Lecture 8: Infertility Flashcards by Hannah Kim

Define Infertility

Failure to conceive after 12 months of
unprotected intercourse

How well did you know this?

Not at all

Perfectly

What assessments do you do for Males with Infertility?

1) Semen analysis (count, motility, volume, total number and morphology)

How well did you know this?

Not at all

Perfectly

What basic assessments do we do for females with infertility?

1) Ovulation (regularity of periods around 28 days, E2, P4, FSH, AMH)
2) Timing (not frequency) of intercourse (having time around ovulation)
3) Sexually Transmitted Infections

How well did you know this?

Not at all

Perfectly

Describe the treatment and drugs given to women who have infertility due to anovulation

Problem: Anovulation

Treatment: Weight gain or loss

Drugs:

1) GnRH (stimulate the prodction of pituitary hormones)
2) C_lomiphene citrate_ (Given to women who don’t ovulate regularly. Selective estrogen receptor modulator- works on receptors and tricsk the brain into thinking that there isn’t much estrogen so it produces more estrogen).- cause multiple-follicular growth
3) Letrazole (Cause Mono-follicular growth- aromatase inhibitor- prevents converseion of androgens to estrogen)
4) FSH

How well did you know this?

Not at all

Perfectly

What is the name of the drug given to women who don’t ovulate regularly?

How does it work?

Clomiphene citrate (Given to women who don’t ovulate regularly.

Selective estrogen receptor modulator- works on receptors and tricsk the brain into thinking that there isn’t much estrogen so it produces more estrogen).

How well did you know this?

Not at all

Perfectly

What are some drug treatments to women with infertility due to anovulation?

1) GnRH (stimulate the prodction of pituitary hormones)
2) Clomiphene citrate (Given to women who don’t ovulate regularly. Selective estrogen receptor modulator- works on receptors and tricsk the brain into thinking that there isn’t much estrogen so it produces more estrogen).- cause multiple-follicular growth
3) Letrazole (Cause Mono-follicular growth- aromatase inhibitor- prevents converseion of androgens to estrogen)
4) FSH

How well did you know this?

Not at all

Perfectly

What are some causes of infertility in women?

Anovluation
PCOS
Tubal Disease
Cervical problems
Nedometriosis
Premature menopause
No uterus

How well did you know this?

Not at all

Perfectly

Describe the treatment and dtugs given to women with infertility due to PCOS

Polycystic Ovarian Syndrome (up to 10% of women)

Treatment:

Weight loss

Letrozole

Meformin- insulin sensitizer

IVF

How well did you know this?

Not at all

Perfectly

What are the symptoms of women with PCOS?

1) Infrequent or no periods
2) Metabolic syndrome- overweight
3) Increased androgens

How well did you know this?

Not at all

Perfectly

Describe the tratment options for women with infertility due to Tubal Disease

Tubal diease- either a tubal pregnancy or cyst, or more commonly an adhesion that blocks off the access of the sperm to the eggs.

Treatment:

Surgery
IV

How well did you know this?

Not at all

Perfectly

Describe the treatment options for women with infertility due to Cervical Problems

Aren’t very common

Treatment:

-IUI intrauterine insemination

Intrauterine insemination (IUI) is a fertility treatment that involves placing sperm inside a woman’s uterus to facilitate fertilization. The goal of IUI is to increase the number of sperm that reach the fallopian tubes and subsequently increase the chance of fertilization.

How well did you know this?

Not at all

Perfectly

Describe the treatment options for women with infertility due to Endometriosis

10% of women

Hormonal contraceptive ablation- surgery

How well did you know this?

Not at all

Perfectly

Describe the treatment options for women with infertility due to Premature menopause (pr rising FSH and decreasing AMH with age)

Donor egg (IVF)

How well did you know this?

Not at all

Perfectly

Describe the treatment options for women with infertility due to No uterus

Surogacy

How well did you know this?

Not at all

Perfectly

Briefly Describe the 6 steps of IVF

1) Produce lots of eggs

By stimulating the ovaries with hormones

2) Eggs retrieved from Ovary

Aspirate and get the egg from most follicles

3) Serm sample provided

4) Egg and sperm combined to allow ferilization

Put in a drop of sperm into each egg
Then put into an incubator
Culture the embryo

5) Fertilized eggs (best ones) introduced into uterus

6) Embryo freezing

How well did you know this?

Not at all

Perfectly

Describe the 1st step of IVF

1) Ovarian stimulation

Stimulation
- FSH
Control
- Prevent ovulation
- We don’t want anything to happen that is unplanned
- GnRH antagonists
Trigger
- Stimulate ovulation once we know the follicles are of a decent size
- HCG or GnRH agonist
Luteal support (after the eggs have been retrieved)
- progesterone- essential because all of the fertility drugs that stimulate the ovaries have a negative effect on the endometrium and advances the endometrium so we need to balance this out.

How do we track the IVF cycle to trigger and OPU?

1) Transvaginal Ultrasound scans
- Measure size of each follicle
- Goes through wall of vagina

2) Blood tests

Estrogen ~1000U/follicle
Progesterone (don’t want this to rise)

Describe the in-vivo fertilisation and development phase in IVF

Basically looking at the growth of the embryo as if it is going down the fallopian tube

Monitor the development every couple of days and grade the eggs

What is an alternative to implanting a fresh embryo?

Freezing the embryo first, and then wait for the woman’s natural hormonal cycle to occur before implanting the emrbyo.
The woman may have hyper-excitable ovaries which can be deadly with all of the hormones

What are some causes of Male Infertility?

1) Oligospermia (low sperm count)
2) OATS (oligoasthenoteratospermia)
3) Azoospermia

Describe the treatment options for male infertility due to Oligospermia

ICSI (intra-cytoplasmimc sperm injection)- take a single sperm and inject it straight into an egg
Donor sperm

Describe the treatment options for male infertility due to OATS

Oligoasthenoteratospermia

Oligo= low concentration

Astheno = slow motility

Terato = Abnormal form

(this is a triple defect)

Treatment

ICSI (intra-cytoplasmic sperm injection)
Donor sperm

What is ICSI?

(intra-cytoplasmic sperm injection)

When a single sperm is injected directly into the egg

Describe the treatment options for male infertility due to Azoospermia

No sperm at all

due to…

1) Kallman’s Snydrome (no GnRH- FSH/LH)
2) Obstructive/vastectomy
3) No spermatogenesis
4) Congenital absnece of the vas

Treatment

Donor insemination
TESA/TESE

(testicular sperm aspiration/extraction + ICSI)

Describe testicular sperm aspiration/extraction Surgical retrieval of sperm

Lots of approaches 1) PESA Stick a needle into the _epididymis_ and take some fluid (hope there's sperm in there) 2) TESA If no sperm is found in the epididymis, go do fine needle aspiration in the testes and _suck out testicular tissue_ 3) TESE If none are found in the small testicular tissue, you have to take out a _chunk of testicular tissue_.

What are some causes of unexplained infertility and what are the treatment options?

**_Problem_** 1) **Unknown aetiology** (Sperm is fine, fallopian tube is fine, know when they're ovulating but cannot get pregnant after 3 years) 2) **Fertilisation issue** (something wrong with egg or sperm- won't know until you try IVF 3) **Age** **_Treatment_** 1) Mild ovarian stimulation with Intrauterine insemination IUI (low tech and not too expensive- few thousand) or 2) IVF (10-12 thousand dollars)

What is AMH? What can it predict?

Women are born with their lifetime supply of eggs, and these gradually decrease in both quality and quantity with age. _Anti-Mullerian Hormone (AMH)_ is a _hormone secreted by cells in developing egg sacs_ (follicles). The level of AMH in a woman's blood is generally a _good indicator of her ovarian reserve._ It can help predict _how many eggs_ you are likely to obtain in an IVF cycle. It may also identify women who may _undergo early menopause_, and therefore who may _lose their fertility earlier_ than average

What is Preimplantation Genetic Screening?

recent innovation 1) Take 3 embryo and make a little hole in the zona pellucida using a lazer (this is because, as the embryo keeps growing, we are hoping that it will herniate out some cells and we can biopsy it) 2) We freeze the cells 3) Genetic sequencing

What is Intrauterine Insemination?

Intrauterine insemination (IUI) is a fertility treatment that involves placing sperm inside a woman's uterus to facilitate fertilization. The goal of IUI is to increase the number of sperm that reach the fallopian tubes and subsequently increase the chance of fertilization.