Infertility Flashcards Preview

Reproduction, development and aging > Infertility > Flashcards

Flashcards in Infertility Deck (19):
1

Define infertility?

Failure to conceive after 12 months of unprotected sex

2

What is a normal (lower limit) ejaculate made of?

15 million/ml
1.5 ml
40% good motility sperm
39 million in ejaculate
4% normal sperm.

3

What would you look at for women fertility?

1) Ovulation:
Regularity of period.
Progesterone levels at day 21 and estrogen at day 12
FSH at days 2-4
anti-mullerian hormone

Timing of intercourse

STIs

4

Causes of anovulation and what are some treatments to stimulate ovulation?

Obestiy or annorexia.

Treatment:
Weight gain or loss.
GnRH
FSH
Clomiphene citrate - selective estrogen modulation (makes brain think there is less estrogen)
Letrazole - aromatase inhibitor (prevents the conversion of androgens to estrogen = brain produce more FSH)

5

What is Polysystic ovarian syndrome and who does it affect?

Has many follicles in the ovary, medium size follicles an large ovaries.

Affects 10% of women.
Infrequent or no periods
Metabolic syndrome - overweight
Increased androgens - alters apearance

Treatment:
Weightloss
Letrazole
Metformin
IVF

6

What tubual disease can cause infertility?

Cyst, tumour, adhesions that block the fallopian tube.

Treat: IVF, surgery to fix the tube

7

What is the treatment for infertility caused by cervical problems?

Treatment: Intrauterine insemination

8

Treatment and symptoms of edometriosis

10% affected (30% infertile)
Painful

Treatment: hormonal contraceptives, ablation surgery

9

How would you makes someone with premature menopause or rising FSH and decreasing AMH pregnant?

Treat with donor egg (IVF)

10

Time lapse photography?

Takes a photo every 10 minutes of the embryo. Can follow development to determine if it is normal.

11

What is oligospermia and how do you treat?

Low sperm count
Treat by taking a single sperm and inseminating an egg (intracytoplasmic sperm injection [ICSI]) or donor sperm

12

What is Oligoasthenoteratosperima (OATS)?

Low concentran, slow moving, abnormal form (3 defect)

Treat with intracytoplasmic sperm injection (ICSI) or donor sperm

13

What is azoospermiaand how do you treat?

No sperm

Causes:
No GnRH - no FSH/LH.
No spermatogenesis.
Obstructive - vasectomy
Congenital vas deferens absence.

Treatment:
Donor sperm
Testicle aspiration of sperm then intracytoplasmic sperm injection [ICSI]

14

Surgical removal of sperm

Fine needle taking fluid from the epididymis (1st try) or tissue from testis (2nd attempt).
Take a larger chunk if that doesn't work.
Milk the seminephrous tubules.

15

What are the steps involved in intracytoplasmic sperm injection?

Select sperm with normal motility and morphology
Immobilize sperm
Aspirate sperm tail first
Position sperm in needle.
Suction pipette
Insert needle into egg
Rupture egg cytoplasm by aspiration
Expel the sperm

16

What are some treatments for unexplained infertility?

Usually associated with age or a problem at the sperm and ovary level.

Mild ovarian stimulation and intrauterine insemination
IVF

17

What can you check to see implatation rate for IVF?

AMH - high means polysystic ovaries and high ovarian reserve

Preimplantation genetic screen analysis of embryos at day 3. Cut hole in zona and allow the cells to herniate out the hole. Take 4-5 cells and do gen seq.

18

Why is age associated with infertility?

Eggs age. Associated with an increased aneuploidy (number of eggs with chromosomal abnormalities) and the implantation rates decrease.

19

What are the steps of IVF?

1) Stimulate follicle production with hormone therapy.
- FSH stimulates the ovary and GnRH antagonists prevent ovulation.
Measure the size of the follices with ultrasound, looking for 3 lead follicles of 18 mm. When follicles have grown sufficiently then want to trigger maturation of the follicles with HCG or GnRH.

2) Remove the eggs from the ovary
-Vaginal ultrasound with an attached needle. It goes through the wall of the vagina and into the ovary. Acquire follicle liquid.

Clean up the sperm sample

Combine for fertilization (just add together) and incubate

Culture and monitor the division before implantation.

Fertilized eggs placed in uterus.
Progesterone is provided for luteal support, which is essential. Prevents the advancing of the endometrium which can be caused by all the drugs required for follicle stimulation.

Embryo freezing