Preconception

Question 1

Fertility

Answer 1

the actual production of children

Question 2

Fecundity

Answer 2

the biological capacity to bear children

Question 3

Infertility

Answer 3

lack of conception after 1 year of unprotected intercourse

Question 4

Subfertility

Answer 4

reduced level of fertility characterized by unusually long time for conception such as having multiple miscarriages, sperm abnormalities, or infrequent ovulation

Question 5

Gonadatropin Releasing Hormone (GnRH)

Answer 5

Stimulates pituitary to release FSH and LH

Question 6

Follicle Stimulating Hormone (FSH)

Answer 6

Stimulates maturation of ovum & sperm

Question 7

Luteinizing Hormone (LH)

Answer 7

Stimulates secretion of estrogen, progesterone & testosterone

Question 8

Estrogen

Answer 8

Stimulates release of GnRH in follicular phase

Stimulates vascularity & storage of glycogen & other nutrients within uterus

Question 9

Progesterone

Answer 9

Prepares uterus for fertilized ovum

Increases vascularity of endometrium

Stimulates cell division of fertilized ova

Question 10

Follicular Phase

Answer 10

First half of cycle

Follicle growth & maturation

Main hormones: GnRH, FSH, estrogen, & progesterone

Question 11

Luteal Phase

Answer 11

Second half of cycle, after ovulation

Formation of corpus luteum (hormone secreting cyst)

Decrease in estrogen & progesterone stimulate menstrual flow

Prostaglandins & cramps

Question 12

Testosterone and androgens

Answer 12

stimulate the maturation and release of sperm from the testes (spermatogenesis)

Question 13

Physiological factors contributing to normal fertility

Answer 13

Normal menstrual cycle (Production of ova)

Sperm maturation, production and storage

Sperm motility

Question 14

Nutrition related disruptors in fertility

Answer 14

Under nutrition
Weight loss
Obesity
High exercise levels
Intake of specific foods & food components

Question 15

Undernutrition

Answer 15

Chronic

• Small impact on fertility and fecundity
• Higher likelihood of small frail infants and infant death

Acute

• Results in dramatic decline in fertility but is recovered with recovered food intake
• Reduces reproductive capacity by modifying hormonal signals that regulate -ovulation and menstrual cycles in females
• Also impairs sperm maturation in male

Question 16

Adipokines

Answer 16

Cell signaling proteins secreted by adipose tissue important to many metabolic processes (estrogen, androgen, leptin specifically for preconception)

Question 17

Body fat and fertility

Answer 17

Excessive and inadequate body fat levels will alter the hormone balance and affect the reproductive cycle
Adipose tissue converts androgens to estrogen by aromatization
Body fat is thus a significant extragonadal source of estrogen
Obese men have significantly lower circulating levels of testosterone
Adiposity influences the direction of estrogen metabolism to more potent or less potent forms

Question 18

Low body fat can lead to…

Answer 18

Delayed onset of menstruation
Amenorrhea
Lowered libido
Reduced sperm production

Question 19

High body fat can lead to…

Answer 19

Increased leptin and insulin levels and a preferential increase in LH, but not FSH, levels.
High insulin levels increases ovarian testosterone production/action.
The net effect of these changes is to stimulate the partial development of follicles that secrete supranormal levels of testosterone, but which rarely ovulate (hence low progesterone).

Question 20

Exercise and fertility

Answer 20

Exercise is associated with positive fertility outcomes
Mechanism: Exercise increases insulin sensitivity, which is related to ovarian function
Moderate-intensity exercise is more beneficial that high-intensity exercise

Question 21

Oxidative stress and fertility

Answer 21

Free radicals can harm:

• Sperm motility and ability to fuse with egg
• DNA within the sperm cell
• Egg and follicular development
• Implantation of egg in uterine wall

Question 22

Free radicals

Answer 22

reactive oxygen species formed during regular metabolic processes containing extra valence electrons and therefore making them more prone to react with other molecules and cause damage (oxidative stress)

Question 23

Antioxidants

Answer 23

neutralize free radicals by donating extra valence electrons

Question 24

Caffeine and fertility

Answer 24

High intakes are linked to reduced fertility (definition of high intake is not clear <200-300mg/day)
Adenosine receptor antagonist that may influence fertility in women but not men

Question 25

Alcohol and fertility

Answer 25

Alcohol intake alters the hormonal milieu - Decreases estrogen and testosterone levels - Disrupts menstrual cycle - Disrupts testicular function How much? Not entirely clear. 1-5 drinks/week = ~40% decreased chance of conception Over 10 drinks/week = ~66% decreased chance of conception

Question 26

Folic Acid

Answer 26

Neural Tube Defects (NTD) such as Spina Bifida and Anencephaly are a very common birth defect due to the neural tube developing and closing at 4 weeks Folic acid functions as a coenzyme during the synthesis of nucleic acids and therefore is required for cell division and formation of the neural tube All processed grain products were mandated to be fortified with folate beginning in 1998

Question 27

Iron

Answer 27

Many women have low iron stores due to menstruation or low iron intakes Improvements in iron status associated with improved fecundity. Possible role in oocyte development?

Question 28

Calcium

Answer 28

Associations between dairy intake and fecundability were generally small and inconsistent across cohorts, maintain RDA

Question 29

Vitamin A

Answer 29

Retinoic acid is used in dermatology to cure acne and psoriasis Should not be prescribed during pregnancy or in women planning to become pregnant

Question 30

Teratogenicity

Answer 30

the ability to cause defects in a developing fetus

Question 31

Vitamin D

Answer 31

Supplementation associated with - Increased endometrial thickness - Improved serum lipids - Decreased risk of endometriosis Important to correct insufficiency and deficiency

Question 32

Conditions impacting conception

Answer 32

Premenstrual syndrome (PMS) ``` Obesity Underweight Female athletic triad Eating disorders Diabetes Polycystic ovary syndrome Phenylketonuria, Celiac disease ```