Week 3 - Fertility Flashcards
WHO clinical definition of infertility?
disease of reproductive system defined by the failure to achieve clinical pregnancy after 12 months of regular unprotected sexual intercourse
WHO demographic definition of infertility 15-49 yrs ?
inability to become/remain pregnant within 5 yrs of exposure to pregnancy
WHO epidemiologic definition of infertility 15-49 yrs?
women at risk of becoming pregnant who report trying unsuccessfully for a pregnancy for 2 years of more
woman’s fertility can be affected by?
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
at what age do most women start becoming less fertile?
around age 30; process speeds up at 35
what 4 conditions occur increasingly with higher body weight as it relates to fertility?
infertility
amenorrhea
anovulation
subfertility
what effect does adipose tissue have on ovulation?
- 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
what is adiponectin?
protein involved in glucose regulation & FA breakdown
how much less likely are obese women to conceive?
43% less likely
obesity alone can lead to infertility despite regular cycles!
what is leptin?
satiety hormone
made by adipose cells
helps regulate energy balance by inhibiting hunger
opposed by actions of ghrelin
man’s fertility affected by?
age unhealthy weight STIs smoking, alcohol prescription meds, OTC, recreational drugs, anabolic steroids toxins, high temperatures cancer tx varicocele, etc. (things affecting pelvis)
male obesity is associated with low levels of which hormone?
testosterone
increased BMI is associated with increased frequency of?
erectile dysfunction
men start becoming less fertile around what age?
40 (sperm count & quality deterioriate)
when father is over 40, what is the increased risk of birth defects?
doubles
miscarriage, stillbirth, fetal abnormalities
government of ontario recommends fertility education for whom?
everyone in their 20s
when should you start monitoring a woman’s fertility when she is over age 30?
right away!
DONT encourage to try to conceive for a year before being tested
to whom should fertility testing/monitoring be offered to?
- 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
what does a song-hysterosalpingogram assess?
uterus & fallopian tubes
what does antimullerian hormone assess?
egg supply
AMH level unaffected by OCP & other hormones
when during the cycle do you assess antral follicle count?
days 1-5
how to you test antral follicle count? what does it test for?
- vaginal u/s
- measure actual # of follicles growing at that moment in the ovaries
what does semen analysis measure?
- quantity & quality of the sperm
- # sperm in each semen sample
- movement & shape of sperm
semen analysis must be conducted within how long of obtaining the sample?
one hour
