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Maternal & Newborn Care > Week 3 - Fertility > Flashcards

Week 3 - Fertility Flashcards

1
Q

WHO clinical definition of infertility?

A

disease of reproductive system defined by the failure to achieve clinical pregnancy after 12 months of regular unprotected sexual intercourse

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2
Q

WHO demographic definition of infertility 15-49 yrs ?

A

inability to become/remain pregnant within 5 yrs of exposure to pregnancy

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3
Q

WHO epidemiologic definition of infertility 15-49 yrs?

A

women at risk of becoming pregnant who report trying unsuccessfully for a pregnancy for 2 years of more

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4
Q

woman’s fertility can be affected by?

A 
age
weight
STIs/PID
endometriosis/PCOS
smoking, alcohol, recreational drugs
env. toxins/radiation/chemicals/pesticides
past use IUDs
co-morbid disease
cancer treatments
abdominal/pelvic surgery
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5
Q

at what age do most women start becoming less fertile?

A

around age 30; process speeds up at 35

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6
Q

what 4 conditions occur increasingly with higher body weight as it relates to fertility?

A

infertility
amenorrhea
anovulation
subfertility

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7
Q

what effect does adipose tissue have on ovulation?

A
  • adipose tissue is active endocrine organ
  • in obese women, leptin is increased and adiponectin is decreased => increased insulin resistance
  • androgen levels may be increased
  • these changes associated with anovulation
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8
Q

what is adiponectin?

A

protein involved in glucose regulation & FA breakdown

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9
Q

how much less likely are obese women to conceive?

A

43% less likely

obesity alone can lead to infertility despite regular cycles!

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10
Q

what is leptin?

A

satiety hormone
made by adipose cells
helps regulate energy balance by inhibiting hunger
opposed by actions of ghrelin

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11
Q

man’s fertility affected by?

A 
age
unhealthy weight
STIs
smoking, alcohol
prescription meds, OTC, recreational drugs, anabolic steroids
toxins, high temperatures
cancer tx
varicocele, etc. (things affecting pelvis)
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12
Q

male obesity is associated with low levels of which hormone?

A

testosterone

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13
Q

increased BMI is associated with increased frequency of?

A

erectile dysfunction

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14
Q

men start becoming less fertile around what age?

A

40 (sperm count & quality deterioriate)

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15
Q

when father is over 40, what is the increased risk of birth defects?

A

doubles

miscarriage, stillbirth, fetal abnormalities

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16
Q

government of ontario recommends fertility education for whom?

A

everyone in their 20s

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17
Q

when should you start monitoring a woman’s fertility when she is over age 30?

A

right away!

DONT encourage to try to conceive for a year before being tested

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18
Q

to whom should fertility testing/monitoring be offered to?

A
  • women28+ who’ve been unable to conceive after 1 year
  • women 30+ unable to conceive after 6 months
  • male partners of women undergoing testing
  • women 30+ who want to start a family - estimate ovarian reserve
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19
Q

what does a song-hysterosalpingogram assess?

A

uterus & fallopian tubes

20
Q

what does antimullerian hormone assess?

A

egg supply

AMH level unaffected by OCP & other hormones

21
Q

when during the cycle do you assess antral follicle count?

A

days 1-5

22
Q

how to you test antral follicle count? what does it test for?

A
  • vaginal u/s

- measure actual # of follicles growing at that moment in the ovaries

23
Q

what does semen analysis measure?

A
  • quantity & quality of the sperm
  • # sperm in each semen sample
  • movement & shape of sperm
24
Q

semen analysis must be conducted within how long of obtaining the sample?

A

one hour

25
Q

what is the multiple birth rate with IUI (w/COS)

A

21-29%

26
Q

what is the multiple birth rate with IVF?

A

27.5%

27
Q

who does Ontario fund IVF for?

A

~2000 IVF tx annually

only women whose fallopian tubes are blocked d/t disease or surgery

28
Q

what is the risk with multiple births?

A
  • increase risk of neonatal mortality, preterm birth, mental & physical defects
  • increase risk of maternal complications - preeclampsia, gestational diabetes, placenta previa or abruption, caesarean delivery
29
Q

what does conventional IVF tx consist of?

A
  • stimulation of ovaries using hormonal meds
  • retrieval of eggs from ovaries
  • fertilization of eggs outside the body
  • transfer of resulting embryo into uterus
30
Q

What does IUI consist of?

A
  • centrifuge separates best quality sperm from seminal fluid

- washed & filtered sperm injected into uterus when a woman is ovulating

31
Q

what is COS?

A

controlled ovarian stimulation

woman injects meds to stimulate release of more than one egg at ovulation

32
Q

what are the advantages of IUI & COS?

A

does not involve surgical procedures!

33
Q

what are the risks of fertility drugs in IUI & COS?

A

ovarian cyst formation

increased risk breast cancer or uterine cancer later in life

34
Q

what is ICSI?

A
  • intracytoplasmic sperm injection

- single high quality sperm injected directly into each egg

35
Q

how frequently is ICSI used?

A

50-70% of procedures?

36
Q

what are the disadvantages of ICSI?

A
  • may affect normal development of genitals in boys

- higher rate of sex chromosomal abnormalities than those conceived naturally or by IVF alone

37
Q

what can be frozen to preserve fertility?

A

eggs
sperm
embryos
esp. if undergoing tx such as radiation, surgery, chemotherapy

38
Q

what is Health Canada’s protocol for sperm donation?

A

donor sperm is frozen and stored for 6 months (“quarantined”)
donor re-tested for any medical issues that may make him an inappropriate donor

39
Q

what is the Assisted Human Reproductive Act?

A
  • what can be paid for
  • makes it illegal to pay for sperm, eggs or surrogacy in Canada
  • makes it illegal to act as an intermediary
  • 2004
40
Q

what are prohibited activities under the Assisted Human Reproductive Act?

A
  • creating in vitro embryo for any purpose other than creating a human being
  • human cloning
  • pre-selecting the sex
  • transplanting sperm/egg/embryo of non-human life form into a human
  • creating/transplanting a hybrid
  • using gametes without consent of donor
  • PAYING, OFFERING TO PAY OR ADVERTISING PAYMENT FOR SPERM/EGGS/IN VITRO EMBRYOS FROM DONORS OR FOR SERVICES OF SURROGATE MOTHER, INCL. 3RD PARTY
41
Q

what is traditional surrogacy?

A

birth mother is also genetic mother

42
Q

what is the intention-based approach to establishing parentage?

A

those who intend to parent regardless of genetic link are recognized as parents

43
Q

T/F? commerical surrogacy is outlawed in Canada?

A

true

44
Q

what is the success rate of IVF for women under 35?

A

47%

45
Q

IVF success rate for women 41 & 42 yrs of age?

A

25% according to Mount Sinai Hospital, Toronto

46
Q

what is the long-term health impact on a child born from ART?

A

slightly greater use of health services

no significant developmental delays

47
Q

what is the protocol for adoption process & ART?

A

families must ‘finish’ infertility tx prior to beginning adoption process, grieve their losses & prepare for lives as adoptive parents

Maternal & Newborn Care (6 decks)

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