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REPD 372 > Module 5: Fertility Concepts and Pathology > Flashcards

Module 5: Fertility Concepts and Pathology Flashcards

1
Q

Fertility

A

-natural capability to produce offspring

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2
Q

Fecundity

A

-potential output of reproduction by an organism
-measured by number of gametes, seeds, etc

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2
Q

Total fertility rate

A

-refers to total number of children born or likely to be born to a woman in her lifetime

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3
Q

Birth rate

A

-total number of live births per 1000 in a population in a year or period

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4
Q

How many couples of reproductive age experience infertility

A

-8-12%

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5
Q

Where is infertility most prevalent

A

-in developed countries

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6
Q

Age-fertility decline

A

-affects both men and women

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7
Q

What gender does age-fertility decline begin earlier in

A

-women

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8
Q

Where do fertility rates tend to be higher

A

-in developing countries
-due to lack of access of contraceptives, poor maternity care, and generally lower levels of female education

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9
Q

Why do developed countries tend to have lower fertility rates

A

-due to lifestyle choices associated with economic affluence where mortality rates are low, birth control is easily accessible, and children often can be seen as economic drain

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10
Q

Global fertility rate

A

-2.5 children per woman

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11
Q

What country has the lowest fertility rate

A

-europe

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12
Q

What is europes fertility rate

A

-1.6 children per woman

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13
Q

What country has the highest fertility rate

A

-africa

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14
Q

What is africas fertility rate

A

-4.7 children per woman

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15
Q

Population dynamic in Canada recently

A

-decline in fertility

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16
Q

How has Canada’s population structure changed

A

-from a relatively young and growing population to an aging population

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17
Q

Clinical terminology of fertility

A

-defined as capacity to establish a clinical pregnancy within 12 months of regular and unprotected sexual intercourse

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18
Q

Clinical terminology of subfertility

A

-general term used to describe any form of reduced fertility with a prolonged time to acheive conception in a couple

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19
Q

Clinical terminology for infertility

A

-incapability to establish a clinical pregnancy after 12 months of regular and unprotected sexual intercourse
-often due to potentially treatable causes

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20
Q

Clinical terminology for sterility

A

-refers to complete incapability to conceive naturally
-ex. due to absence of gonads regardless of cause

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21
Q

Primary infertility

A

-refers to couples who have not become pregnant after a minimum of 1 year of sexual intercourse without using birth control methods

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22
Q

Secondary infertility

A

-refers to couples who have previously carried a pregnancy to term, but are now unable to conceive

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23
Q

Factors that influence infertility

A

-hormones
-gametes
-gonads
-reproductive ducts
-external genitalia

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24
Q

How do hormones determine fertility

A

-circulating levels of regulator hormones of the reproductive system

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25
Q

How do gametes determine fertility

A

-quantity and quality of oocytes in females and sperm in males

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26
Q

How do gonads determine fertility

A

-anatomy and function of ovaries or testes

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27
Q

How do reproductive ducts determine fertility

A

-anatomy and function of the reproductive ducts in male and female

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28
Q

How does the external genitalia determine fertility

A

-anatomy and function of the external genitalia

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29
Q

What is the process of diagnosing infertility

A

-medical history
-physical exam

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30
Q

Medical history

A

-allows doctors to identify previous factors that may have caused fertility issues, as well as current factors that may be contributing
-takes into account medical condition, previous injuries or surgeries, and behavioural factors such as smoking

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31
Q

Physical exam

A

-evaluates presence of structural abnormalities in external genitalia and reproductive tract
-blood analyses allows doctors to detect hormonal imbalances and other potential metabolic abnormalities

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32
Q

Factors considered during medical history check

A

-previous physical injuries
-previous infections
-current systemic diseases
-current hormonal conditions
-current lifestyle factors
-other serious conditions

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33
Q

Specific diagnostic tests for males

A

-semen analysis
-testicular biopsy
-imaging

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34
Q

Semen analysis

A

-used to detect sperm abnormalities such as azoospermia

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35
Q

Testicular biopsy

A

-used to determine unexplained male infertility and azoospermia

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36
Q

Imaging in males

A

-pelvic and scrotal ultrasound or MRI

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37
Q

Specific diagnostic tests for both males and females

A

-physical exam
-hormonal tests
-genetic testing

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38
Q

Hormonal tests specific hormones both male and female

A

-FSH
-testosterone or progesterone

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39
Q

Genetic testing

A

-to diagnose certain genetic disorders affecting fertility

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40
Q

Specific diagnostic tests in females

A

-imaging

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41
Q

Imaging in females

A

-generally a hysterosalpingography which is an x ray of uterus and fallopian tubes to check for abnormalities

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42
Q

Idiopathic infertility

A

-when clinicians are still unable to identify the cause of infertility
-treatment can still be given and a successful pregnancy might be achieved

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43
Q

Congenital disorders that can cause infertility

A

-turners syndrome
-klinefelter syndrome

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44
Q

Turners syndrome

A

-condition in which a female is partially or completely missing one of her X chromosomes

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45
Q

Turners syndrome symptoms

A

-short stature
-webbing of neck
-widely spaced nipples
-cardiac and renal abnormalities
-other hormonal imbalances among many other health issues

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46
Q

Klinefelter syndrome

A

-genetic disorder in which boys are born with an extra X chromosome
-can cause hypogonadism in males

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47
Q

Klinefelter syndrome symptoms

A

-small testes
-tall/slender build
-low testosterone
-karyotyping

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48
Q

Menopause

A

-the point at which a woman no longer has menstrual period
-ovaries have stopped producing most of their estrogen and releasing eggs

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49
Q

When does menopause usually occur

A

-14-55 years of age

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50
Q

Premenopause

A

-years from puberty to menopause
-also referred to as the reproductive life of a female

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51
Q

Final menstrual period (menopause)

A

-defined as one year of spontaneous missed periods without any abnormality or drugs that can alter menstrual cycles

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52
Q

Postmenopause

A

-stage which begins with the last menstrual period and continues for the rest of a womans life

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53
Q

Perimenopause

A

-starts before menopause and continues 12 months after it
-when the body begins to undergo several physical and hormonal changes

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54
Q

Premature menopause

A

-spontaneous cessation of menses before age 40

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55
Q

What can induce artificial menopause

A

-radiation therapy
-oophorectomy (surgical removal of ovaries)

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56
Q

Follicular pool

A

-the number of extra follicles available for maturation

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57
Q

Ovarian reserve

A

-the capacity of the ovaries to produce an oocyte capable of fertilization and pregnancy

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58
Q

What happens to the follicular pool and ovarian reserve with age

A

-both decline progressively

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58
Q

Hormonal changes related to menopause

A

-increased sensitivity to GnRH
-less suppression of FSH secretion

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59
Q

Increased sensitivity to GnRH

A

-continual loss of remaining follicles means there is a decrease in the production of gonadotropin surge inhibiting factor
-resulting in higher sensitivity of pituitary to GnRH and therefore a rise in LH

60
Q

Less suppression of FSH secretion

A

-rise in FSH which is attrivuted to a decreased production of inhibin B and antimullerian hormone (AMH)
-increasing FSH levels accelerates process of selection and recruitment of dominant follicles
-this speeds up the loss of remaining follicles

61
Q

Oxidative stress

A

-physiological imbalance in the production of reactive oxygen species (ROS)

62
Q

Reactive oxygen species (ROS)

A

-natural byproducts of metabolism which cause cellular damage by oxidizing and altering cellular DNA

63
Q

Lifestyle factors and oxidative stress

A

-oxidative stress can be significantly worsened by lifestyle choices such as unhealthy diet, sedentarism, and smoking etc

64
Q

Fertility and oxidative stress

A

-considered to be a major factors in the process of natural fertility decline

65
Q

When does the risk of experiencing pregnancy complications increase

A

-after the age of 35

66
Q

When does age-related fertility decline start in men

A

-around 40 years of age

67
Q

Andropause

A

-progressive hormone decline in males
-also known as late-onset hypogonadism

68
Q

Andropause symptoms

A

-low sex drive
-lack of energy
-difficulty getting erections
-loss of muscle mass or strength
-increased body fat
-depression and/or mood swings
-hot flashes

69
Q

What percent of men at age 40 are impacted by erectile dysfunction

A

-10%

70
Q

What percent of men over the age of 70 are impacted by erectile dysfunction

A

-80%

71
Q

What is one of the primary causes of erectile dysfunction on men over 50

A

-atherosclerotic disease

72
Q

Other potential causes of erectile dysfunction

A

-psychological
-neurological
-hormonal
-pharmacological
-anatomical

73
Q

What happens to serum testosterone levels with time

A

-decrease

74
Q

What is the decrease of serum testosterone levels due to

A

-decrease in leydig cells
-deterioration of testicular perfusion
-disturbances to GnRH and chorionic gonadotropin secretion

75
Q

Primary hypogonadism

A

-testosterone deficiency due to a testicular defect

76
Q

Secondary hypogonadism

A

-testosterone deficiency caused by a problem with the pituitary gland or hypothalamus
-testes are normal but there is abnormal signaling from the brain

77
Q

Sex hormone binding globulin (SHBG)

A

-a hormone that binds to testosterone in the blood and reduces the amount of available testosterone

78
Q

Primary testicular failure

A

-decine in testosterone secretion caused by a deficiency or absence of leydig cell function

79
Q

How is sperm affected with age

A

-volume, motility, and morphology are all decreased

80
Q

Why are sperm affected with age

A

-often due to increase in replication errors, DNA mutations and fragmentation in sperm cells

81
Q

Benign prostatic hyperplasia

A

-prostate enlargement in older men

82
Q

What happens to semen volume after the age of 45

A

-gradually decreases due to functional decline of accessory glands

83
Q

What are children born to older parents most at risk for

A

-down syndrome

84
Q

Direct injury to genitals

A

-have potential to result in permanent impairment of function depending on severity

85
Q

Which gender are direct injuries more common in

A

-males

86
Q

Direct injuries in women

A

-not common
-can happen as a vaginal or uterine prolapse after childbirth

87
Q

Indirect injury

A

-would involve an injury to a non-reproductive structure that ends up interfering with normal reproductive function

88
Q

Example of indirect injury

A

-spinal cord injury

89
Q

How can spinal cord injuries affect reproductive function

A

-loss of mobility in legs
-can affect innervation of reproductive organs

90
Q

Parasympathetic innervation of male reproductive system

A

-parasympathetic nerves from S2-4 nerve roots primarily control erectile function by controlling arterial dilation

91
Q

Sympathetic innervation of the male reproductive system

A

-sympathetic nerves from T11-L2 control detumescence and contribute to ejaculation and emission by controlling gland secretions and release of sperm

92
Q

What is detumescence

A

-the subsidence of a swelling, especially the return of a swollen penis, to the flaccid state

93
Q

What can SCI inflicted nerve damage lead to in males (impaired)

A

-reflecogenic erections
-psychogenic erections

94
Q

Reflexogenic erections

A

-an erection which is stimiulated by direct stimulation of genital region

95
Q

Psychogenic erections

A

-initiated by thoughts and erotic stimuli, independent of direct genital stimulation

96
Q

What can happen to sperm production with SCI

A

-production and quality can decrease due to factors such as increased temperature due to prolonged sitting, decreased physical activity, and less frequent sperm discharge

97
Q

Parasympathetic innervation of the female reproductive system

A

-parasympathetic nerves from S2-4 nerve roots control clitoral erection as well a relaxation of uterine smooth muscles

98
Q

Sympathetic innervation of female reproductive system

A

-sympathetic nerves from T11-L2 control the contraction of the uterus

99
Q

Somatic innervation of the female reproductive system

A

-derived from both T12-L2 and S2-S4 and provides pain perception

100
Q

What is amenorrhea

A

-the absence of menstruation
-happens often to women after suffering a traumatic injury to the spine

101
Q

Changes in sexual response in women after SCI

A

-decreased lubrication

102
Q

Can women with an SCI still get pregnanct

A

-yes because sexual function is independent of reproductive function in women

103
Q

Risks of pregnancy during SCI

A

-higher risk of preterm labour
-thrombosis or autonomic dysreflexia
-brachycardia
-excessive sweating and headaches

104
Q

What is an infection that can have a major impact on reproductive function

A

-STI’s

105
Q

What is the most common communicable disease that affects fertility

A

-chlamydia

106
Q

Chlamydia effects in women

A

-can cause pelvic inflammatory disease

107
Q

What is pelvic inflammatory disease

A

-infection that spreads to upper reproductive tract
-can result in injury and scarring of affected tissue
-can result in tubal factor infertility

108
Q

Chlamydia effects in males

A

-can cause infections in urethra and epididymis
-associated with sperm damage via DNA fragmentation

109
Q

What percent of poeple in canada have had HPV at some point

A

-70%

110
Q

HPV symptoms

A

-asymptomatic
-genital warts
-cancer

111
Q

Types of cancer that can be caused by HPV infection

A

-cervical cancer
-anal cancer
-oropharyngeal cancer
-rarer cancers such as vaginal, vulvar, and penile

112
Q

Treatment options for HPV induced cancers

A

-surgery
-radiation therapy
-chemotherapy
-hormone therapy

113
Q

Surgery for HPV induced cancer

A

-best approach
-depending on location can sometimes harm reproductive tissues and cause scarring

114
Q

Radiation therapy for HPV induced cancers

A

-high energy radiation from x rays, gamma rays, neutrons, protons, etc
-can equally damage normal cells
-some organs can be protected such as ovaries with ovarian shielding

115
Q

Chemotherapy for HPV induced cancer

A

-involves use of drugs to stop growth of cancerous cells
-can be toxic to normal cells, and can impair the function of gonads

116
Q

Hormone therapy for HPV induced cancer

A

-can disrupt the menstrual cycle and the HPG axis
-this may then affect fertility

117
Q

HPV prevention

A

-hygiene
-condom use
-vaccines

118
Q

Vaccines for HPV

A

-can provide significant protection against becoming infected
-traditionally given to girls but now may be given to boys as well

119
Q

Common chronic conditions associated with fertility

A

-hypertension
-type II diabetes
-cardiovascular disease

120
Q

Diabetes effects in females

A

-alterations in length of menstrual cycle
-alterations in age of onset of menopause

121
Q

What condition is common with insulin resistance

A

-PCOS

122
Q

What does insulin act a under normal conditions in women

A

-gonadotropin in theca cells

123
Q

Diabetes affects in males

A

-erectile dysfunction
-ejaculatory dysfunction
-higher percentage of sperm with nuclear and mitochondrial DNA fragmentation
-lower implantation rates
-early onset of childhood diseases

124
Q

Diabetes induced autonomic neuropathy

A

-may be the cause of erectile and ejcaculatory dysfunction in men

125
Q

Main lifestyle factor that may affect fertility

A

-nutrition

126
Q

Malnutrition effect on fertility

A

-lacks nutrients to produce energy or maintain cellular processes
-affect fertility through disruption of hormones in the HPG axis
-food deprivation disrupts the GnRH pulse

127
Q

Overnutrition effect on fertility

A

-can result in hyperlipidemia, hyperinsulemia etc
-this can increase androgen secretion and impact fertility
-can also have a negative impact on energy homeostasis by forcing body to compensate for excess nutritional intake

128
Q

Impact of glucose on female fertility

A

-insulin resistance is strongly associated with PCOS

129
Q

Impact of glucose on male fertility

A

-abnormal glucose homeostasis is believed to negatively affect sperm cell metabolism
-dysfunction in nutrient transport and decreased fertility

130
Q

Other lifestyle factors that may affect fertility

A

-physical activity
-alchohol intake
-smoking habit
-drug use
-medication use

131
Q

What is an assisted reproductive technology

A

-methods that help to treat subfertility

132
Q

Assisted reproductive technology

A

-intrauterine insemination
-in vitro fertilization
-third part assisted ART

133
Q

Intrauterine insemination

A

-insemination is acheived by using a catheter to deposit sperm directly into the uterine cavity as close to the fallopian tube as possible

134
Q

In vitro fertilization

A

-eggs and sperm are incubated in a laboratory to produce a viable embryo
-the embryo is then transferred to the womans uterus

135
Q

Third party assisted ART

A

-where someone other than the parents aids in reproduction
-surrogacy
-egg/sperm donation

136
Q

Intrauterine insemination process

A

-may be combined with controlled ovarian hyperstimulation, where hormone injection is used to promote maturation of additional follicles
-this injection is timed around ovulation and sperm is deposited in fallopian tube before ovulation

137
Q

Stages of in vitro fertilization

A

-ovarian stimulation
-egg retrieval
-sperm retrieval
-fertilization
-embryo transfer

138
Q

IVF ovarian stimulation

A

-injected hormones are used to promote the maturation of more than follicle

139
Q

IVF egg retrieval

A

-eggs are collected from the ovaries by inserting a hollow needle through the vaginal wall to access the ovary

140
Q

IVF sperm retrieval

A

-male provides a semen sample that will be used in lab to combine with egg
-sperm are centrifuged to concentrate it and reduce volume of semen

141
Q

IVF fertilization

A

-concentrated semen is placed in a petri dish with the egg and incubated overnight to fertilize
-if they do not fertilize on their own, fertilization if performed via intracytoplasmic sperm injection

142
Q

IVF embryo transfer

A

-transferred to the uterus 1-6 days after fertilization, by using a long tube to inject it directly into the uterus

143
Q

Types of third party assisted ART

A

-sperm donation
-embryo donation
-gestational surrogacy
-egg donation
-traditional surrogacy

144
Q

Sperm donation

A

-can be used to perform IUI or IVF

145
Q

Embryo donation

A

-used in cases when both partners are infertile
-embryos can be frozen for adoption

146
Q

Gestational surrogacy

A

-similar to traditional but carrier is implanted with embryo that is not biologically related to her

147
Q

Egg donation

A

-egg donor will undergo ovarian hyperstimulation and egg retreival, and donated eggs with me fertilized with IVF and placed in uterus

148
Q

Traditional surrogacy

A

-when woman is infertile
-surrogate is inseminated with sperm from male partner, which will produce a child that is related to male partner and surrogate

REPD 372 (6 decks)

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