Unit 7: conception

Question 1

What process seperates the follicular and luteal stage of development?

Answer 1

Ovulation

Question 2

What supplements are recommended as preconception advice?

Answer 2

Folic acid - prevent neural tube defects
Zn supplements - helps eggs mature and increases sperm count
Selenium - is an antioxidant, prevent damage to DNA during gamete formation, reduce the possibility of a miscarriage

Question 3

What are some temporary causes of infertility?

Answer 3

Illness - fever will increase temperature of scrotum, reduce sperm production
Medication - chemotherapy, NSAIDs, steroids.
STIs - damage the reporductive tract, particularly in males can damage the epipidymis and the urethra

Question 4

How do NSAIDs reduce fertility?

Answer 4

Reduce levels of FSH and LH
Reduced prostanoids prevents the rupture of the mature ovarian follicle, inhibits ovulation

Question 5

How do steroids reduce fertility?

Answer 5

Mimic negative feedback mechanism of testosterone of the hypothalamus, reduce the release of GnRH hence reduce FSH and LH.

Question 6

What is the term for reduced sperm count?

Answer 6

Olgiospermia

Question 7

What is the term for a zero sperm count?

Answer 7

Azoospermia

Question 8

How does stress effect fertility?

Answer 8

• altered libido
• erectile dysfunction in men
• increased cortisol triggers negative feedback, reduces ACTH, reduced sex steroids production
• inhibited FSH and LH

Question 9

How is a progesterone level test performed?

Answer 9

Typically is a blood test at GP surgery

Question 10

What will be tested in a testicular examination?

Answer 10

Physical exam by the GP on the scrotum, testes, penis and peritoneum
- lumps
- temperature
- variocele (will increase temperature)
- ensure testes have desceneded
- cough reflex may indicate a hernia

Question 11

How is a semen analysis test performed?

Answer 11

Done as regular as every 64 days
Recommend abstinence for 3 days and urination before test sample collected
Should not use a condom or sheath as this may damage the sperm
Normally done in the GP surgery if done at home must be delivered to GP surgery within 1 hour

Question 12

What are the normal values of a semen analysis?

Answer 12

Morphology = 5%
Motility - 40% or 38% progressive
Vitality - 58%
Concentration - 15 million per ml, typically gives a total of 36 million
ph - 7.2

Question 13

What are some of the risks of being older when pregnant?

Answer 13

Increased risk of multiple pregancies,
Miscarriage
Chromosomal abnormalities
Pre-eclampsia
Often require early admission into hospital for additional monitoring

Question 14

What is the average age of menapause?

Answer 14

45-55yrs old

Question 15

What are some common side effects of oral contraceptives?

Answer 15

nausea
Ovarian and breast cancer risk
Weight fluctuation
Blood clots
May link to depression

Question 16

What are the different types of oral contraceptives and how do they work?

Answer 16

Combined pill = oestrogen and progesterone
Oestrogen only pill
Work by preventing ovulation and thickening the cervical mucus
Monophasic - one pill for 21 days than none for 7 days
Phasic - different pills over 21days then none for 7 days
Placebo pills - continue to take pills in 7 days but does not contain hormone

Question 17

How does the patch work as a contraceptive?

Answer 17

Works for 7 days
Releases oestrogen and progesterone into the skin

Question 18

How does the injection work as a contraceptive?

Answer 18

Works for 3 months
Releases progesterone into the skin

Question 19

How does the implant work as a contraceptive?

Answer 19

Works for 1 year
Releases progesterone into the skin

Question 20

How does the IUD/coil work as a contraceptive?

Answer 20

Works for 5 to 10 years
Contains spermicide - copper (not if made from plastic)
Block passage into the fallopian tube
Typically only recommended for older women who have already had children

Question 21

How do ovulation predictor kits work?

Answer 21

Urine tests
Detect levels of LH
Often get a positive result from LH spike 40 hours before ovulation occurs
Identify when most likely to conceive.

Question 22

What is the advice around taking pregnancy tests?

Answer 22

Are 98% accurate when used correctly - still recommend taking two tests
hCG peaks around week 9 - when most likley to get a positive result
recommend taking on the first day of a missed period, or 21 days after the incidence of unprotected sex
False negatives can occur if the test is taken too soon.

Question 23

Describe how a pregnancy test works

Answer 23

pee over free to move blue beeds with hCG antibodies attached.
Fixed strip with monoclonal antibodies for hCG, if pregnanct hCG binds to moving blue beeds then the fixed antiboides creating a blue line
If not pregnancy will not bind so no blue line and beeds are washed off by urine
Control line - fixed antibodies that binds to blue beeds regardless if hCG is present.

Question 24

What is the difference between tests performed at the GP or at the fertility clinic?

Answer 24

GP ; mainly blood tests, urine tests and physical examinations
Fertility clinic: more specialist imaging such as ultrasound
laparoscopy - small camera to look at internal structures
HSG test - dye in womb to look for structural anomalies, mainly blockages in the fallopian tube

Question 25

What are the regulations and guidelines of IVF?

Answer 25

40yrs or above - 1 cycle, qualify after 6 months of regular unprotected sex
Younger than 40yrs - 3 cycles, qualify after 2 years of regular unprotected sex or 12 cycles of artificial insemination of which 6 cycles are intrauterine insemination

Question 26

What is the process of IVF?

Answer 26

Control Ovarian Hyperstimulation: daily injections of gonadotrophins to encourage follicle maturation, progress is monitored on an ultrasound
Mother given hCG to prepare the uterus
Surgical removal of the mature egg transvaginally under ultrasound guidance, egg will be cultured in an incubator
Intracytoplasmic sperm fertilisation
Embryo transfer at day 3 or day 5 using a soft catheter transvaginally.

Question 27

What is the process in intrauterine insemination?

Answer 27

Sperm is artificially deposited near the cervix using a speculum and a catheter.
This is cheaper but less effective than IVF

Question 28

What are the different hormonal therapies to treat infertility?

Answer 28

Sex steroids - give artificial, oesotrogen, progesterone, FSH, LH of GnRH depending on what is depleted
Clomphine - females only, stimulates gonadotrophin release and removes inhibitory effect of oestrogen
Tamoxifen - blockes oestrogen receptors, removes inhibitory effects.

Question 29

What are the regulations regarding adoption?

Answer 29

Must be 21yrs old
Must have secure home and finances
Often takes 6 to 21 months to qualify as an elegible parent before lookin for a child
Done through a local authority or a voluntary agency

Question 30

What are the regulations regarding fostering?

Answer 30

Must be 18yrs old
Most organisations will not accept until 21yrs olf
Complex approval and application process

Question 31

What is the hypothesis of the cause of puberty?

Answer 31

The hypothalamus activation pathway
Before puberty GnRH releasing neuroens recieve inhibitory signals
Leptin (found in adipose tissue) binds to LepR this activates Kiss 1 Neurones, this sends an activatory kisspeptin signal to GnRH releasing neurones in the hypothalamus
Leads to pulsatile release of GnRH