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Reproductive System > Common Reasons for Impaired Fertility > Flashcards

Common Reasons for Impaired Fertility Flashcards

1
Q

what are factors that may impair female fertility

A
  • biological
  • age
  • lifestyle factors and environmental exposures
  • gender affirming care
  • psychological impacts
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2
Q

define infertility

A
  • disease of male or female reproductive system defined by failure to achieve a pregnancy after 12 months or more of regular unprotected sexual intercourse
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3
Q

define primary infertility

A
  • when an individual has never achieved a pregnancy
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4
Q

define secondary infertility

A

inability to achieve a subsequent pregnancy following at least one prior pregnancy

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5
Q

prevalence of infertility

A
  • 1 in 6 people of reproductive age experience infertility
  • globally between 48 and 188 million people suffer from infertility
  • based on regional infertility prevalence, lifetime prevalence of infertility very similar no matter where you are on planet
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6
Q

does infertility prevalence matter change if from high-income country vs low- and middle-income country

A

no

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7
Q

causes of infertility (ie/ female or male or unexplained or both) for patients in A&NZ who attend IVF

A
  • female-related 39%
  • male-related 15%
  • female / male 13%
  • unexplained 30%
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8
Q

list 4 examples of ovulatory disorders which can be a biological cause of female infertility

A
  • polycystic ovary syndrome (PCOS)
  • hypothalamic dysfunction
  • premature ovarian insufficiency / premature ovarian failure
  • thyroid disorders
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9
Q

[biological causes - ovulatory disorders] describe polycystic ovary syndrome (PCOS)

A

characterised by:
- presence of multiple small follicles (containing oocytes) / cysts on enlarged ovaries
commonly observed with:
- irregular / absent menstrual cycles
- hyperandrogenism
- associated metabolic impacts
- associated psychological impacts

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10
Q

[biological causes - ovulatory disorders] describe hypothalamic dysfunction

A
  • disruption of hormone release from hypothalamus results in irregular or absent ovulation
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11
Q

[biological causes - ovulatory disorders] describe premature ovarian insufficiency / failure

A
  • occurs when ovaries stop functioning <40yrs leading to irregular or absent ovulation
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12
Q

[biological causes - ovulatory disorders] describe thyroid disorders

A
  • abnormal thyroid function - either hypothyroidism or hyperthyroidism - that can disrupt ovulation
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13
Q

[biological causes - ovulatory disorders] what is the most prevalent cause of anovulation and major contributor to infertility

A

polycystic ovary syndorme (PCOS)

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14
Q

[biological causes - ovulatory disorders - PCOS] prevalence of PCOS

A
  • 5-18% of reproductive age girls, women, and those assigned female at birth
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15
Q

[biological causes - ovulatory disorders - PCOS] is PCOS heritable?

A

yes

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16
Q

[biological causes - ovulatory disorders - PCOS] how does ethnic variation affect PCOS

A
  • manifestation
  • how it affects people
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17
Q

list 2 structural issues which can be biological causes of female infertility

A
  • tubal disorders, including blocked oviducts
  • uterine disorders
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18
Q

[biological causes - structural issues - tubal disorders] how do blockages in oviduct contribute to infertility

A
  • blockages prevent sperm from reaching ovulated oocyte in oviduct
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19
Q

[biological causes - structural issues - tubal disorders] causes of tubal disorders

A

can be caused by:
- untreated sexually transmitted infections (STIs)
- complications of unsafe abortion
- postpartum sepsis
- abdominal / pelvic surgery

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20
Q

[biological causes - structural issues - uterine disorders] list 3 types of uterine disorders and an example of which can impact female fertility

A
  • inflammatory (eg. endometriosis)
  • congenital (eg/ septate uterus - thin piece of tissue remaining in uterine cavity)
  • benign (eg/ fibroids or polyps)
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21
Q

[biological causes - structural issues - uterine disorders - inflammatory] describe endometriosis briefly

A
  • endometrial-like tissue (lesions) found outside uterine cavity
    (note: endometrial tissue = tissue that normally lines uterus)
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22
Q

[biological causes - structural issues - uterine disorders - inflammatory] symptoms of endometriosis

A

symptoms vary but commonly associated w/
- dysmenorrhoea (pain during menstruation)
- dyspareunia (pain during intercourse)
- chronic pelvic pain
- bowel disturbances

23
Q

[biological causes - structural issues - uterine disorders - inflammatory] prevalence of endometriosis

A

~10% of reproductive age girls, women, and those assigned female at birth

24
Q

[biological causes - structural issues - uterine disorders - inflammatory] is subfertility / infertility commonly associated with endometriosis incl prevalence numbers

A
  • yes
  • infertility is 30-50% higher for those with endometriosis
  • 25-50% of women with infertility have endometriosis
25
Q

[biological causes - structural issues - uterine disorders - inflammatory] what are factors of endometriosis that contribute to the associated infertility

A
  • unable to have sex at time of ovulation due to dyspareunia
  • disrupted function of oviducts due to adhesions (blockages)
  • reduced number of viable oocytes
  • endometrium is less responsibe to progesterone
26
Q

via atresia, the number of oocytes _______ with age

A

decrease

27
Q

when is highest number of oocytes present & how many

A

20wks gestation
6-7 million oocytes

28
Q

how many oocytes at birth, puberty, and age 51

A

1-2 million at birth
300,000-500,00 at puberty
1000 at age 51

29
Q

what declines gradually with age for females and at what ages is it accelerated and what age thereafter does it decrease more rapidly

A
  • fertility
  • accelerates ~32yrs
  • decreases more rapidly after ~37yrs
30
Q

what other decline occurs with oocytes with age

A
  • decline in oocyte quality
31
Q

since oocyte quality declines with age, what trend is seen regarding live birth outcomes of eggs

A
  • live birth outcome is dependent on age of oocyte
  • with increasing age, see decrease in chance of a live birth
  • note: if donor egg is used, patient carrying embryo ageing is not significant to live birth occurring
32
Q

lifestyle factors of substance abuse that can affect fertility - list 4

A
  • alcohol
  • smoking
  • illicit drugs
  • prescription medications
33
Q

[lifestyle factors - substance abuse] describe alcohol use regarding fertility

A
  • excessive alcohol consumption
  • can disrupt ovulation and menstrual cycle
    => impairs infertility
34
Q

[lifestyle factors - substance abuse] describe smoking regarding fertility

A
  • smoking associated w decreased ovarian reserve (lower quantity and / or quality of oocytes) and premature ovarian ageing
    => incr risk of infertility
35
Q

[lifestyle factors - substance abuse] describe illicit drugs regarding infertility

A
  • use of various drugs incl marijuana, cocaine
  • associated w irregular menstrual cycles and reduced fertility
36
Q

[lifestyle factors - substance abuse] describe prescription medications regarding infertility

A
  • some medications when abused can negatively affect fertility
37
Q

environmental factors of toxins that can affect fertility - list 3

A
  • environmental pollutants and toxins
  • occupational exposures
  • plastics / cosmetics
38
Q

[environmental factors - toxins] describe what kinds of exposures to environmental pollutants and toxins can impact fertility

A
  • pesticides
  • heavy metals
  • industrial chemicals
    may disrupt hormonal balance
39
Q

[environmental factors - toxins] describe what kind of occupational exposures can impact fertility

A
  • workplace exposures including in manufacturing or agriculture may pose risks
40
Q

[environmental factors - toxins] describe how plastics / cosmetics can impact fertility

A
  • some plastics and cosmetics contain endocrine-disrupting chemicals
  • that can interfere w hormone signalling
    => negatively affect fertility
41
Q

environmental factors of cancer treatments that can affect fertility - list 4

A
  • chemotherapy drugs
  • radiation therapy
  • surgery
  • hormone therapies
42
Q

[environmental factors - cancer treatment] describe how chemotherapy drugs can impact fertility

A
  • chemotherapy drugs can damage oocytes
  • leading to diminished ovarian reserve
  • varies based on drug type, drug dosage, patient age
43
Q

[environmental factors - cancer treatment] describe how radiation therapy can impact fertility

A
  • pelvic radiation may affect ovaries
  • causing damage to oocytes
    => reducing fertility
  • dependent on radiation dose and area treated
44
Q

[environmental factors - cancer treatment] describe how surgery impacts fertility

A
  • removal (partial or whole) of reproductive organs or structures may impact fertility
45
Q

[environmental factors - cancer treatment] describe how some hormone therapies used in cancer treatment can impact fertility

A
  • some hormone therapies used in cancer treatment may cause temporary or permanent fertility
46
Q

what does gender affirming care for transgender men and non-birnary people involve

A
  • involves use of hormone therapy to achieve testosterone levels that is within typical range for cisgender males for patient to obtain desired level of masculinisation
47
Q

are the effects of prolonged androgen (testosterone) exposure in gender affirming care on fertility known & what has this led to clinically

A
  • no, remain unknown
  • thus, clinical consensus that fertility preservation occur before hormone treatment
48
Q

how can psychological stress disrupt hormones

A
  • stress leads to release of cortisol
  • cortisol can interfere w reproductive hormones
49
Q

[psychological factors] what can chronic stress result in

A
  • chronic stress can lead to irregular menstrual cycles or amenorrhoea (absence of menstruation)
50
Q

[psychological factors] how can stress lead to impaired ovulation

A
  • stress can negatively impact hypothalamus
  • which is region of brain involved in regulation and induction of ovulation
51
Q

[psychological factors] what can prolonged stress result in

A
  • prolonged stress may reduce oocyte quality
52
Q

list risk factors for female infertility

A
  • advanced age
  • smoking / tobacco
  • medical conditions (eg/ endometriosis, polycystic ovary syndrome)
  • certian medical treatments (eg/ cancer treatments)
  • STIs
    (+)- weight (over or under)
53
Q

in gender affirming care for transgender men and non-binary people, if fertility preservation is begun after androgen therapy, what does it require

A
  • requires pausing testosterone administration -> can cause psychological stress

Reproductive System (21 decks)

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