Test 2 Infertility Flashcards by Jade Ring

Define infertility…

No conception >1 yr unprotected sex - 6 months if woman >35

Inability to carry a pregnancy to live birth

Involuntary ability to conceive when desired

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Dif between Primary & Secondary Infertility…

Prime = never could

Secondary = have before, cant now

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Is a lesbain considered infertile…

Yes.

She lacks the male partner

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PGS

Preimplantation Genetic Diagnosis

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Average sperm per ejaculation….

Normal conception requires ______ sperm / ml with normal motility

Sperm count & infertility

Mild
Mod
Severe

Average = 400 million

Conception requires 20 / ml Norm Motility

Mild 15 - 20 / ml 35 - 50 % Motility
Mod 5 - 10 / ml 20 - 35% Motility
Severe <5 / ml or <20% Motility

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Illness, mumps, cirrhosis, renal failure
Genital infection
Varicocele
Exposure to Toxins
Drugs
Elevated scrotal temp, saunas, hot tubs
Autoimmune response

Factors that affect sperm

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DM Peripheral vascular disease
Antihypertensive meds
CNS dysfunction, drugs, psych problems,
Surgery to spinal cord

Erection problems

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Ab normal Ejaculation

Retrograde Ejaculation…
Hypospadias….

Retrograde Ejaculation: Ejaculation goes backwards into bladder

Hypospadias: Urethral opening on underside of penis

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What can go wrong with seminal fluid to cause infertility…

Stay Coagulated.

Normally Coagulates then liquifies within 30 mins.

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Test male or female first to determine infertility with couple…

How?

Male

Semen analysis (Structure, Volume, Motility)

Endocrine (Testosterone)
US Genital
Testicle biopsy

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Women born with all their eggs

Decline in # through the lifetime

7 million at birth
300,000 at puberty
Few thkusand late 30’s

T or F

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Normal ovulation

The following is the order of events in ovulation.

Hypothalamus (Secrets / Which Does)

Pituitary (Hormones)

Hypothalamus secrets GnRH Gonadotropin-Releasing Hormone

GnRH stimulates the Pituitary

Pituitary releases FSH (Follicle-stimulating hormone) & luteinizing hormone (LH)

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Name the hormone

Stimulates maturity of several follicles - small fluid-filled sac in the ovaries. Contains an immature egg (oocyte).

As Follicles mature the ovary releases estrogen to thicken the endometrium

Follicle stimulating hormone
FSH

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Follicle contains an immature egg which will mature with help from FSH.

As the Follicle matures the ovary secrets estrogen, why?

To thicken the endometrium

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Luteinizing hormone

24 - 36 hrs prior to ovulation, LH increases

What is the purpose of LH…

Stimulates final maturation and release of the ovum (Mature female egg cell)

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______ is a mature egg cell that is part of the female reproductive system.

It is the female gamete (reproductive cell) and carries half the genetic material needed for reproduction.

When fertilized by a sperm cell, the ovum can develop into a zygote, the first stage of a developing embryo.

An ovum (plural: ova)

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Collapsed follicle from which the ovum was released.

Produces Progesterone & Estrogen which preparss the endometrium for implantation

Corpus luteum

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Estrogen builds the house (uterine lining) during the first half of the cycle.

Progesterone keeps the house ready for a baby after ovulation.

True

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Match to appropriate Structure.

GnRH (Stimulates Pituitary Gland to release FSH & LH)

FSH (Stimulates ovary which causes maturation of follicles) & LH (Stimulates ovary and final maturation and release of ovum)

As follicle matures Estrogen is released (thickens endometrium)

Progesterone & Estrogen (Prepares endometrium for implantation)

Ovary, Pituitary, Corpus luteum, Hypothalamus

Hypothalamus
GnRH (Stimulates Pituitary Gland to release FSH & LH)

Pituitary
FSH (Stimulates ovary which causes maturation of follicles) & LH (Stimulates ovary and final maturation and release of ovum)

Ovary
As follicle matures Estrogen is released (thickens endometrium)

Corpus luteum
Progesterone & Estrogen (Prepares endometrium for implantation)

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GnRH ….
FSH….
LH….
Progesterone & Estrogen….

(Prepares endometrium for implantation)

(Stimulates ovary which causes maturation of follicles)

(Stimulates Pituitary Gland to release FSH & LH)

(Stimulates ovary and final maturation and release of ovum)

GnRH (Stimulates Pituitary Gland to release FSH & LH)

FSH (Stimulates ovary which causes maturation of follicles) & LH (Stimulates ovary and final maturation and release of ovum)

As follicle matures Estrogen is released (thickens endometrium)

Progesterone & Estrogen (Prepares endometrium for implantation)

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Oligoovulation / Anovulation
Commonly, lack of FSH

Are common causes of female infertility

Tx…..

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Clomiphen (Clomid)

Anti-estrogen - Blocks effects of estrogen

Pituitary notices lack of precieved estrogen & secrets more FSH & LH to índuce ovulation

Purpose of Clomiphen Citrate (Clomid) - an Anti-estrogen medicine

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Induce ovulation

It blocks body from sensing estrogen which makes body increase FSH & LH

Partial fallopian tube obstruction may result in…

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Ectopic pregnancies

STD
Endometriosis
Scarring from PID,surgery, peritonitis
Ovarian cysts
Congenital anomalies

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Fallopian tube problems

AMA Percent chance of getting preggers at 30 40

30- 20% chance 40- 5%

Ovaries enlarged with multiple small cysts. Irregular menstruation / impaired fertility High Risk for miscarriage Excessive testosterone production gives Hair & Skin (Acne) issues Increased Risk of developing DM Obesity/ Heart Disease

Polycystic Ovary Syndrome PCOS

TX for PCOS Polycystic Ovarian Syndrome

Clomid / Femara

Trouble ovulating. It is often prescribed for infertility and is considered one of the first-line treatments for women with conditions like polycystic ovary syndrome (PCOS) or other ovulation-related problems.

Clomid (Clomiphene citrate)

Clomid blocks the effects of estrogen in the brain. This tricks the brain into thinking estrogen levels are low, prompting the pituitary gland to release more follicle-stimulating hormone (FSH) and luteinizing hormone (LH). These hormones (2)

Help follicles in the ovaries grow. Trigger ovulation (release of an egg).

Causes of repeated pregnancy loss

1. Abnormal fetal chromosomes - SAB 1st trimester Chromosomal analycist frequently order on fetuses delivered 2nd / 3rd trimester 2. Abnormalities of cervix or uterus

Uterine myomas (Benign) and adhesions may have this affect on pregnancy (2)

Alter perfusion Preterm labor

Basal body temperature Day 1: Your period starts. Days 2–13: Your temperature stays around 97.2°F to 97.5°F. Day 14: Ovulation happens (you don’t feel it). The next morning, your temp jumps to 98.0°F. Days 15–28: Your temp stays high (98.0–98.3°F). Day 29: If you’re not pregnant, your temp drops, and your period starts again. What is your body temperature when you can get preggers...

A few days before the temperature increase (Ovulation)

BBT is lowest rest body temperature 1st half menstrual cycle is lower than 2nd half (when ovulating / fertile) BBT DROPS JUST SLIGHTLY BEFORE OVULATION & RISES DURING OVULATION/ PREGGERS T or F

Spinnbarkheit ....

How much cervical mucus can be stretched between fingers or slide / slip cover Just before / after ovulation MUCUS IS SCANT, THICK, STICKY and opaque Stretches <6cm Prior & 2-3 days after ovulation MUCUS IS THIN, SLIPPERY, AND CLEAR - resembles egg-white, stretches >6cm

MUCUS IS SCANT, THICK, STICKY and opaque Stretches <6cm MUCUS IS THIN, SLIPPERY, AND CLEAR - resembles egg-white, stretches >6cm Which one is more likely to get preggers...

Just before / after ovulation MUCUS IS SCANT, THICK, STICKY and opaque Stretches <6cm Prior & 2-3 days after ovulation MUCUS IS THIN, SLIPPERY, AND CLEAR - resembles egg-white, stretches >6cm Egg whites gets preggers

Antihistamine, vag infection, contraceptive foams, Sexual arousal, semen, Clomid All hav3 an influence on....

Cervical mucus assessment

Ovulation prediction (BBT, Cervical Mucus, Serum progesterone lvl) Pelvic US Postcoital test: Evaluate Cervical mucus / sperm function Endocrine test Hysterosalpingography: Patency verfied by contrast medium & US (Can unclog passage way & help with pregnancy) Endometrial biopsy Hysterscopy (go inside with a scope & clear out any scarring) Laproscopy (go inside with a scope & clear out any scarring) Used for...

Test for female infertility

Infertility Meds Corrects excessive prolactin secreted by the Anterior Pituitary & Increased ovulation & stimulates progesterone secretion by corpus luteum Causes ovulation, increase GnHr secretion from the hypothalamus, thus increasing FSH & LH Increased blood flow to the penis, Erection Clomiphen citrate (Clomid) Bromocriptine (Parlodel) Sildenafil (Viagra)

Bromocriptine (Parlodel) Corrects excessive prolactin secreted by the Anterior Pituitary & Increased ovulation & stimulates progesterone secretion by corpus luteum Clomiphen citrate (Clomid) Causes ovulation, increase GnHr secretion from the hypothalamus, thus increasing FSH & LH Sildenafil (Viagra) Increased blood flow to the penis, Erection

Corrects excessive prolactin secreted by the Anterior Pituitary & Increased ovulation & stimulates progesterone secretion by corpus luteum

Bromocriptine (Parlodel)

Causes ovulation, increase GnHr secretion from the hypothalamus, thus increasing FSH & LH

Clomiphen citrate (Clomid)

Increased blood flow to the penis, Erection

Sildenafil (Viagra)

Infertility meds Stimulates ovulation in female/ sperm production in males. Stimulates production of progesterone by corpus luteum Reduces endometriosis (2) Leuprolide (Lupron) Nafarelin (Synarel) Chorionic Gonadotropin (hCG, Pergonal)

Chorionic Gonadotropin (hCG, Pergonal) Stimulates ovulation in female/ sperm production in males. Stimulates production of progesterone by corpus luteum Leuprolide (Lupron) Nafarelin (Synarel) Reduces endometriosis (2)

Chorionic Gonadotropin (hCG, Pergonal)

Stimulates ovulation in female/ sperm production in males. Stimulates production of progesterone by corpus luteum

Leuprolide (Lupron) Nafarelin (Synarel)

Reduces endometriosis

(First Line) artificial inseminación Use clomiphen for best results Hormone levels are closely monitored US to evaluate follicle (goal 2-3) Semen sample is obtained & washed, then inserted through cervix and placed high in the uterus

Interuterine Insemination (IUI)

Putting sperm & egg together in the fallopian tube via Laproscopic procedure. Give woman progesterone Name process...

Gamete Intrafallopian Transfer Rarely done

Bypasses blocked or Absent fallopian tubes Ova & Sperm are mixed together in lab 2 - 5 days later embryos are returned to the UTERUS Give progesterone to promote implantation Excess embryos maybe frozen Issue of Concern: Multiple concpetions, may require selective reduction.

Im Vitro Fertilization IVF

Intracytoplasmic Sperm Injection (ICSI) Describe.... Required if you do Genetic Testing

IVF But, single sperm is injected into egg

BUFA

Baby up for adoption

Open vs Closed adoption

Open = Regular contact with birth mother Closed = NO Contact

(Estrogen / Progesterone)builds the uterine lining. ( Estrogen/Progesterone) fine-tunes and maintains it, ensuring it’s ready for implantation and early pregnancy support. If fertilization doesn’t happen, hormone levels drop, and the uterine lining sheds as a period.

Estrogen builds the uterine lining. Progesterone fine-tunes and maintains it, ensuring it’s ready for implantation and early pregnancy support.

Test 2 Infertility Flashcards

(51 cards)