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Unit 7: LGS > Week 4 > Flashcards

Week 4 Flashcards

1
Q

Define Infertility

A
  • lack of conception despite regular intercourse w/o use of contraception for 1 year
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2
Q

Subfertility

A
  • a decrease, but not an absence, of fertility potential
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3
Q

Sterility

A
  • complete inability to achieve fertility
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4
Q

Fecundity

A
  • probability of achieving a live birth in one menstrual cycle
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5
Q

2 things related to age-related decrease in rate of conception
- age

A
  • decrease in embryo quality
  • decrease in coital frequency
  • 35-45
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6
Q

Fertility factors in male

  • urethral meatus
  • testicle size
  • varicocele
  • meds
  • surgery/trauma
  • gential tract infections
  • CF
  • other
A
  • abnormal location -> deposition of sperm in a less favorable location during intercourse
  • smaller testicles produce less sperm
  • dilation and incompetence of spermatic veins -> testes need optimal temp and this will keep temp higher than normal leading to impaired spermatogenesis
  • furantoins: used for UTIs, CCBs, Exogenous steroids
  • Radiation, Chemotherapy, Inguinal hernia surgery, Lead exposure
  • Prostatitis, Mumps orchitis
  • CF: mucus plugging; ciliary dyskinesia: sperm cannot be moved because there is no beating of the cilia–> abnormal transport of semen/sperm
  • hot tub and tight briefs
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7
Q

Labs ordered to test males fertility ability

  • how many times
  • when?
A
  • sperm volume
  • sperm concentration, morphology, motility, and vitality
  • sperm transport disorder
  • 3x
  • after 2-4 days of abstinence
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8
Q

Male endocrine eval for fertility

  • LH, FSH, Testosterone
  • Prolactin
  • Thyroid
  • FSH
A
  • Low LH, FSH, or testosterone: indicate hypothalamic pit failure
  • elevated: prolactin producing tumor and prolactin inhibits GnRH which will decrease LH and FSH resulting in decreased spermatogenesis
  • Hypothyroidism can cause infertility
  • elevated, indicated parenchymal damage to the testes -> inhibin is produced by the sertoli cells of semineferous tubules -
    > provides principle feedback control of FSH secretion
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9
Q

Define coitus

  • what to avoid

- recommendation after?

A
  • intercourse approx every 1-2 days during periovulatory period (days 12-16 of of 28 day cycle)
  • avoid toxic lunbricants and use non-toxic lubricant
  • woman should lie on her back for at least 15 min to prevent rapid loss of semen from vagina
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10
Q

How male coital factors can be improved

  • low sperm density/ motility due to hypo-pit failure
  • hyperprolactinemia
  • Abnormal semen vol and sperm count
A
  • injection of human menopausal gonadotropins -> made from urine of menopausal women (includes FSH and LH)
  • dopamine agonist (bromocriptine or cabergoline)
  • sperm washing (small volume by centrifugation and large numbers of sperm placed within the uterus. If there is any antigenic material or sperm antibodies in the seminal fluid, sperm washing is useful) and intrauterine insemination
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11
Q

For which causes of female infertility is temperature tracking useful?

  • For which causes is it not useful?
  • other investigations to r/o peggys ovulation
  • How is endometrial biopsy related to ovulation?
A
  • Useful: when you’re trying to figure out if ovulation is a problem
  • Not useful: if there are any structural abnormalities in the fallopian tubes or uterus
  • serial measurement of urinary LH, mid-luteal level of serum progesterone, endometrial biopsy, serial pelvic US (r/o tubal blockage or intrauterine abnormalities)
  • If the woman is ovulating, there is thickening of the endometrium and you can test hormonal levels from the sample tissue
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12
Q

How to induce ovulation if patient is not ovulating regularly?

  • luteal insufficiency
  • pituitary insufficiency
  • hypothalamic amenorrhea
  • hyperprolactinemia
  • PCOS
A
  • clomiphene citrate or gonadtropins
  • injection of hMG
  • SC or IV GnrH in small pulses every 90-120 minutes
  • dopamine agonists (bromocriptine or cabergoline)
  • laprascopic ovarian drilling
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13
Q

Spinnbakeit test

  • looking for
  • how?
A
  • watery cervical mucus a few days before ovulation

- touch mucus with piece of pH paper and life vertically -> mucus should extend in a thread to at least 6 cm

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14
Q

Postcoital (Sims-Huhner) test

  • when is it done?
  • what is it used for?
  • how often is it used?
A
  • performed 2-12 hrs after intercourse
  • assess number and motility of spermatazoa that have entered the cervical canal
  • analyze interactions between sperm and cervical mucus
  • not used very often
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15
Q

Investigation and tx of pt with antibodies in cervical mucus that destroy larrys sperm

  • not meds
  • meds
A
  • Sperm washing and IUI –> Ab in cervical mucus can react with antigens in semen which can decrease sperm motility. Sperm wash can remove non-sperm components.
  • antibiotic for both partners (doxycycline)–> cyrotherapy if antibiotics do not help and cervicitis persists
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16
Q

Uterine and tubal factors leading to infertility

  • 3
  • labs
  • tx
A
  • submucosal myomas or endometrial polyps
  • Myomectomy
  • Tubal occlusoin: finmbrial end, mid-segment or isthmus cornu
  • hysterocalpingography: radiologic procedure to investigate the shape of the uterine cavity and the shape and patency of the fallopian tubes. This means it is a special x-ray using dye to look at the womb (uterus) and Fallopian tubes. It injects a radio-opaque material into the cervical canal and usually fluoroscopy with image intensification. A normal result shows the filling of the uterine cavity and the bilateral filling of the fallopian tube with the injection material.
  • microsurgical tuboplasty OR laprascopic neosalpingostomy for fimbrial occlusion (making a new opening for the fallopian tubes )
17
Q

Peritoneal factors that can cause infertility

  • how?
  • meds
  • other tx
A
  • endometriosis: interfere with tubal motility, cause tubal obstruction, or cause adhesions
  • adhesions hold the fimbriae away from the ovarian surface so it can’t grab the oocyte
  • Danazol, GnRH analogues (agonists and antagonists) or oral medroxyprogesterone acetate
  • laprascopic surgery to remove endometriosis, adhesions and endometriomas
18
Q

Unexplained factors of infertility

- Treatment

A
  • defect in sperm transportation
  • defect in ability of sperm to fertilize the egg
  • presence of anti-sperm antibodies
  • minimal endometriosis
  • mildly reduced ovarian reserve
  • IUI w/ washed sperm and controlled ovarian stimulation to increase rate of conception
19
Q

Major Assisted Reproductive Technologies (5)

A
  • ovarian stimulation +/- intrauterine insemination
  • in vitro fertilization
  • intracytoplasmia sperm injection: gets around transportation issues
  • embryo trnasfer +/- embryo freezing
  • oocyte donation
20
Q

Technique used for IVF

A
  • GnRH is given in mid-luteal phase to prevent pre-mature ooctye development from LH increase
  • stimulation of ovaries by FSH which leads to….
  • oocyte maturation
  • ovulation
  • oocyte retrieval
  • fertilization
  • transfer of embryo to uterus
21
Q

Contrast IVF with embryo transfer to standard IVF

- when is one used over the other

A
  • the IVF with embryo transfer is with eggs from donor and needs hormone supplementation until end of first trimester
  • in absence of ovaries use IVF w/ ET
22
Q

Outcomes of ART

  • mean conception rate
  • mean live delivery rate
  • rate of ectopic pregnancy
  • percent able to conceive with ART
A
  • 50-60% infertile couples
  • 30-40%
  • 2-3% compared to 1% with natural conception
  • 80-85% are able to conceive -> and success rate has improved each year
23
Q

NaPro Technology

  • stands for?
  • what is it?
  • what is given?
  • outcomes vs IVF
A
  • Natural Procreative Technology
  • a more in depth assessment for infertility, will have considerable amount of data to look at how the hormones proceed over time in combo with the rest of the ovulatory cycle –> leads to a more fine tuned assessment of the cycle and it gives us a better assessment at the patient’s potential factors that could be obstructing fertility
  • Rather than giving supraphysiologic doses of hormones, it would be just physiologic hormones to encourage natural procreative process rather than superseding it
  • rate for NaPro was 70-80% versus IVF at 50-60%
24
Q

Types of counseling for infertile couples

  • patient centered care
  • infertility counseling
  • psychotherapy
A
  • information gathering and analysis, implications and decision making counseling
  • implications and decision making counseling, support counseling, crisis counseling
  • crisis counseling and therapeutic counseling
25
Q

What tools are available for counseling infertile couples

  • SCREENIVF
  • FertiQo:
  • FertiSTAT
  • PCRI
A
  • predict treatment distress
  • assess impact of infertility on quality of life
  • learn about and engage in behavior change to optimize fertility
26
Q

What are risk factors for Pt’s experiencing distress

A

○ Multiple failed attempts
○ Sexual dysfunction
○ Menstrual irregularity

27
Q

Avoidance coping strategies

  • what is it?
  • such as?
  • does it work?
A
  • avoiding potential triggers
  • baby showers, events where people are celebrating having kids, social media, seeing people with children, etc.
  • maladaptive way of coping, it actually makes it worse
28
Q

How can some of these situational/social factors play into infertility related distress?
- recommend?

A
  • Relationship difficulty: especially if it was present prior
  • Couples therapy can be helpful
29
Q

Gender differences in infertility counseling

A
  • women: more emotionally affected and willing to seek treatment but also at greater risk for avoidance of coping strategies
  • men: less willing to seek treatment; tend to focus on problem-solving strategies.
30
Q

Sexual dysfunction in infertility counseling

  • women
  • men
  • both
A
  • decrease in sexual desire/satisfaction and severe marital strain
  • decreased ability to control ejaculation, lower levels of sexual satisfaction, lower self-esteem and increased feelings of anxiety
  • loss of control and confidence in body as well as a sense of failure in themselves
31
Q

Considerations for counseling about third party conception

A
  • provide alternative perspective such as adoption, foster-care, or living a life without children
  • discuss issues such as legal parenthood, the need to adopt a child after surrogacy, and the right of offspring to access information of the gamete donor and/or surrogate

Unit 7: LGS (4 decks)

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