Causes anatomical (stenosis, hypoplasia, septum)
• Trauma

Cervical factor
• Causes anatomical (DTC, conization, synechiae)
• Alteraz. Cervical mucus (endocerviciti, anovulation, idiopathic)

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16
Q

CAUSES of MALE STERILITY

A

Cryptorchidism
Primary and secondary hypogonadism
-Kallman syndrome
-Klinefelter syndrome
Inflammation (orchitis, TBC, mycoplasma,
chlamydia)
Seminal tract obstruction
Varicocele
Immunological factor

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17
Q

Epidemiology of couple sterility

A

Each year about 240,000 new form in Italy
couples; about two years of marriage to 48,000
they find they have infertility problems. Over
20,000 pairs each year ask for advice
sterility and of these about 10,000 undergo infertility treatment (AIED 1992) the tit (AIED 1992)

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18
Q

Diagnostic procedure of the infertile couple

A

History

Clinical examination (Visit + USG)

First evaluation factor infertility

No conceptions -> Primary infertility

Prev. Pregnancies
-> secondary infertility

abortions are also important

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19
Q

Diagnosis of sterility for female

A

DIAGNOSIS STERILITY ‘

FEMALE
History
Menarche
Features menstrual flow
Hirsutism
Galactorrhoea
Sexual habits
Dyspareunia
Familiarity for infertility
Diabetes
Drugs or Drugs
Means of contraception

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20
Q

Physical examination gynecological
hormonal tests

A

Physical examination gynecological
Hormonal assays
FSH
LH
Estradiol
Prolactin
Progesterone
DHEA - S
Δ4-Androstenedione
TSH
FT

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21
Q

BASIC instrumental tests

A

CTB + Score + MC PCT
Echography
ISG
Hysteroscopy
Coelioscopy

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22
Q

Indications for diagnostic hysteroscopy

A

INDICATIONS for diagnostic hysteroscopy
appearance of endocervical polyps;
Sonographic suspicion of octopus
abnormal uterine bleeding
(Metrorrhagia, menometrorrhagia)
Dystrophies endometrial
LOST IUD
Sterility and infertility

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23
Q

Possible hysteroscopy findings

A
  • CAVITY ‘UTERINE,
  • POLYPOSIS ENDOMETRIAL
  • polipus endocervical,
  • Submucosal myoma,
  • sinechia,
  • Neoformation
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24
Q

Histerosalpyngography

A

And a radiographic examination that consists injecting into the uterus, through the cervical canal a contrast medium cervical canal a contrast medium iodized
Assess the state of tubal patency

25
Possible findings of histerosalpyngography (ziureti skaidrese)
Patency 'tubal(PERVIETA' TUBARICA) Tubal occlusion
26
DIAGNOSIS of Male sterility
**MALE** History Diabetes Pubertal development Sexual habits Medications and Drugs Alcohol Smoke Libido Infectious diseases (mumps, tbc) Surgeries (varicocele)
27
CAUSES MALE infertility
Cryptorchidism Primary and secondary hypogonadism -Kallman syndrome -Klinefelter syndrome Inflammation (orchitis, TBC, mycoplasma, chlamydia) Seminal tract obstruction Varicocele Immunological factors Idiopathic infertility
28
Physical examination of a man
Physical Examination Scrotal examination volume consistency pain Examination semen Macroscopic characters: Volume (N = 1.5 to 5 ml) 5 ml) Viscosity pH (N = 7.2 to 8) Microscopic features: Concentr. Sperm Morphology Motility
29
Other tests of a male
Hormonal assays FSH, LH Testosterone Prolactin Estradiol Scrotal ultrasound Doppler (Grade varicocele) Testicular biopsy (Azoospermic) Vescicolodeferentografia
30
what is PCT?
PCT Test interaction mucus Cervical and sperm live
31
Possible choices of sterility therapy
DRUG THERAPY Chirurgia MEDICALLY ASSISTED fertilization
32
SURGERY
The surgery involved in infertility for correction of malformations Mullerian not compatible with there prosecution pregnancy (uterine septum, Uterus didelphys), or solve diseases that occur as a mechanical barrier to fertilization and implantation of the embryo (myomas, adhesions tubal).
33
Possible surgical operations for infertility treatment
* Removal of uterine septum (HSG / laparotomy) * Metroplasty (Uterus didelphys) * salpingolisis * Myomectomy
34
Par. II: Assisted reproduction Main Features definition, techniques
To facilitate the solution of reproductive problems resulting from sterility or by infertility, you can resort to assisted reproduction techniques. For assisted reproduction techniques means all proceedings involving the processing of human eggs, sperm or embryos in a project that seeks pregnancy: • Techniques of fertilization intracorporeal • Techniques of IVF
35
Par. II: Assisted reproduction intracorporeal fertilization
Fertilization intracorporeal It represented intrauterine insemination, which involves introducing instrumental seed, suitably treated in the laboratory, inside the uterine cavity (alternatively, in the vagina, in the neck uterus or even the tuba), of the natural cycle in ovulatory phase or after pharmacological induction ovulation:
36
Par. II: Assisted reproduction intracorporeal fertilization. indications.
• Indications or idiopathic infertility or mild oligoasthenospermia or Anovulation or Endometriosis or cervical factor infertility from organic or immunological or Sexual difficulties of the individual or couple
37
Par. II: Assisted reproduction intracorporeal fertilization​. aims.
Aims or Increase the number of pregnancies per cycle or reduce ovarian stimulation or reduce the incidence of side effects or Get a singleton pregnancy
38
Par. II: Assisted reproduction intracorporeal fertilization​. preliminary tests.
• Preliminary tests or tubal Functionality or Any infections in place: in fact, the legislation requires to verify that there are no HBV, HCV or HIV
39
Par. II: Assisted reproduction intracorporeal fertilization​. Technique.
Technique: or preparation of semen (homologous or heterologous) is concentrated, selected and capacitated. In particular, the concentration helps to avoid the introduction of PG (Present in the semen), which would induce uterine contraction and expulsion of liquid or Waiting natural ovulation or ovulation induction or insertion of sperm
40
Par. II: Assisted reproduction IVF. techniques
Techniques or IVF (In vitro fertilization with embryo transfer) or ICSI (intracitoplastic sperm injection): These two techniques differ only in the mode of production of embryos in the laborator
41
Par. II: Assisted reproduction IVF. phases
Phases * or induction of superovulation (ie grow more than one follicle): requires drugs that induce ovulation * or follicular aspiration (ie aspirate and research follicle) and oocyte collection * or Recognition of gamete and embryo obtaining * or embryo transfers (no more than three embryos):
42
Par. II: Assisted reproduction IVF. induction of superovulation. Protocol of ovulation induction
Protocol of ovulation induction • Choice of drugs • Choice of treatment regimens or multiple daily doses Protocol or protocol with a single dose • Timing:
43
Par. II: Assisted reproduction IVF. induction of superovulation. Protocol of ovulation induction. choice of drugs.
or Preventing premature luteinization and ovulation: GnRH or Induction multiple follicular development: FSH, LH or Induction of oocyte maturation and follicular outbreak: hCG or luteal phase support: progesterone
44
Par. II: Assisted reproduction IVF. induction of superovulation. Protocol of ovulation induction​. timing
Timing: there are no significant differences in terms of pregnancy rate, but may be: or first day of the cycle or Regardless of the stage of the cycle or late luteal phase: would have the advantage of a hypothetical majority follicular recruitment
45
Par. II: Assisted reproduction IVF. induction of superovulation. medications.
* Gonadotropins: induce superovulation * GnRH Analogs: prevent early luteinisation •or Agonists: have a greater affinity for the GnRH GNRHR, on which still more time, preventing the binding of GnRH * or antagonists * Progesterone (oral or vaginal): during the luteal phase
46
Par. II: Assisted reproduction IVF. induction of superovulation. gonadotrophins
or Recombinant: FSH, LH or Urinary: FSH, LH, hCG but also, which has a β chain identical
47
Par. II: Assisted reproduction IVF. induction of superovulation. GNRH analogs. agonists
or Agonists: have a greater affinity for the GnRH GNRHR, on which still more time, preventing the binding of GnRH Effects • Initial flare-up • Down-regulation of gonadotropic cells • Blocking endogenous preovulatory LH • Synchronization of follicular recruitment Regimens • Long protocol • Short protocol • Ultrashort protocol • Stop protocol
48
Par. II: Assisted reproduction IVF. induction of superovulation. GNRH analogs. antagonists
or antagonists Competitive inhibition for pituitary GnRH receptor\> 20 times greater affinity GnRH native and 2 times greater of agonisit Dose-dependent effect Immediate action after administration (hours) without flare-up Locking the spontaneous LH peak in late follicular phase
49
Par. II: Assisted reproduction IVF. induction of superovulation. GNRH analogs. antagonists advantages over the agonists
Advantages over the agonists • Rapid inhibition of premature LH peak • Minor duration of stimulation • Lower levels of E2 per day
50
Par. II: Assisted reproduction IVF. induction of superovulation. Parameters that influence the choice.basic.
• basic or Anamnestic: age medical history, previous cycles or Clinical: associated diseases (DM, hyperandrogenism, endometriosis) or biochemical and instrumental
51
Par. II: Assisted reproduction IVF. induction of superovulation. Parameters that influence the choice. in the course of stimulation.
• In the course of stimulation: evaluation ovarian response or curve increase estradiol or E2 / number of follicles after 4-6 days to stimulation
52
Par. II: Assisted reproduction IVF. induction of superovulation. monitoring of superovulation​
Monitoring of superovulation • Ultrasound • Dosage RIA-17 βestradiolo
53
Par. II: Assisted reproduction IVF. or follicular aspiration and oocyte collection
or follicular aspiration (ie aspirate and research follicle) and oocyte collection (Pick up): the removal of the ovarian follicular fluid is performed with transvaginal the use of an ultrasound-guided fine needle. Advantages are: Absence of general anesthesia Reduced operating time Minor risks Most acceptability Low cost
54
Par. II: Assisted reproduction IVF. or Recognition of gamete and embryo obtaining. IVF
IVF: you take the oocyte surrounded by cells of the corona radiata and put it Test tube with 5,000 sperm. After 18 hours it is checked whether the sperm is entered in the oocyte: this means that it must be employed a semen capacitated
55
Par. II: Assisted reproduction IVF. or Recognition of gamete and embryo obtaining. ICSI
ICSI: it takes one sperm and inject directly into the oocyte, in its cytoplasm. To do this, you must first denude the oocyte from the cells of corono radiata and the combined ooforo
56
Par. II: Assisted reproduction. IVF. embryo transfers​
or embryo transfers (no more than three embryos): the product of the process of fertilization is transferred to the uterus of the woman. The process is similar to insemination, but differs for the type of catheter used
57
Par. II: Assisted reproduction indications for it.
Indications or Male Infertility: oligoasthenospermia serious or tubal factors or idiopathic infertility or multiple female factor or immunological infertility
58
Par. 2. assisted reproduction. GIFT
GIFT It is the Gamet intrafallopian transfer, which involves the insertion of the tube through a gamete laparoscopy under general anesthesia

ginecologia (11 decks)

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