Week 3 ARTS (Q. 7) Flashcards
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
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
What are some causes of Infertility?
Hint: (SOOUUUPE)
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
What is Fecundability?
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
What is Fecundity?
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
Nicotine from cigarette smoking in females has been linked to infertility. How?
Nicotine increases cervical mucus –> toxic to sperm
Alterations in tubular physiology
Decreases estrogen and altered tubular ciliogenesis
Nicotine and polycyclic hydrocarbons –> oocyte follicle destruction
How do narcotics increase male infertility?
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
How does Marijuana increase male infertility?
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.
How does nicotine affect male fertility?
Alters sperm morphology
Nicotine effects -
• testicular atrophy
• blocks spermatogenesis
• alters sperm morphology
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.. IUI - Intrauterine Insemination
What is the pathophysiology of Endometriosis?
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
What is Primary Fertility and Secondary Fertility?
Primary = Never been pregnant
Secondary = Been pregnant in the past (does not mean a live birth has needed to take place)
How are malefactors tested for infertility?
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
What are the 7 risk factors for infertility?
ACA ICEE
A - Alcohol
C- Caffeine
A - Age (35+)
I - Illicit Drug Use
C - Cigarettes
E - Excessive Exercise (underweight)
E - Environmental Factors (radiation, shiftwork, chemicals etc)
What are some causes of female infertility? (5)
- Ovulation Disorder
- Endometriosis
- Pelvic Adhesions
- Tubal Blockage/Abnormalities
- Hyperprolactemia (excess prolactin)
If a male has a concentration < 2million sperm/mL they are infertile or fertile?
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)
What are the signs and symptoms of Endometriosis?
Dysmenorrhea (painful heavy flow)
Dysuria (pain while urinating)
Dyschezia (pain while pooing)Dyspareunia (pain during sex)
Also
- Chronic Fatigue
- Infetility
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
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
Ovarian Hyper-Stimulation Syndrome (OHSS)
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
Why would the Donor Sperm Insemination technique be used for fertilisation?
Hint: 3 male physiology reasons and 1 non-male physiology reason
Male partner does not
- produce sperm
- produce normal sperm
- high chance of genetic disease
Or same-sex marriages
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?
- High risk of passing disease or genetic abnormality
- The woman has experienced several miscarriages
In your own words, what is the difference between
‘Intrauterine Insemination’ and ‘in-vitro fertilisation”
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
What does the acronym GIFT mean and how is it different from IVF?
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
What is Intracytoplasmic Sperm Injection?
ICSI involves direct injection of a single sperm into each egg to achieve fertilisation
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
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
