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Repro Week 2 > Infertility > Flashcards

Flashcards in Infertility Deck (33)
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1
Q

Within 24 hrs the zygote will go to the 4 cell stage, and then to the 8 cell stage by day 3, then to a proliferative morula stage, and then to a blastocyte by day 5

A
2
Q

What must happen to a blastocyst for implantation (attachment to the endometrium) to occur?

A

It must lose its zona pellcuida, aka hatching. The blastocyt attaches from the inner cell mass in humans

3
Q

The embryo heart starts beating at age 5 when the embryo is still in the form of a disc

A
4
Q

When does an embryo start to be called a fetus?

A

10 weeks gestation

5
Q
A
6
Q

What is infertility defined as?

A

1 yr of unsuccessful attempts to conceive when younger than 35. After 35, 6 months of intercourse without conception defines infertiity

Affects 10-15% couples in the US

7
Q

How much sperm is destoryed in the vagina?

A

Up to 95% due to the acidity (It takes about 5 minutes for sperm to ascend to the fallopian tubes once in the vagina)

8
Q

How much sperm is destroyed in the cervical canal?

A

Not much because the cervix produces mucus to protect sperm

9
Q

Where does fertilization most commonly occur?

A

ampulla of the fallopian tubes

10
Q

What are the most common factors for infertility?

A

Female factors (60%)

Male factors (40%)

Combined M-F (20%)

11
Q

Where are the most common problems in women?

A

Tubal and peritoneal (30-40%)- arise primarily from infections, including *Chlymidia* and Gonorrhea

Ovulatory (15%)- PCOS is a big factor

Cervical and Uterine/endometrial (5-10%)

12
Q

What are the main effects of DES?

A

T-shaped uterus and a small cervical opening that does not have many glands so it cant produce as much mucus

13
Q

How could TB lead to infertility?

A

It can lead to inflammation of the cervix, causing constriction

14
Q

What are some ways to test for cervical factor?

A

Cultures to look for infection and protozoa including uroplasma and microplasma (these can cause miscarriages) and vaginosis can cause pre-term delivery

15
Q

What are some types of uterine/endometrial factor?

A

Anatomical changes (Congenital malformations, (submucosal) fibroids, adhesions)- can lead to miscarriages as well as infertility

Functional abnormalities (endoemtritis, decreased receptivity)

16
Q

What other symptoms are submucosal fibroids associated with besides infertility?

A

menorrhagia and miscarriages

17
Q

Why would endomterial/uterus/peritoneal inflammation lead to infertility?

A

Inflammation makes the endometrium/uterus/etc. release some cytokines that pre-activate the sperm to switch its motility from forward motion to side-to-side motion before it reaches the egg and because it doesnt have much energy source (only some mitochondrial in the neck of the tail), will tire the sperm and prevent fertilization

18
Q

T or F. Endometritis is a cause of recurring miscarriages

A

T. It is still inflammation so it decreases receptivity of the endometrium

19
Q

How is uterine/endometrial factor evaluated?

A
  • transvaginal ultrasound or sonohysterography (insert a catheter TV and inject normal saline to help open up the uterine cavity and outline the contours) for the presence of any abnormalities of fibroids
  • Hysteroscopy (surgery with a camera to visualize the cavity)
  • Hysterosalpingography (inject radioopaque medium through the medium and look under floroscopy at the uterus). Stops from visualizes any muscle, can only see the contour of the cavity or tubes
  • Endometrial biopsy (more rare for fertility purposes, more so for recurrent prgenancy loss related to endometritis)
20
Q

What uterine abnormalities are related to infertility?

A

Septate and arcuate uterus

dont have infertility in bicornate and unicornate (but may see recurrent miscarriages or pre-term delivery)

21
Q

What are some tubal/peritoneal factors?

A

Mainly anatomical changes due to DES exposure (causing coarctation of the fimbrial part, raising the risk of ectopic pregnancy), tubal ligation, adhesions (infections, mainly Chylmdia), and endometriosis)

22
Q

Why would endometriosis be disadvantageous to the tubes?

A

they are cyclically active and can result in bleeding, inflammation, and scarring of the tubes leading to infertility (mild endometriosis can also lead to ectopic pregnancy)

23
Q

How are tubal/peritoneal factors evaluated?

A
  • Hysterosalpingography to show contours of the tubes
  • Laparoscopy (camera through the belly-button) with chromospertubation (inject blue-dye to see if the fimbriae are patent are not)
  • Sonohysteography has limited use
24
Q

What are some causes of ovarian factor?

A
  • oligo/anovulation
  • luteal phase deficiency
25
Q

Why do women with PCOS have luteal phase duration deficiencies?

A

Because there is crowding of the follicles in the ovarian cortex (some of the follicles are still primary while others are closer to tertiary phase because estrogen is not as high and these older follciles tend to linger and not produce as much progesterone), the lack of progesterone can lead to miscarriage and the lack of early estrogen can lead to inferitlity

The eggs are not to blame, its the follicle!

26
Q

How would you evaulate for ovulatory dysfunction?

A

Make sure to take an accurate menstrual history (account for age- older and younger are more likely to have variable periods), basal body temp, serum progesterone at about 7 days prior to menses

Or can use urinary LH execretion kits (threshold of 40units/ml indicates that ovulation will occur within 48 hrs),

basal FSH/clomiphene challange test (low FSH is good=good ovarian reserve; high FSH means that estrogen is not being made by the ovaries; most commonly seen in older women or younger women exposed to chemo). Can also test AMH (high AMH= good ovarian reverse)

Oligo-amenorrhea testing

27
Q

Conc might want to be closer to 50mil/Ml

The round cells are white cells. They should not be present and are indicative of male infection (most likely male prostatitis)

A
28
Q

What pts typically get prostatis?

A

Either very active or very sedentary men

29
Q

When is retrograde ejaculation most common?

A

Men who have diabetes because the neck of the bladder will not constrict at the time of ejaculation due to neuropathy

30
Q

What can cause duct obstruction besides vasectomy?

A

inflammation

31
Q

What causes congential bilateral absence of the vas deferens?

A

cystic fibrosis- these men will ONLY have prostatic secretions, but will not sperm or seminal vesicle contributions (fructose)

32
Q
A
33
Q
A