Test 2 Infertility Flashcards
Define infertility…
No conception >1 yr unprotected sex - 6 months if woman >35
Inability to carry a pregnancy to live birth
Involuntary ability to conceive when desired
Dif between Primary & Secondary Infertility…
Prime = never could
Secondary = have before, cant now
Is a lesbain considered infertile…
Yes.
She lacks the male partner
PGS
Preimplantation Genetic Diagnosis
Average sperm per ejaculation….
Normal conception requires ______ sperm / ml with normal motility
Sperm count & infertility
Mild
Mod
Severe
Average = 400 million
Conception requires 20 / ml Norm Motility
Mild 15 - 20 / ml 35 - 50 % Motility
Mod 5 - 10 / ml 20 - 35% Motility
Severe <5 / ml or <20% Motility
Illness, mumps, cirrhosis, renal failure
Genital infection
Varicocele
Exposure to Toxins
Drugs
Elevated scrotal temp, saunas, hot tubs
Autoimmune response
Factors that affect sperm
DM Peripheral vascular disease
Antihypertensive meds
CNS dysfunction, drugs, psych problems,
Surgery to spinal cord
Erection problems
Ab normal Ejaculation
Retrograde Ejaculation…
Hypospadias….
Retrograde Ejaculation: Ejaculation goes backwards into bladder
Hypospadias: Urethral opening on underside of penis
What can go wrong with seminal fluid to cause infertility…
Stay Coagulated.
Normally Coagulates then liquifies within 30 mins.
Test male or female first to determine infertility with couple…
How?
Male
Semen analysis (Structure, Volume, Motility)
Endocrine (Testosterone)
US Genital
Testicle biopsy
Women born with all their eggs
Decline in # through the lifetime
7 million at birth
300,000 at puberty
Few thkusand late 30’s
T or F
T
Normal ovulation
The following is the order of events in ovulation.
Hypothalamus (Secrets / Which Does)
Pituitary (Hormones)
Hypothalamus secrets GnRH Gonadotropin-Releasing Hormone
GnRH stimulates the Pituitary
Pituitary releases FSH (Follicle-stimulating hormone) & luteinizing hormone (LH)
Name the hormone
Stimulates maturity of several follicles - small fluid-filled sac in the ovaries. Contains an immature egg (oocyte).
As Follicles mature the ovary releases estrogen to thicken the endometrium
Follicle stimulating hormone
FSH
Follicle contains an immature egg which will mature with help from FSH.
As the Follicle matures the ovary secrets estrogen, why?
To thicken the endometrium
Luteinizing hormone
24 - 36 hrs prior to ovulation, LH increases
What is the purpose of LH…
Stimulates final maturation and release of the ovum (Mature female egg cell)
______ is a mature egg cell that is part of the female reproductive system.
It is the female gamete (reproductive cell) and carries half the genetic material needed for reproduction.
When fertilized by a sperm cell, the ovum can develop into a zygote, the first stage of a developing embryo.
An ovum (plural: ova)
Collapsed follicle from which the ovum was released.
Produces Progesterone & Estrogen which preparss the endometrium for implantation
Corpus luteum
Estrogen builds the house (uterine lining) during the first half of the cycle.
Progesterone keeps the house ready for a baby after ovulation.
True
Match to appropriate Structure.
GnRH (Stimulates Pituitary Gland to release FSH & LH)
FSH (Stimulates ovary which causes maturation of follicles) & LH (Stimulates ovary and final maturation and release of ovum)
As follicle matures Estrogen is released (thickens endometrium)
Progesterone & Estrogen (Prepares endometrium for implantation)
Ovary, Pituitary, Corpus luteum, Hypothalamus
Hypothalamus
GnRH (Stimulates Pituitary Gland to release FSH & LH)
Pituitary
FSH (Stimulates ovary which causes maturation of follicles) & LH (Stimulates ovary and final maturation and release of ovum)
Ovary
As follicle matures Estrogen is released (thickens endometrium)
Corpus luteum
Progesterone & Estrogen (Prepares endometrium for implantation)
GnRH ….
FSH….
LH….
Progesterone & Estrogen….
(Prepares endometrium for implantation)
(Stimulates ovary which causes maturation of follicles)
(Stimulates Pituitary Gland to release FSH & LH)
(Stimulates ovary and final maturation and release of ovum)
GnRH (Stimulates Pituitary Gland to release FSH & LH)
FSH (Stimulates ovary which causes maturation of follicles) & LH (Stimulates ovary and final maturation and release of ovum)
As follicle matures Estrogen is released (thickens endometrium)
Progesterone & Estrogen (Prepares endometrium for implantation)
Oligoovulation / Anovulation
Commonly, lack of FSH
Are common causes of female infertility
Tx…..
Clomiphen (Clomid)
Anti-estrogen - Blocks effects of estrogen
Pituitary notices lack of precieved estrogen & secrets more FSH & LH to índuce ovulation
Purpose of Clomiphen Citrate (Clomid) - an Anti-estrogen medicine
Induce ovulation
It blocks body from sensing estrogen which makes body increase FSH & LH
Partial fallopian tube obstruction may result in…
Ectopic pregnancies
STD
Endometriosis
Scarring from PID,surgery, peritonitis
Ovarian cysts
Congenital anomalies
Fallopian tube problems
AMA
Percent chance of getting preggers at
30
40
30- 20% chance
40- 5%
Ovaries enlarged with multiple small cysts.
Irregular menstruation / impaired fertility
High Risk for miscarriage
Excessive testosterone production gives Hair & Skin (Acne) issues
Increased Risk of developing DM
Obesity/ Heart Disease
Polycystic Ovary Syndrome
PCOS
TX for PCOS
Polycystic Ovarian Syndrome
Clomid / Femara
Trouble ovulating. It is often prescribed for infertility and is considered one of the first-line treatments for women with conditions like polycystic ovary syndrome (PCOS) or other ovulation-related problems.
Clomid (Clomiphene citrate)
Clomid blocks the effects of estrogen in the brain. This tricks the brain into thinking estrogen levels are low, prompting the pituitary gland to release more follicle-stimulating hormone (FSH) and luteinizing hormone (LH).
These hormones (2)
Help follicles in the ovaries grow.
Trigger ovulation (release of an egg).
Causes of repeated pregnancy loss
- Abnormal fetal chromosomes - SAB 1st trimester
Chromosomal analycist frequently order on fetuses delivered 2nd / 3rd trimester
- Abnormalities of cervix or uterus
Uterine myomas (Benign) and adhesions may have this affect on pregnancy (2)
Alter perfusion
Preterm labor
Basal body temperature
Day 1: Your period starts.
Days 2–13: Your temperature stays around 97.2°F to 97.5°F.
Day 14: Ovulation happens (you don’t feel it). The next morning, your temp jumps to 98.0°F.
Days 15–28: Your temp stays high (98.0–98.3°F).
Day 29: If you’re not pregnant, your temp drops, and your period starts again.
What is your body temperature when you can get preggers…
A few days before the temperature increase (Ovulation)
BBT is lowest rest body temperature
1st half menstrual cycle is lower than 2nd half (when ovulating / fertile)
BBT DROPS JUST SLIGHTLY BEFORE OVULATION & RISES DURING OVULATION/ PREGGERS
T or F
T
Spinnbarkheit ….
How much cervical mucus can be stretched between fingers or slide / slip cover
Just before / after ovulation MUCUS IS SCANT, THICK, STICKY and opaque Stretches <6cm
Prior & 2-3 days after ovulation MUCUS IS THIN, SLIPPERY, AND CLEAR - resembles egg-white, stretches >6cm
MUCUS IS SCANT, THICK, STICKY and opaque Stretches <6cm
MUCUS IS THIN, SLIPPERY, AND CLEAR - resembles egg-white, stretches >6cm
Which one is more likely to get preggers…
Just before / after ovulation MUCUS IS SCANT, THICK, STICKY and opaque Stretches <6cm
Prior & 2-3 days after ovulation MUCUS IS THIN, SLIPPERY, AND CLEAR - resembles egg-white, stretches >6cm
Egg whites gets preggers
Antihistamine, vag infection, contraceptive foams, Sexual arousal, semen, Clomid
All hav3 an influence on….
Cervical mucus assessment
Ovulation prediction (BBT, Cervical Mucus, Serum progesterone lvl)
Pelvic US
Postcoital test: Evaluate Cervical mucus / sperm function
Endocrine test
Hysterosalpingography: Patency verfied by contrast medium & US (Can unclog passage way & help with pregnancy)
Endometrial biopsy
Hysterscopy (go inside with a scope & clear out any scarring)
Laproscopy (go inside with a scope & clear out any scarring)
Used for…
Test for female infertility
Infertility Meds
Corrects excessive prolactin secreted by the Anterior Pituitary & Increased ovulation & stimulates progesterone secretion by corpus luteum
Causes ovulation, increase GnHr secretion from the hypothalamus, thus increasing FSH & LH
Increased blood flow to the penis, Erection
Clomiphen citrate (Clomid)
Bromocriptine (Parlodel)
Sildenafil (Viagra)
Bromocriptine (Parlodel)
Corrects excessive prolactin secreted by the Anterior Pituitary & Increased ovulation & stimulates progesterone secretion by corpus luteum
Clomiphen citrate (Clomid)
Causes ovulation, increase GnHr secretion from the hypothalamus, thus increasing FSH & LH
Sildenafil (Viagra)
Increased blood flow to the penis, Erection
Corrects excessive prolactin secreted by the Anterior Pituitary & Increased ovulation & stimulates progesterone secretion by corpus luteum
Bromocriptine (Parlodel)
Causes ovulation, increase GnHr secretion from the hypothalamus, thus increasing FSH & LH
Clomiphen citrate (Clomid)
Increased blood flow to the penis, Erection
Sildenafil (Viagra)
Infertility meds
Stimulates ovulation in female/ sperm production in males. Stimulates production of progesterone by corpus luteum
Reduces endometriosis (2)
Leuprolide (Lupron)
Nafarelin (Synarel)
Chorionic Gonadotropin (hCG, Pergonal)
Chorionic Gonadotropin (hCG, Pergonal)
Stimulates ovulation in female/ sperm production in males. Stimulates production of progesterone by corpus luteum
Leuprolide (Lupron)
Nafarelin (Synarel)
Reduces endometriosis (2)
Chorionic Gonadotropin (hCG, Pergonal)
Stimulates ovulation in female/ sperm production in males. Stimulates production of progesterone by corpus luteum
Leuprolide (Lupron)
Nafarelin (Synarel)
Reduces endometriosis
(First Line) artificial inseminación
Use clomiphen for best results
Hormone levels are closely monitored
US to evaluate follicle (goal 2-3)
Semen sample is obtained & washed, then inserted through cervix and placed high in the uterus
Interuterine Insemination (IUI)
Putting sperm & egg together in the fallopian tube via Laproscopic procedure.
Give woman progesterone
Name process…
Gamete Intrafallopian Transfer
Rarely done
Bypasses blocked or Absent fallopian tubes
Ova & Sperm are mixed together in lab
2 - 5 days later embryos are returned to the UTERUS
Give progesterone to promote implantation
Excess embryos maybe frozen
Issue of Concern: Multiple concpetions, may require selective reduction.
Im Vitro Fertilization IVF
Intracytoplasmic Sperm Injection (ICSI)
Describe….
Required if you do Genetic Testing
IVF
But, single sperm is injected into egg
BUFA
Baby up for adoption
Open vs Closed adoption
Open = Regular contact with birth mother
Closed = NO Contact
(Estrogen / Progesterone)builds the uterine lining.
( Estrogen/Progesterone) fine-tunes and maintains it, ensuring it’s ready for implantation and early pregnancy support.
If fertilization doesn’t happen, hormone levels drop, and the uterine lining sheds as a period.
Estrogen builds the uterine lining.
Progesterone fine-tunes and maintains it, ensuring it’s ready for implantation and early pregnancy support.
