infertility Flashcards
(35 cards)
- Inability to conceive after 1 year of unprotected, regular sexual intercourse
- If over 35 years if no conception in past 6 months
- Any inability to conceive when desired
- Includes repeated miscarriage
- Affects approximately 15% of couples of reproductive age
Infertility
never have conceived - infetility
primary infertility
conceived once but unable to conceive again •40-50% of causes are idiopathic •Other 50% •1/3 male •1/3 female •1/3 male and female partners
secondary infertility
Primary hypogonadism (testicular failure)
30-40% of male cases:
•Variocele (40% of cases)
•Medication: Nicotine, Alcohol Abuse, Anabolic steroids, Antihypertensive
•Cocaine & Marijuana Use
•Toxin exposure
•Heavy metal, organic solvents, pesticides, radiation
male factors of impairment
- Testicular surgeries or injury
- Cryptorchidism
- Chromosomal abnormality
- Genital radiation or Chemotherapy
- Vas deferens & Epididymal absence (e.g. Cystic Fibrosis)
- Hormonal Dysfunction (e.g. excess androgen or estrogen)
- Orchitis
- Post-pubertal mumps
- Sexually transmitted disease
male factors of impairment 2
- Abnormal amount, structure, motility
- Azoospermia—absence of functional sperm
- Oligospermia—decreased number of functional sperm
- Impaired sperm function—normal 400 mil/ml
abnormalities of sperm
Affect ability to deposit sperm near the cervix •Erectile Dysfunction •Peripheral vascular disorder •Hypothyroidism •Major depression
abnormal erections
•Affect ability to deposit sperm near cervix
•Retrograde ejaculation—flow into bladder
-Diabetes
-Sympathetic nerve dysfunction
-Antihypertensives, psychotropics
•Obstructive azoospermia
-Hypospadias, epispadias
-Varicocele
•Alcohol/drug use affecting neurological functioning
abnormal ejaculation
•Seminal fluid does not enter cervix or uterus
•Nourishes sperm until can enter cervix
•Alkaline to counteract acidic vaginal fluids
•Coagulates but then becomes liquefied 30 minutes after ejaculation
-Problem if does not liquefy
•Abnormal seminal fluid indicative of inflammation, obstruction, infection
seminal fluid
Fertility dependent on
•Normal ova production
•Open pathway(s) from cervix to fallopian tube
•Uterine endometrium adequate to support growth
factors of women
•Ovulation dependent upon hypothalamus releasing GnRH and pituitary releasing FSH and LH; and the ability of ovaries to respond
•Number of oocytes established as fetus
-Eggs age with woman
-Eggs subjected to lifetime of environmental agents, drugs
•May have normal or irregular menses
disorders of ovulation
-Scarring, adhesions impair conception and/or implantation •Endometriosis •STDs, PID •Surgery •Congenital anomaly •May result in ectopic pregnancy -Impaired fimbriae or cilia motility
disorders of fallopian tubes
- Polyps
- Scarring from culposcopy, biopsy
- Infection
- Abnormal cervical mucus impairs sperm
- Normal at ovulation is consistency of egg white
abnormalities of the cervix
- Abnormalities of fetal chromosomes
- Abnormalities of cervix or uterus
- Endocrine abnormalities
- Immunologic factors
- Environmental agents
repeated pregnancy loss
- Genetic errors result in spontaneous abortion
- Most errors are random
- One or both parents may be carrier
- Consider genetic counseling if > 2 miscarriage
abnormalities in fetal chromosomes
- Abnormal structure of cervix or uterus affecting implantation or fetal growth
- DES exposure in utero—incompetent cervix, uterine malformation, cancer
- Surgery
- Trauma
- Fibroids
abnormalities of cervix and uterus
- Luteal phase defect—inadequate progesterone to support implantation, placenta
- Hypothyroidism and hyperthyroidism
- Diabetes
- Obesity –(inadequate diet)
- Advanced Age (sharp decline at age 42)
endocrine abnormalities
- Rejection of embryo as foreign by maternal immune system
* Lupus
immunologic factors
- Radiation
- Alcohol
- Accutane
- Cigarette smoke
- Cocaine
- Solvents
- Pesticides
- Lead, mercury
environmental agents
- HIV
- CMV
- Rubella
- Varicella
- Herpes
- Hepatitis
- Parvovirus—fifth disease
- Toxoplasmosis
- GBS
- TB
infections
- Thorough health history with reproductive history
- Obtain specific information regarding sexual intercourse (male & female)
- Physical exam (male & female)
assessment
Start with least invasive •Semen Analysis •Basal body temperature •Cervical mucus assessment •Ovarian function assessment -hormone levels •Pelvic organ assessments -Ultrasound -Hysterosalpingography -Laparoscopy
diagnostic exams
•Natural Family Planning Education •Clomid (Clomiphene Citrate) -Common side effects: --Decreased cervical mucus --Hot flushes --Breast and Pelvic pain --Nausea •Severe: Ovarian hyperstimulation syndrome -Acute fluid shift into extravascular space
medical therapy to facilitate pregnacy
•Surgery -Endoscopy -Laparotomy -Transcervicalballoon tuboplasty •Therapeutic insemination •Surrogacy
medical therapy 2
