FERTILITY TESTING Flashcards by Queenie Mae

If a woman gets pregnant and ALWAYS experiences a miscarriage or still births = still considered as __ and is fairly common

INFERTILITY

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Used to know whether an individual is capable of conceiving. Assess inability of males and females to conceive after 1 yr. of trying (unprotected sex, w/o contraceptives)

fertility testing

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Infertile couple’s chance of conception:
20% conceive in a _
50% in _
75% in _
90% in a _

month
3 months
6 months
year

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– no. of pregnancies

Gravidity / gravida (G)

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– no. of births of viable offspring

Parity / para (P)

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–no.of abortions

Abortus(Ab/A)

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– no pregnancy at all

Nulligravida gravida 0

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– one pregnancy

Primigravida gravida 1 (G1)

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has never gotten pregnant, couples unable to conceive even after 1 month of trying

PRIMARY INFERTILITY (G0P0)

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Has been pregnant previously but currently cannot get pregnant or unable now

SECONDARY INFERTILITY

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2 pregnancies but 0 successful delivery

: G2P0

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two pregnancies, no babies since there are 2 abortions

gravida 2, para 0, abortus 2

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PURPOSE of SEMEN ANALYSIS

for FERTILITY TESTING (collect 2-3 samples with 2 weeks interval),
for POST VASECTOMY (if still capable of producing sperm)
for forensic analysis (alleged rape)

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METHOD OF COLLECTION:

MASTURBATION or SELF-PRODUCTION
Coitus Interruptus
Condom Method
Vaginal Vault Aspiration

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PRIOR TO COLLECTION of SEMEN ANALYSIS
ABSTINENCE _
NOT >5 days causing an increase in _ but decrease IN _, diff. _ (DID NOT ABSTAIN will decreased in vol)
It assesses whether there is a problem on the _

2-3 days
volume
motility
color
ejaculation

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Used if the patient has _, it is when semen entered the bladder instead of emerging thru the penis during the orgasm but it is still possible to reach the sexual climax but in little or no amount of semen at all termed as _

POST-EJACULATE URINE SAMPLE
- retrograde ejaculation
- dry orgasm

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The semen/sample must be transported in lab within _ after the collection at temperature _→ because _ will be performed

30-60 mins
37C
liquefaction

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Performed after liquefaction

Viscosity
Volume: >2ml (2-5ml) and it depends on the abstinence
Semen pH: slightly ALKALINE (7.2-7.8)

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Sperm concentration
we usually use either the WBC squares/ RBC squares
 2 WBC squares must be read
 5 RBC squares must be read

Normal:

20-160 million/ml

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Semen analysis Diluting fluids:

cold water (most commonly used),
sodium bicarbonate,
formalin

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Sperm Count

Normal count: at least _

40 million/ejaculate

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 If no sperm is seen in association with low semen volume, perform _, as it can be found in the semen its purpose is to confirm the presence of fluid from the seminal vesicle and to rule out _ in post-ejaculate urine

FRUCTOSE TEST
- retrograde ejaculation

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50% shows moderate to strong forward motion or movement it is performed on a well-mixed liquefied semen within _ of specimen collection
_ is usually used, for estimation, where it is being graded

Sperm Motility
1hour
Hanging drop motion

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sperm motility grading

 Grade 4: rapid straight
 Grade 3: slower speed, some lateral
 Grade 2: slow, noticeable lateral
 Grade 1: no forward
 Grade 0: no movement at all

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Sperm Motility If the motility <50%: perform _, where _ are used, they will stain the sperm whether the sperm is still alive or  Dead: _  Alive: _ Sample that has no visible sperm needs to be _ and examined if there’s an Impact or damage sperm fragments and test will be repeated in _

SPERM VIABILITY - Eosin Y & Nigrosin stains - RED - BLUISH WHITE OR COLORLESS - centrifuged - 4- 6 months

Sperm Morphology Routine: _ Strict: _ _are being evaluated Stains used: _,_,_ Possible appearance of sperm if not normal (picture)

>50% normal >30% normal forms 200 sperms Wrights, Giemsa, Papanicolaou

measurement of average # of defects per sperm → could be used to improve the correlation between sperm morphology and fertility

Teratoazoospermic index (TZI)

When sperms are _, they tend to STICK to each other either head-to-head, tail to tail, midpiece to midpiece or mix ways (head to tail, midtail to head, etc.) The _ actually PREVENTS the sperm from swimming through the cervical mucus Distinguish clumping due to bacterial infection or tissue debris because typically it involves non-specific orientation of sperm, which is the immunologic cause of infertility.

Sperm Agglutination - motile - CLUMPING

Direct or indirect mixed agglutination reaction (MAR) for screening test to detect _ or _

IgG or IgA

SPERM AGGLUTINATION grade

grade 0 no adhhesion grade 1 isolated <10% grade 2 moderate <30% grade 3 large <50%

Detect all three Ig classes (_,_,_ ) and when beads are coated with monospecific antisera to each class

IMMUNOBEAD ASSAY IgG, IgM, IgA

Purpose: it demonstrates the sperm affected. If its tail, head or the midpiece.

IMMUNOBEAD ASSAY

–abnormality/LOW sperm concentration

Oligospermia

– LOW sperm motility, DYSMOTILITY

Asthenospermia

– ABNORMALITY in sperm MORPHOLGY

Teratospermia

Locate DAMAGE or BLOCKAGE in male reproductive tract which includes _,_ _

ULTRASOUND/ULTRASONOGRAPHY - prostate, seminal vesicle and ejaculatory duct

COST EFFECTIVE & NON-INVASIVE and could potentially uncover the underlying pathologies that are not usually seen during regular physical exams of men. MORE ACCURATE to help in performing successful treatment

ULTRASOUND/ULTRASONOGRAPHY

For the mixed-sex couples, usually for the infertility diagnosis, they consult in _ for them to know the options for the fertility testing.

ANDROLOGY specialist reproductive urologist

General rule for fertility testing:

MALE patient to UROLOGIST FEMALE patient to GYNECOLOGIST

Taking tissue sample from 2 testicles which produces sperm and male sex hormone (testosterone) for lab analysis

TESTICULAR BIOPSY

is used to determine whether sperm production problem is caused by blockages; Use _ for IVF Used to diagnose _or determine cause of _

Testicular biopsy - sperm - testicular cancer - lump in the testes

Usually patients are _, it can be performed FAST in the clinic; takes _ to be performed by the doctor or other trained professionals After biopsy, the patient must AVOID _; if the area is swollen, you can use _ RECOVERY: it is NORMAL to have DISCOLORATION and BLEEDING, and even DISCOMFORT for a FEW days RESULT: it will be analyzed under a microscope; the _ will be the one to identify or detect the px’s sperm production and development

TESTICULAR BIOPSY - OUTPATIENTS - 15-20 minutes - aspirin acetaminophen PATHOLOGIST

Evaluate condition of vas deferens and ejaculatory ducts Some doctors use_ for easy visualization injected to vas deferens and ejaculatory ducts _ is taken as the dye flows through ejaculatory ducts Only performed when there are ABNORMAL findings in biopsy and when the ultrasound is UNCERTAIN

VASOGRAPHY - radiologic dye - X-ray

Detects peroxidase negative polymorphonuclear WBC which can only be detected thru immunocytochemical. Helps in differentiating leukocytes and germ cells.

PANLEUKOCYTE (CD45) IMMUNOCYTOCHEMICAL STAINING

There are currently NO REFERENCE VALUES for _. If there are FEWER CD45-positive cells THAN SPERMATOZOA in the sample (i.e. <400) the sampling error will _. In this case, report sampling error for the number of cells counted If FEWER than 25 CD45-positive cells are counted, report the number of CD45-positive cells observed with comment _

PANLEUKOCYTE (CD45) IMMUNOCYTOCHEMICAL STAINING - CD45 - EXCEED 5% - “Too few for accurate determination of concentration”

Consensus threshold value: _ for peroxidase positive cells

x 10^6 cells/mL

_ imply HIGHER conc. of total WBC

Peroxidase positive cells

HOW TO AVOID FERTILITY

1) Observe good personal hygiene and health practices 2) Use loose-fitting underwear 3) Avoid long, hot baths, even saunas 4) Avoid drinking alcohol frequently/heavily 5) Avoid exposure to toxic substances 6) Avoid radiation if possible 7) Avoid drugs, alcohol, smoking, drug use 8) Avoid STI (sexually transmitted infections/diseases) 9) Mumps can cause destruction to testes

MALE INFERTILITY CAUSES:

Prostatic dysfunction Low semen volume Low fructose

Alters the pH of semen, FROM 7.2-7.8 to 8. It also reduces acid phosphatase.

Prostatic dysfunction

can be due to EJACULARTORY DUCT DYSFUNCTION, agenesis of vas deferens or seminal vesicles

Low semen volume

can be due to DYSGENESIS of seminal vesicles

Low fructose

MANAGEMENT OF MALE INFERTILITY

1) Take medications to increase sperm production 2) Take antibiotics to heal infections affecting fertility 3) Taking clinically proven supplements or anything that can increase sperm production (anything that increases the number of healthy sperm increases possibility of conception)

HORMONE TREATMENT _ or _ may increase sperm count Hormone analysis is done if _,_, or other abnormalities are seen in multiple sperm analysis = assess _,_ _

- Clomid or testosterone - azoospermia, oligospermia - basal testosterone, LH, and FSH

LIFESTYLE CHANGE Avoid _,_,_,_,_,_.

heat sources, radiation, chemicals, alcohol, drugs, and tobacco

_ are important and age of the egg cells _ - commonly used

Follicles Hormone Testing

ABSENCE of Menstrual flow Genetic and/or anatomic abnormality _ abnormality Reason why they assess the hormones of the patient

AMENNORHEA - Endocrine

Infection caused by Yeast/Fungi → _ Bacterial Vaginosis/ trichomoniasis → _

TERAZOL Metronidazole

ENDOMETRIOSIS __ (_ – SUPRESS ovulation, FSH/LH. Menstruation)

DANAZOL - Danocrine

Continuously to SUPRESS ovulation and tx endometriosis.

ORAL CONTRACEPTIVES

SURGICAL REMOVAL ( CERVICAL PROBLEMS )

Estrogen Therapy Cryosurgery

→ before ovulation for a few months, enhancement of quality and quantity of the cervical mucus.

Estrogen Therapy

→ freeze the surface of the cervix or if she has recurrent cervicitis.

Cryosurgery

ENDOCRINE PROBLEMS

Hypothyroid – replacement therapy [Synthroid] Hyperthyroid – surgery, radioiodine, meds Hyperthyroidism

FALLOPIAN TUBE PROBLEMS → the person does NOT have the ability to ovulate. Usually this may be the cause of infertility and endometriosis since the travel of eggs from the fallopian tube to tubal obstructions from adhesion is prevented. Then the ovaries are converted into endometriosis and then possible cause of infertility is the production of metabolites that may cause problems in implantation of zygote.

ANOVULATION

 TREATMENT of ANOVULATION: _

Surgical (treatment for infertility that is usually by endometriosis)

 GOLD STANDARD in Endometriosis → __.  It is better than _.  LAPAROSCOPY is faster when it comes to the recovery period.

LAPAROSCOPY - laparotomy

causes more post-surgical adhesions compared to laparoscopy but both of them could be used for diagnostic and therapeutic.

LAPARATOMY

Sperm is collected through MULTIPLE ejaculations MANUALLY placed in the female’s uterus or fallopian tubes Success rate is 5-15% (average is 8%)

ARTIFICIAL INSEMINATION / INTRAUTERINE INSEMINATION (IUI)

FERTILIZATION of mature ovum in lab and re-implantation of zygotes into uterus by laparoscopy Sperm and egg are fertilized in the laboratory, after which the fertilized egg is RE-IMPLANTED into the uterus If tests show NO sperm production, donor sperm is used to help facilitate conception. Sperm is collected from another individual (sperm bank) and is placed in female thru IUI Fallopian tubes are blocked in IVF candidates; sperm sample must be normal Advantages: if you want to get pregnant at a later year in your life, you can get your eggs frozen and fertilized later Disadvantages: costly

IVF IN VITRO FERTILIZATION

Success rate is 20% (above 30% if below 35 y/o)

IVF IN VITRO FERTILIZATION

Difference bet. IUI and IVF: __ has involvement of the egg stimulation, retrieval, fertilization, and transfer; IVF usually involves surrogate mothers. In __, sperm is injected into the uterus to decrease the sperm travel time to the egg_

IVF IUI

Why does IVF fail? The major reason is _. As the female ages, the egg quality diminishes. Many embryos are not able to implant after transfer into the uterus. Even embryos that are fine in the laboratory can have defects that could cause them to die instead of growing. Other factors: _,_,_,_

embryo quality - egg age, ovarian response, chromosomal issues, and lifestyle factors.

RISK FACTORS OF HAVING INFERTILITY

age smoker weight sexual history

the quality and quantity of human eggs begin to RECLINE with increasing age in the __. Rate of_ is faster resulting in fewer and poorer quality of eggs w/c makes it more difficult and increase rate of miscarriage

MID-30 follicle loss

Sexually Transmitted Infection (_,_) can damage fallopian tube. Unprotected intercourse with multiple partners increases the later on.

Chlamydia, Gonorrhea

THINGS TO DO TO OPTIMIZE FERTILITY:

MAINTAIN NORMAL WEIGHT QUIT SMOKING AVOIDALCOHOL REDUCE STRESS REDUCING CAFFEINE CONSUMPTION

Hypo anechoic, well circumscribed commonly located at head Simple cyst (no sperm) and spermatoceles (sperm present) not associated w/ infertility

CYST

Enlarged, thickened, decrease echogenicity MAGI associated with decreased motility, increased sperm DNA fragmentation, abnormal sperm morphology

INFECTIONS

MASSES Presence of vascularity, variedechotexture Most commonly _; others - _,_,_

adenomatoid tumors - cystadenoma, mesothelioma, sarcoma

Epididymal enlargement, prominence of retetestis, hypoechoic appearance Normal volume ejaculate with oligoazoospermia

OBSTRUCTION

SURGICAL BIOPSY of small tissue sample from both testicles Physician or doctor will make an incision in skin and pea size amount of testicular tissue will be removed You will feel pressure or minor discomfort but no pain Certain parts can be closed through stitcher (stitch removal is not needed) Same procedure done on 2nd testicle

OPEN BIOPSY

Fine / Core needle biopsy Tissue sample is aspirated Also performed on BOTH testicles Depends on the type of needle used if both cases, insert needle thru skin if you are having a core needle biopsy, the difference in open biopsy is that you will hear a clicking or popping sound because that means the tissue sample is extracted wherein the tissue sample will be drawn from the syringe

PERCUTANEOUS BIOPSY

Sperm abnormalities caused by:

INFLAMMATION of the testicles SWOLLEN veins in the scrotum ABNORMAL developed testicles

Low sperm count or lack of sperm

A PRE-EXISTING genetic condition Use of alcohol, tobacco or other drugs SEVERE mumps infection AFTER puberty Hermia repairs (can destroy testicles) Hormone disorder Exposure to POISONOUS chemicals Exposure to RADIATION BLOCKAGE by a previous infection Wearing restrictive or tight underwear INJURY to the groin area

Ejaculation problems

PREMATURE ejaculation Retrograde ejaculation Erectile dysfunctions COMPLICATIONS from radiation therapy or surgery

OTHER causes of Male Infertility History of STDs; UTI Use of certain types of medications For example:

chemotherapy, steroids, anti-hypertensive, anxiolytics

- checkip the pelvic organ of the females it is also used to determine the egg supply/ ovarian reserve of women by counting the number of follicles on both ovaries during certain phase of menstrual cycle. This counting is known as __ Help to see the size and position/structure of the vagina, cervix, uterus and both ovaries

PELVIC ULTRASOUND - Antrak follicle count.

; it could show if there is a blockage in the fallopian tubes that prevents egg from reaching the uterus or prevent the sperm from moving to fallopian tube to fertilize the egg. Looks at the inside of the uterus and fallopian tubes and the area around them. Take pictures using steady beam of xray (_) then the radiographic dye passes the uterus to determine whether there is an injury inside the utureus/fallopian tube

HYSTEROSALPINGOGRAM Xray - fluoroscopy

look at the inside of the uterus and utilizes _ to have a clearer image. Can help find the cause of bleeding/ problems in conceiving. Utilizes saline and ultrasound to look at the female reproductive organs

SONOHYSTEROGRAM - saline/salt solution

used to determine if there are cysts, scar tissue adhesions, fibroids, infections that can affect the fertility used to treat conditions like _ general anesthesia is used in the procedure can also collect tissue for biopsy where laparoscope (tube) is used.

LAPAROSCOPY - endometriosis

Used to assess the woman's pelvic organs (uterus, fallopian tubes, and ovaries) using a thin, lighted scope that is put through a small cut (incision) in the belly.

LAPAROSCOPY

best way to prevent cervical cancer once in the legal age/become sexually active - should undergo pap smear

PAP SMEAR

Routine physical exam for women - Collects a small sample of cells from the cervix Purpose: for determine whether there are changes in the cells of the cervix during the test, the Dr. would collect a small sample of cells form the cervix and lower part of the uterus and send it to lab

pap smear

What to do if an abnormal result is obtained in Pap smear?

Conduct colposcopy

uterine or cervical causes several conditions that can impact the fertility by interfering in implantation or inc the likelihood of miscariage

Benign polyps or tumors endometriosis scarring uterine abnormalities present from birth cervical stenosis (narrowing)

ex fibroids or myomas that are common in the uterus which can block the uterus therefore interfering implantation affecting the fertility however there are also lots of women who have polyps yet able to get pregnant

Benign polyps or tumors -

- this happens when there is a surgical procedure or removal of extra tissue growth which results to scarring or inflammation within the uterus which can disrupt implantation

endometriosis scarring

- example when there is an abnormal shape in the uterus it may cause problem

uterine abnormalities present from birth

narrowing the cervix w/c can be caused by inherited malformation or damage to cervix, sometimes the cervix cant produce best type of mucus w/c allow the sperm to travel through the cervix going to uterus

cervical stenosis (narrowing)

Test to look at the vagina and cervix through a lighted magnifying tool (colposcope) (lighted magnifying tool) that has _ magnification

COLPOSCOPY - 2-60x

The camera is hooked into the colposcope hence, the physician can take pictures of the vagina and cervix for permanent record of the patient. During the procedure, _,_ can be used to clearly see the area of interest. This is done through placing the cotton swab to vinegar/lodine- swab vagina/cervix-see a clearer view - if there are abnormal cells - collect and assess it under the microscope for histopath/cytology

COLPOSCOPY - vinegar (Acetic acid), lodine (lugol's solution)

hormone imbalance that causes the ovulation disorders also associated in insulin resistance, obesity, abnormal hair growth (face,body), acne MOST COMMON cause

PCOS/polycystic ovary syndrome

OVULATION DISORDERS

- PCOS/polycystic ovary syndrome - Hypothalamic dysfunction - Premature ovarian failure/Primary Ovarian Insufficiency - Too much PRL/prolactin hyperprolactinemia

2 hormones (_,_) produced in pituitary gland are responsible for stimulation of ovulation each month Excess physical/emotional stress, recent substantial weight gain/ weight loss = can disrupt the production of these hormones which could then affect the ovulation

Hypothalamic dysfunction - FSH, LH

Ovaries NO longer produce eggs disease is caused by autoimmune response or can also be caused by premature loss of egg due to genetics or chemotherapy lowers the estrogen production unger age of 40 (early menopause)

Premature ovarian failure/Primary Ovarian Insufficiency

excess production of PRL in the pituitary glands REDUCE estrogen production = INFERTILITY related to pituitary gland problem, medications or other diseases

Too much PRL/prolactin hyperprolactinemia

DAMAGE/BLOCK in the FALLOPIAN TUBE that keeps the sperm from passing through the egg

TUBAL INFERTILITY

Pelvic inflammatory disease Pelvic tuberculosis

- infection in the fallopian tubes/uterus because of STI (Chlamydia, gonorrhea, etc) Previous surgery in the abdomen or pelvis Surgery for ectopic pregnancy - the fertilized egg is implanted and developed in the fallopian tube instead of uterus

Pelvic inflammatory disease

- due to Mycobacterium tuberculosis MAJOR cause of infertility

Pelvic tuberculosis

can AFFECT fertility in less direct way such as damaging the egg/sperm

ENDOMETRIOSIS

should be REMOVED through surgical procedure - can cause scarring - fallopian tube can be blocked/affected - egg & sperm cannot unite - NO fertilization Affects lining of the uterus - implantation of fertilized egg is disrupted

Extra tissue growth outside the uterus