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Special Populations > Week 3 ARTS (Q. 7) > Flashcards

Week 3 ARTS (Q. 7) Flashcards

1
Q

What is the WHO definition of infertility?

A. failure to conceive after one year of unprotected sex
B. failure to conceive after two years of unprotected sex
C. failure to never conceive
D. failure to conceive post first pregnancy

A

B. failure to conceive after two years of unprotected sex

Data shows that:

23% of couples conceive > 1month 
50% > 3months
70% > 6 months
85% > 12 months
93% > 24 months
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2
Q

What are some causes of Infertility?

Hint: (SOOUUUPE)

A

SOOUUUPE

S - Sperm Antibodies
O - Ovulation Disorders
O - Oligospermia
U - Uterine Cavity Abnormalities
U - Uterine Cervix Abnormalities 
U - Unexplained Infertility 
P - Peritubal Adhesions
E - Endometriosis
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3
Q

What is Fecundability?

A

The probability of falling pregnant in a single menstrual cycle

Differs among women; differs among the same women from cycle to cycle

Age 20 - 24 have no fertility problem is between 20 and 25%

Fecundability is lower for older or subfertile populations

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4
Q

What is Fecundity?

A

Fecundity is the potential to reproduce and how much a single person can reproduce over a lifetime.

High Fecundity = Fish produce many offspring from 1,000,000 eggs per year

Low Fecundity = Hippos produce 20 offspring over 45 years

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5
Q

Nicotine from cigarette smoking in females has been linked to infertility. How?

A

Nicotine increases cervical mucus –> toxic to sperm
Alterations in tubular physiology
Decreases estrogen and altered tubular ciliogenesis
Nicotine and polycyclic hydrocarbons –> oocyte follicle destruction

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6
Q

How do narcotics increase male infertility?

A

Opiates can modify the Hypothalamic-pituitary control of gonadotropins and Prolactin

This alters the production of testosterone leading to a decrease in sperm count and quality

Also influencing libido, sexual dysfunction and menstrual irregularity

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7
Q

How does Marijuana increase male infertility?

A

THC inhibits LH, FSH and Prolactin decreasing sperm count. It also weakens the sexual drive

THC also has a direct harmful effect on the movement of sperm.

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8
Q

How does nicotine affect male fertility?

A

Alters sperm morphology

Nicotine effects -
• testicular atrophy
• blocks spermatogenesis
• alters sperm morphology

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9
Q

Investigation and Mx of Infertility

Damage to the cervix from surgery; the inability for the cervix to produce mucus to optimise sperm transit; can all be come overcome by?

A. Intrauterine Insemination
B. Donor Eggs
C. Intravenous GnRH treatment
D. Ovarian Hyper-Stimulation

A

A.. IUI - Intrauterine Insemination

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10
Q

What is the pathophysiology of Endometriosis?

A

Endometriosis is when the tissue lining the inside of the uterus grows outside the uterus.

Can cause chronic pain, internal bleeding, infertility, fatigue, bowel and urinary problems

Approx 30% of infertile patients have endometriosis

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11
Q

What is Primary Fertility and Secondary Fertility?

A

Primary = Never been pregnant

Secondary = Been pregnant in the past (does not mean a live birth has needed to take place)

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12
Q

How are malefactors tested for infertility?

A 
Semen Analysis (3-5 days after abstinence)
- volume
- sperm concentration
- azoospermia (no sperm in ejaculate)
- motility
- sperm morphology 
- sperm signalling proteins
Hormone and Genetic Testing
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13
Q

What are the 7 risk factors for infertility?

ACA ICEE

A

A - Alcohol
C- Caffeine
A - Age (35+)

I - Illicit Drug Use
C - Cigarettes
E - Excessive Exercise (underweight)
E - Environmental Factors (radiation, shiftwork, chemicals etc)

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14
Q

What are some causes of female infertility? (5)

A
  • Ovulation Disorder
  • Endometriosis
  • Pelvic Adhesions
  • Tubal Blockage/Abnormalities
  • Hyperprolactemia (excess prolactin)
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15
Q

If a male has a concentration < 2million sperm/mL they are infertile or fertile?

A

Infertile

WHO recommends normal values

  • Volume - 2mL or greater
  • Concentration - 20mil/mL
  • Motility - at least 50% + forward progression
  • Morphology - at least 30% normal form (build)
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16
Q

What are the signs and symptoms of Endometriosis?

A

Dysmenorrhea (painful heavy flow)
Dysuria (pain while urinating)
Dyschezia (pain while pooing)Dyspareunia (pain during sex)

Also

  • Chronic Fatigue
  • Infetility
17
Q

Clomiphene, Bromocriptine, Gonadotropins, and Intravenous GnRH ‘Drugs’ are used for the treatment of?

A. Low Testosterone Levels in Males
B. Anovulatory Infertility
C. Contraception
D. High Progesterone levels in Females

A

B. Anovulatory Infertility (of a menstrual cycle) in which ovulation does not occur.

Ovulation Induction
The drugs stimulate the ovaries to develop and release eggs
- the objective of producing 1- - 2 mature follicles which will ovulate
- attempts to mimic a naturally occurring process
which culminates in ovulation of a single follicle

In certain circumstances, multiple follicle stimulation is the desired

In controlled ovarian hyperstimulation utilised in conjunction with intrauterine insemination (IUI) or IVF

  • follicles can then be harvested from the woman
  • used during the in vitro fertilisation process or allow for timed ovulation for sperm to inseminated during IUI
18
Q

Ovarian Hyper-Stimulation Syndrome (OHSS)

A

E. Results in intravascular hypervolaemia

Leakage of fluid through the impaired blood vessels

  • Massive fluid-shift from the intra-vascular bed (blood vessels) to the third compartment –> results in intravascular hypovolemia with concomitant development of edema, ascites, hydrothorax and/or
    hydropericardium
19
Q

Why would the Donor Sperm Insemination technique be used for fertilisation?

Hint: 3 male physiology reasons and 1 non-male physiology reason

A

Male partner does not

  • produce sperm
  • produce normal sperm
  • high chance of genetic disease

Or same-sex marriages

20
Q

Other than a woman who cannot produce her own eggs or they are of low quality, what would be another reason for her to receive donor eggs?

A
  • High risk of passing disease or genetic abnormality

- The woman has experienced several miscarriages

21
Q

In your own words, what is the difference between

‘Intrauterine Insemination’ and ‘in-vitro fertilisation”

A

IUI has the males sperm injected through the female’s cervix and into the uterus at or just before ovulation so natural process take over

IVF- the sperm and egg are left in a culture dish for egg fertilisation –> then placed in women’s uterus

22
Q

What does the acronym GIFT mean and how is it different from IVF?

A

Gamete-Intrafallopian Transfer

  • instead of fertilisation occurring in a culture dish (IVF) the women’s eggs are retrieved from the ovaries.
  • Then an egg is inserted between two layers of sperm in fine tubing.
  • Sperm and egg are injected into the fallopian tube for natural conception
  • No longer common practice except for religious folk
23
Q

What is Intracytoplasmic Sperm Injection?

A

ICSI involves direct injection of a single sperm into each egg to achieve fertilisation

24
Q

Other than donor eggs, what is the method used to reduce the risk of potential genetic abnormalities passed to children?

A. IVF
B. GIFT
C. ICSI
D. PGD

A

D. Preimplanation Genetic Diagnosis (PGD)

Embryos generated via IVF are screened for genetic conditions. Embryos unaffected with genetic abnormalities may be selected for uterine placement

25
Q

What is the Treatment for Endometriosis?

A
  • Removal of Lesions
  • NSAIDs
  • Low Dose Oral Contraceptive Pills
26
Q

What is the Aetiology of Endometriosis?

A

Relatively unknown but suspected to be the following.

  • Retrograde menstruation = menstrual blood containing endometrial cells that flow back through the fallopian tubes.
  • Altered immune response
  • Ovarian growth factors
27
Q

What treatment artificial insemination technique is used to overcome Endometriosis?

A

IVF if severe

Woman’s Fallopian tubes are blocked or damaged.

28
Q

What are the 4 types of artificial insemination techniques?

A

Intrauterine insemination
- The implantation of semen directly into the uterine tubes.

Reasons for intrauterine insemination (male)

  • Male partner does not produce sperm
  • Male partner does not produce normal sperm
  • High risk of the male passing on genetic disease or abnormality to child.
  • Mechanical difficulties - not able to ejaculate, can not get hard

Reasons for intrauterine insemination (female)
- Women who have normal and healthy fallopian tubes, but for unknown reasons cannot conceive.

In-Vitro Fertilization (IVF)
- Woman’s eggs are collected along with sperm from either partners or donors. Eggs and sperms are left in a cultural dish to allow eggs to be fertilized, if fertilisation occurs the embryo is then placed into a woman’s uterus.

Reasons for IVF Female
- Woman’s fallopian tubes are blocked or damaged, this can be seen in severe cases of endometriosis or autoimmune disease.

Gamete Intrafallopian Transfer (GIFT)
- The process of injection, both sperm and egg directly into the fallopian tube.

Why Gamete intrafallopian transfer used?
- For cultural safety and those with religious reason to not go the IVF route.

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