Flashcards in Fertilization-Infertility: Detti Deck (11)
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1
Definition of Infertility
- One year of unprotected intercourse without conception
- After 35 yrs of age: 6mo of unprotected intercourse without
conception
*Affects 10-15% of couples in the US
2
Describe the following factors in the human reproductive process:
-Male factor
-Cervical factor
-Ovarian factor
-Tubal/Peritoneal factor
-Uterine factor
-Male factor: sperm ascend through cervix, uterus, tubes; acquire the capacity to fertilize the oocyte
-Cervical factor: filters and nurture sperm into uterus and tubes
-Ovarian factor: ovulation of a mature oocyte must occur
-Tubal/peritoneal factor: tubes capture ovulated oocyte and transport sperm and embryo
-Uterine factor: uterus is receptive to embryo implantation and support pregnancy
3
How do the male and female factors contribute (quantitatively) to infertility?
Female factor - 60%
-->mostly tubal/peritoneal issues (30-40%), followed by ovulatory (15%) and cervical/uterine (5-10%)
Male factor - 40%
-->ex low volume, retrograde ejaculation, duct obstruction, hypogonadism, CBAVD
Combined - 20%
4
What tests can be done to evaluate male factor infertility?
- Semen analysis (for volume, concentration, motility, morphology, pH, and round cells)
- FSH, LH, PRL, Testosterone
- Karyotype
- Y chromosome microdeletions
5
What are some causes of cervical factor infertility?
What tests would be done to evaluate?
- anatomical changes (ex: DES exposure)
- infections
- changes in mucus characteristics
Tests: cultures, post-coital test
6
What are some causes of uterine/endometrial factor infertility?
What tests would be done to evaluate?
- Anatomical changes (congenital malformations, fibroids, adhesions)
- Functional abnormalities (endometritis, dec. receptivity, things that cause premature sperm activation)
Tests: TV Ultrasound and Sonohysterography; Hysterosalpingography; Hysteroscopy; Endometrial biopsy
7
What are some causes of tubal/peritoneal factor infertility?
What tests would be done to evaluate?
- Anatomical changes (congenital malformations, bilateral tubal ligation, adhesions, endometriosis)
Tests: Hysterosalpingography; Laparoscopy with chromopertubation; Sonohysterography
8
What are some causes of ovarian/ovulatory factor infertility?
What tests would be done to evaluate?
-Ovulatory dysfunction: Oligo/Anovulation (PCOS); Luteal phase deficiency (def progesterone)
Tests: Menstrual history (in detail!); Basal body temperature (will tell of ovulating at all); Serum progesterone; Urinary LH excretion (ov. predictor kits); Basal FSH/Clomiphene challenge test (will give indication of available oocyte reservoir); Oligo-amenorrhea testing
9
Treatment of male factor infertility
– Endocrine treatment
– intra-uterine sperm injection (IUI), TDI
– assistive reproductive technology (ART)
10
Treatment of female factor infertility
- Correction of anatomical defects
- Treatment of infections
- Restoration of a regular ovulatory pattern; i.e. ovulation induction with Clomiphene Citrate, Aromatase Inhibitors, Gonadotropins
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