Module 5: Fertility Concepts and Pathology Flashcards
(150 cards)
1
Q
Fertility
A
-natural capability to produce offspring
2
Q
Fecundity
A
-potential output of reproduction by an organism
-measured by number of gametes, seeds, etc
2
Q
Total fertility rate
A
-refers to total number of children born or likely to be born to a woman in her lifetime
3
Q
Birth rate
A
-total number of live births per 1000 in a population in a year or period
4
Q
How many couples of reproductive age experience infertility
A
-8-12%
5
Q
Where is infertility most prevalent
A
-in developed countries
6
Q
Age-fertility decline
A
-affects both men and women
7
Q
What gender does age-fertility decline begin earlier in
A
-women
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
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
10
Q
Global fertility rate
A
-2.5 children per woman
11
Q
What country has the lowest fertility rate
A
-europe
12
Q
What is europes fertility rate
A
-1.6 children per woman
13
Q
What country has the highest fertility rate
A
-africa
14
Q
What is africas fertility rate
A
-4.7 children per woman
15
Q
Population dynamic in Canada recently
A
-decline in fertility
16
Q
How has Canada’s population structure changed
A
-from a relatively young and growing population to an aging population
17
Q
Clinical terminology of fertility
A
-defined as capacity to establish a clinical pregnancy within 12 months of regular and unprotected sexual intercourse
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
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
20
Q
Clinical terminology for sterility
A
-refers to complete incapability to conceive naturally
-ex. due to absence of gonads regardless of cause
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
22
Q
Secondary infertility
A
-refers to couples who have previously carried a pregnancy to term, but are now unable to conceive
23
Q
Factors that influence infertility
A
-hormones
-gametes
-gonads
-reproductive ducts
-external genitalia
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How do hormones determine fertility
-circulating levels of regulator hormones of the reproductive system
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How do gametes determine fertility
-quantity and quality of oocytes in females and sperm in males
26
How do gonads determine fertility
-anatomy and function of ovaries or testes
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How do reproductive ducts determine fertility
-anatomy and function of the reproductive ducts in male and female
28
How does the external genitalia determine fertility
-anatomy and function of the external genitalia
29
What is the process of diagnosing infertility
-medical history
-physical exam
30
Medical history
-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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Physical exam
-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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Factors considered during medical history check
-previous physical injuries
-previous infections
-current systemic diseases
-current hormonal conditions
-current lifestyle factors
-other serious conditions
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Specific diagnostic tests for males
-semen analysis
-testicular biopsy
-imaging
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Semen analysis
-used to detect sperm abnormalities such as azoospermia
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Testicular biopsy
-used to determine unexplained male infertility and azoospermia
36
Imaging in males
-pelvic and scrotal ultrasound or MRI
37
Specific diagnostic tests for both males and females
-physical exam
-hormonal tests
-genetic testing
38
Hormonal tests specific hormones both male and female
-FSH
-testosterone or progesterone
39
Genetic testing
-to diagnose certain genetic disorders affecting fertility
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Specific diagnostic tests in females
-imaging
41
Imaging in females
-generally a hysterosalpingography which is an x ray of uterus and fallopian tubes to check for abnormalities
42
Idiopathic infertility
-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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Congenital disorders that can cause infertility
-turners syndrome
-klinefelter syndrome
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Turners syndrome
-condition in which a female is partially or completely missing one of her X chromosomes
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Turners syndrome symptoms
-short stature
-webbing of neck
-widely spaced nipples
-cardiac and renal abnormalities
-other hormonal imbalances among many other health issues
46
Klinefelter syndrome
-genetic disorder in which boys are born with an extra X chromosome
-can cause hypogonadism in males
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Klinefelter syndrome symptoms
-small testes
-tall/slender build
-low testosterone
-karyotyping
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Menopause
-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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When does menopause usually occur
-14-55 years of age
50
Premenopause
-years from puberty to menopause
-also referred to as the reproductive life of a female
51
Final menstrual period (menopause)
-defined as one year of spontaneous missed periods without any abnormality or drugs that can alter menstrual cycles
52
Postmenopause
-stage which begins with the last menstrual period and continues for the rest of a womans life
53
Perimenopause
-starts before menopause and continues 12 months after it
-when the body begins to undergo several physical and hormonal changes
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Premature menopause
-spontaneous cessation of menses before age 40
55
What can induce artificial menopause
-radiation therapy
-oophorectomy (surgical removal of ovaries)
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Follicular pool
-the number of extra follicles available for maturation
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Ovarian reserve
-the capacity of the ovaries to produce an oocyte capable of fertilization and pregnancy
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What happens to the follicular pool and ovarian reserve with age
-both decline progressively
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Hormonal changes related to menopause
-increased sensitivity to GnRH
-less suppression of FSH secretion
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Increased sensitivity to GnRH
-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
Less suppression of FSH secretion
-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
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Oxidative stress
-physiological imbalance in the production of reactive oxygen species (ROS)
62
Reactive oxygen species (ROS)
-natural byproducts of metabolism which cause cellular damage by oxidizing and altering cellular DNA
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Lifestyle factors and oxidative stress
-oxidative stress can be significantly worsened by lifestyle choices such as unhealthy diet, sedentarism, and smoking etc
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Fertility and oxidative stress
-considered to be a major factors in the process of natural fertility decline
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When does the risk of experiencing pregnancy complications increase
-after the age of 35
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When does age-related fertility decline start in men
-around 40 years of age
67
Andropause
-progressive hormone decline in males
-also known as late-onset hypogonadism
68
Andropause symptoms
-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
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What percent of men at age 40 are impacted by erectile dysfunction
-10%
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What percent of men over the age of 70 are impacted by erectile dysfunction
-80%
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What is one of the primary causes of erectile dysfunction on men over 50
-atherosclerotic disease
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Other potential causes of erectile dysfunction
-psychological
-neurological
-hormonal
-pharmacological
-anatomical
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What happens to serum testosterone levels with time
-decrease
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What is the decrease of serum testosterone levels due to
-decrease in leydig cells
-deterioration of testicular perfusion
-disturbances to GnRH and chorionic gonadotropin secretion
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Primary hypogonadism
-testosterone deficiency due to a testicular defect
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Secondary hypogonadism
-testosterone deficiency caused by a problem with the pituitary gland or hypothalamus
-testes are normal but there is abnormal signaling from the brain
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Sex hormone binding globulin (SHBG)
-a hormone that binds to testosterone in the blood and reduces the amount of available testosterone
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Primary testicular failure
-decine in testosterone secretion caused by a deficiency or absence of leydig cell function
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How is sperm affected with age
-volume, motility, and morphology are all decreased
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Why are sperm affected with age
-often due to increase in replication errors, DNA mutations and fragmentation in sperm cells
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Benign prostatic hyperplasia
-prostate enlargement in older men
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What happens to semen volume after the age of 45
-gradually decreases due to functional decline of accessory glands
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What are children born to older parents most at risk for
-down syndrome
84
Direct injury to genitals
-have potential to result in permanent impairment of function depending on severity
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Which gender are direct injuries more common in
-males
86
Direct injuries in women
-not common
-can happen as a vaginal or uterine prolapse after childbirth
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Indirect injury
-would involve an injury to a non-reproductive structure that ends up interfering with normal reproductive function
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Example of indirect injury
-spinal cord injury
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How can spinal cord injuries affect reproductive function
-loss of mobility in legs
-can affect innervation of reproductive organs
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Parasympathetic innervation of male reproductive system
-parasympathetic nerves from S2-4 nerve roots primarily control erectile function by controlling arterial dilation
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Sympathetic innervation of the male reproductive system
-sympathetic nerves from T11-L2 control detumescence and contribute to ejaculation and emission by controlling gland secretions and release of sperm
92
What is detumescence
-the subsidence of a swelling, especially the return of a swollen penis, to the flaccid state
93
What can SCI inflicted nerve damage lead to in males (impaired)
-reflecogenic erections
-psychogenic erections
94
Reflexogenic erections
-an erection which is stimiulated by direct stimulation of genital region
95
Psychogenic erections
-initiated by thoughts and erotic stimuli, independent of direct genital stimulation
96
What can happen to sperm production with SCI
-production and quality can decrease due to factors such as increased temperature due to prolonged sitting, decreased physical activity, and less frequent sperm discharge
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Parasympathetic innervation of the female reproductive system
-parasympathetic nerves from S2-4 nerve roots control clitoral erection as well a relaxation of uterine smooth muscles
98
Sympathetic innervation of female reproductive system
-sympathetic nerves from T11-L2 control the contraction of the uterus
99
Somatic innervation of the female reproductive system
-derived from both T12-L2 and S2-S4 and provides pain perception
100
What is amenorrhea
-the absence of menstruation
-happens often to women after suffering a traumatic injury to the spine
101
Changes in sexual response in women after SCI
-decreased lubrication
102
Can women with an SCI still get pregnanct
-yes because sexual function is independent of reproductive function in women
103
Risks of pregnancy during SCI
-higher risk of preterm labour
-thrombosis or autonomic dysreflexia
-brachycardia
-excessive sweating and headaches
104
What is an infection that can have a major impact on reproductive function
-STI's
105
What is the most common communicable disease that affects fertility
-chlamydia
106
Chlamydia effects in women
-can cause pelvic inflammatory disease
107
What is pelvic inflammatory disease
-infection that spreads to upper reproductive tract
-can result in injury and scarring of affected tissue
-can result in tubal factor infertility
108
Chlamydia effects in males
-can cause infections in urethra and epididymis
-associated with sperm damage via DNA fragmentation
109
What percent of poeple in canada have had HPV at some point
-70%
110
HPV symptoms
-asymptomatic
-genital warts
-cancer
111
Types of cancer that can be caused by HPV infection
-cervical cancer
-anal cancer
-oropharyngeal cancer
-rarer cancers such as vaginal, vulvar, and penile
112
Treatment options for HPV induced cancers
-surgery
-radiation therapy
-chemotherapy
-hormone therapy
113
Surgery for HPV induced cancer
-best approach
-depending on location can sometimes harm reproductive tissues and cause scarring
114
Radiation therapy for HPV induced cancers
-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
Chemotherapy for HPV induced cancer
-involves use of drugs to stop growth of cancerous cells
-can be toxic to normal cells, and can impair the function of gonads
116
Hormone therapy for HPV induced cancer
-can disrupt the menstrual cycle and the HPG axis
-this may then affect fertility
117
HPV prevention
-hygiene
-condom use
-vaccines
118
Vaccines for HPV
-can provide significant protection against becoming infected
-traditionally given to girls but now may be given to boys as well
119
Common chronic conditions associated with fertility
-hypertension
-type II diabetes
-cardiovascular disease
120
Diabetes effects in females
-alterations in length of menstrual cycle
-alterations in age of onset of menopause
121
What condition is common with insulin resistance
-PCOS
122
What does insulin act a under normal conditions in women
-gonadotropin in theca cells
123
Diabetes affects in males
-erectile dysfunction
-ejaculatory dysfunction
-higher percentage of sperm with nuclear and mitochondrial DNA fragmentation
-lower implantation rates
-early onset of childhood diseases
124
Diabetes induced autonomic neuropathy
-may be the cause of erectile and ejcaculatory dysfunction in men
125
Main lifestyle factor that may affect fertility
-nutrition
126
Malnutrition effect on fertility
-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
Overnutrition effect on fertility
-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
Impact of glucose on female fertility
-insulin resistance is strongly associated with PCOS
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Impact of glucose on male fertility
-abnormal glucose homeostasis is believed to negatively affect sperm cell metabolism
-dysfunction in nutrient transport and decreased fertility
130
Other lifestyle factors that may affect fertility
-physical activity
-alchohol intake
-smoking habit
-drug use
-medication use
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What is an assisted reproductive technology
-methods that help to treat subfertility
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Assisted reproductive technology
-intrauterine insemination
-in vitro fertilization
-third part assisted ART
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Intrauterine insemination
-insemination is acheived by using a catheter to deposit sperm directly into the uterine cavity as close to the fallopian tube as possible
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In vitro fertilization
-eggs and sperm are incubated in a laboratory to produce a viable embryo
-the embryo is then transferred to the womans uterus
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Third party assisted ART
-where someone other than the parents aids in reproduction
-surrogacy
-egg/sperm donation
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Intrauterine insemination process
-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
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Stages of in vitro fertilization
-ovarian stimulation
-egg retrieval
-sperm retrieval
-fertilization
-embryo transfer
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IVF ovarian stimulation
-injected hormones are used to promote the maturation of more than follicle
139
IVF egg retrieval
-eggs are collected from the ovaries by inserting a hollow needle through the vaginal wall to access the ovary
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IVF sperm retrieval
-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
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IVF fertilization
-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
IVF embryo transfer
-transferred to the uterus 1-6 days after fertilization, by using a long tube to inject it directly into the uterus
143
Types of third party assisted ART
-sperm donation
-embryo donation
-gestational surrogacy
-egg donation
-traditional surrogacy
144
Sperm donation
-can be used to perform IUI or IVF
145
Embryo donation
-used in cases when both partners are infertile
-embryos can be frozen for adoption
146
Gestational surrogacy
-similar to traditional but carrier is implanted with embryo that is not biologically related to her
147
Egg donation
-egg donor will undergo ovarian hyperstimulation and egg retreival, and donated eggs with me fertilized with IVF and placed in uterus
148
Traditional surrogacy
-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
