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Medicine: PBL wrap-ups > Unit 7 Week 1: Conception > Flashcards

Unit 7 Week 1: Conception Flashcards

1
Q

causes of male infertility

A

hormone imbalance
genetic problems
undescended testicles
tubule defects
STI’s and inflammation
varicoses
prior surgeries
overheating testicles
excessive alcohol, smoking and illegal drugs
obesity
medications
increased scrotum temp
testicular cancer
congenital defects
testicular injury
premature ejaculation
delayed ejaculation
retrograde ejaculation

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2
Q

hormone imbalance male infertility

A

hypogonadism
decreased sperm production

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3
Q

genetic problems male infertility

A

klinefelter syndrome: males for with extra X chromosome
leader to decreased testosterone
decreased size testicles
no sperm production

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4
Q

undescended testicles male infertility

A

increased temperature on abdomen
decreased sperm quality and production

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5
Q

STI’s and inflammation male infertility

A

prostatitis
epididymitis
orchitis

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6
Q

prior surgeries male infertility

A

vasectomy/ surgeries in genital regions

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7
Q

obesity male infertility

A

high amounts of fatty tissues in surround regions will increase temperature

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8
Q

which medications can cause male infertility

A

testosterone replacement
long term anabolic steroid use
chemotherapy
some antibiotics/ anti-depressants

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9
Q

increased scrotum temperature male infertility

A

abnormal sperm motility and shape

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10
Q

premature ejaculation

A

before vaginal penetration

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11
Q

delayed ejaculation

A

may be unable to ejaculate

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12
Q

retrograde ejaculation

A

semen to bladder instead of urethra

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13
Q

what is varicoceles

A

abnormal swelling of veins in pampniform plexus (transport deoxygenated blood away from the testicles)
pampniform plexus drains to testicular vein
resistance in these veins leads to back flow of deoxygenated blood
can cause infertility by increasing temperature of testicles as blood is pooling/ testicular atrophy

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14
Q

varicoceles is more common on which side

A

left side as drains to renal vein
increased vein length so increased resistance
right Side drains to inferior vena cava

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15
Q

symptoms of varicoceles

A

pain/ discomfort
reduced fertility
may have no symptoms

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16
Q

presentation of varicoceles

A

scrotal mass, may feel like a bag of worms
more prominent when standing but may disappear when lying down
testicular asymmetry but this is also present in healthy individuals

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17
Q

how should you respond if swelling doesnt go away in suspected varicoceles

A

when lying down if the swelling doesnt go away it may indicate retroperitoneal tumours that are obstructing drainage of renal vein
needs urgent urology referral

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18
Q

testing for varicoceles

A

ultrasound
blood tests for FSH and testosterone
semen analysis

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19
Q

varicoceles treatment

A

painkillers if needed
surgery: only if pain, testicular atrophy or reduced fertility

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20
Q

investigations for male infertility

A

most cases are of unknown aetiology
diagnosed if abnormal semen parameters in 2 semen analysis tests separated by one month
different investigations include:
medical history
physical exam
urinanalaysis
semen analysis
hormonal tests

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21
Q

semen analysis

A

tests the health and viability of the sperm
measures: number, shape, motility, ph, ouse, liquefaction, appearance
tested 7 days apart and over course of 2-3 months, average gives the most conclusive result
to get a good sample: semen at body temperature, too warm or too cold is inaccurate

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22
Q

physical examination male infertility

A

look at penis, prostate, testes and scrotum
testes may have lumps or deformities
penis: shape structure any obvious abnormalities

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23
Q

results of semen analysis

A
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24
Q

what affects sperm count

A

alcohol
caffeine
herbs
prescription drugs
recreational drug use
tobacco

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25
urinalysis male infertility
can indicate presence of infection
26
hormonal tests male infertility
evaluate testosterone and FSH levels
27
any further testing that may be used in male infertility
seminal fructose test post-ejaculate urinanalysis semen leukocyte analysis Kruger and WHO morphology anti-sperm antibodies test sperm penetration assay scrotal and transrectal ultrasound testicular biopsy vasography genetic testing specialised sperm function test sperm plasma membrane chlamydia test
28
causes of female infertility
hypothyroidism premature ovarian failure scarring from surgery cervical mucus problems fibroids endometriosis pelvic inflammatory diseases polycystic ovary syndromw
29
hypothyroidism female infertility
decreased thyroxine causes decreased FSH and LH secretion menstrual cycle won't be regulated follicles won't be stimulated in growth
30
prematur ovarian failure female infertility
where ovaries stop working in age under 40 sometimes runs in families
31
scarring from surgery female infertility
pelvic surgery can scar/ damage fallopian tubes cervical surgery may scar/ shorten cervix which may cause premature birth
32
cervical mucus problems female infertility
when ovulating it will thin so sperm can swim easier problems with mucus then conception may be harder
33
fibroids female infertility
benign growths in/around the womb may prevent fertilised egg implanting/ may block fallopian tubes
34
endometriosis female infertility
tissue similar to womb lining grows elsewhere e.g. ovaries, fallopian tubes and can cause blockages surgery can help improve chances of pregnancy
35
pelvic inflammatory diseases female infertility
womb inflammation/ fallopian tubes/ ovaries often caused by STI's
36
polycystic ovary syndrome female infertility
ovaries produce excessive androgens (testosterone) can cause imbalance in reproductive hormones causing irregular periods small follicle cyst on ovaries due to lack of ovulation insulin resistance= androgen production
37
investigations female infertility
hormone testing hormone level testing imaging tests ovarian reserve testing pregnancy testing
38
hormone level testing female infertility
blood tests done on specific days of the menstrual cycle hormone imbalance will affect ovulation and fertility hormones that are tested: progesterone LH FSH estradiol
39
progesterone levels female infertility
low levels= corpus leuteum impaired function high levels aren't concerning
40
LH levels female infertility
low levels= problem with hypothalamus/ ovulation high levels= PCOS, POF
41
FSH levels female infertility
low levels= decreased ovarian function high levels= problems with pituitary/ hypothalamus
42
estradiol levels female infertility
low levels= problems with hypothalamus high levels= problems with ovaries e.g. tumour or cyst
43
which imaging tests are done to investigate female infertility
ultrasound hysterosalpingography laparoscopy
44
ultrasound female infertility
analyse fluid as it passes through fallopian tubes checks for any abnormalities of blockages
45
hysterosalingography female infertility
specialised x rat to view inside of uterus and fallopian tubes thin tube threaded through the vagina and cervix contrast material injected into the uterus, series of x rays follow dye into the tubes outlining the shape of the uterus and fallopian tubes
46
laparoscopy female infertility
minimally invasive surgical technique where telescopic like instrument with light and camera are inserted into the abdomen through a small incision
47
ovarian reserve testing female infertility
determines woman's remaining egg supply quality and quantity and can be done by measuring: 1. day 2 or 3 FSH levels: elevated FSH= diminished egg supply 2. AMH testing (anti-mullerian hormone): higher= higher egg supple or immature follicles in ovaries 3. antra follicle count: using ultrasound you can count women's follicles
48
pregnancy testing female infertility
check urine/ blood for hormone HCG (human chorionic gonadotrophin) HCG is produced after fertilised egg attaches to uterus wall normally 6 days after fertilisation if HCG rises rapidly, doubles every 2/3 days anything 25mlU/ml considered positive and less than 5 negative false positives: taking test too soon after fertility medicine/ ovary problems/ menopause false negatives: test too early, test result too soon, time of day as urine is most concentrated in the morning
49
qualitative HCG
binary yes or no
50
quantitative HCG
tells you the exact HCG content in the blood
51
IVF eligibility
women under 40 should be offered 3 cycles of IVF on the NHS if: trying to get pregnant through regular unprotected sex for 2 years not been able to get pregnant after 12 cycles of artificial insemination, at least 6 of these using intrauterine insemination (IVI) if you have been 40 during the cycle, complete the cycle but no further cycles are offered if IVF is only likely treatment then refer straight away all women aged 40-42 offered 1 cycle if the NICE criteria are met
52
different types of oral contraceptives
combined pill progestin only pill emergency contraceptive pill
53
combined pill
also contains oestrogen
54
progestin only pill
55
emergency contraceptive pill
56
different types of non-oral contraceptives
implant IUD/ copper coil injection patch vaginal ring diaphragm/ cap condoms: internal and external fertility awareness withdrawal method female sterilisation male sterilisation IUS/ hormonal coil
57
injection
58
patch
59
external condoms
60
withdrawal method
61
female sterilisation
62
male sterilisation
63
fertility awareness
64
IUS
65
IUD
66
internal condoms
67
vaginal ring
68
diaphragm/cap
69
what could be done to increase chances of conception
stop smoking maintain a healthy weight reduce OH intake intercourse every 2-3 days out of 7 intercourse around ovulation loose fitting clothing? avoid vaginal lubricants
70
ovulation predictors
detects rise in LH rise in LH signals egg release darker line than control line ovulation in the middle of the cycle LH peaks 12 hours before ovulation positive reading you should expect to ovulate 12-36 hours after take multiple times a day false positive= PCOS
71
what are the 4 main hormones involved in the mestrual cycle
oestrogen progesterone follicle stimulating hormone FSH leutenising hormone LH
72
FSH function
stimulates follicle development
73
LH function
causes ovulation
74
oestrogen function
steroid sex hormone that acts on tissues with oestrogen receptors to promote female characteristics: develop breast tissue, vulva, vagina, uterus, endometrium, thin cervical mucus to allow sperm penetration, causes negative feedback to decrease FSH and LH
75
progesterone function
steroid sex hormone if pregnancy occurs then placenta takes over at 5 to 10 weeks acts on tissues already acted on by oestrogen: thicken and maintain endometrium, thickens cervical mucus and causes rise in body temperature
76
what are the 2 phases of the menstrual cycle
follicular phase and luteal phase follicular phase can vary in days but normally 14 days luteal always 14
77
follicular phase
hypothalamus releases gonadotrophin releasing hormone causes FSH release and LH release from anterior pituitary in ovaries there are a finite number of primordial follicles FSH stimulates around 15-20 follicles to develop once a month as follicles develop the granulosa cells surrounding them will secrete oestrogen before ovulation there is a decrease in oestrogen and increase in LH causes one follicle to reach ovary surface and release the ovum ovulation occurs at day 14
78
luteal phase
follicle that released ovum collapses and becomes corpus luteum corpus luteum secretes high levels of progesterone and some oestrogen if the egg is fertilised will secrete HCG, maintaining corpus leuteum if the ovum isn't fertilised then the corpus leuteum will degenerate, stops producing oestrogen and progesterone removes negative feedback of FSH and LH so FSH begins to increase and cycle begins lack of production of oestrogen and progesterone will cause breakdown of endometrium causing menstruation
79
menstruation
cycle day 1 superficial and middle layers separate from basal layers of endometrium tissue breaks down inside of the uterus released from the cervix to the vagina fluid containing blood will then release from the vagina lasting 1-8 days= period
80
what does hypothalamus secrete menstruation
gonadotrophin releasing hormone
81
what does the anterior pituitary secrete menstruation
FSH LH
82
what do the follicles in the ovaries secrete menstruation
oestrogen
83
what does the corpus leuteum secrete menstruation
progesterone and oestrogen
84
what does the embryo secrete menstruation
human chorionic gonadotrophin (HCG)
85
6 stages of fertilisation
sperm transport sperm capacitation sperm-oocyte interaction sperm-oocyte fusion completion of meiosis 2 zygote formation and implantation
86
transport of sperm
vagina: where ejaculate is deposited, coagulates to form alkaline loose gel to protect against vaginal acidity and immunological response cervix: cervical mucus and high levels of oestrogen cause sperm to change microstructure of mucus= easy passage uterus: uterine contractions to propel sperm to uterus
87
sperm capacitation
epithelial interactions between sperm and uterine wall will destabilise plasma membrane of the sperm acrosomal reaction occurs: glycoprotein coat covering acrosome is removed sperm plasma and acrosomal membrane fuse enzyme released from acrosome (acrosin, hyaluronidase, hexasaminidase) increase in Cat Per channels in flagellum, Ca2+ influx and sperm motility hyper activated
88
sperm-oocyte interactions
corona radiata: capacitated sperm pass through hyaluronidase dissolves hyaluronic acid cementing corona radiata cells zona pellucida: sperm penetrate here due to across released from acrosome, made up of 4 main glycoproteins ZP1-4 ZP3 are the only ones that bind to the receptors on the surface of human sperm
89
sperm-oocyte fusion
cortical reaction: sperm fuses with the cell membrane of the oocyte triggers increase in Ca2+ in eggs cytosol causes release of lysosomal enzymes in cortical granules initiate zona reaction= slow polyspermy block as cortical granules harden the oocyte membrane release of hydrolytic enzymes further degrade the zona pellucida stimulates exocytosis of cortical granules to harden the oocyte membrane, impenetrable to further sperm
90
completion of meiosis 2
oocyte completes myosis 2 forms definitive ovum and polar body polar body is degrades
91
zygote formation and implantation
pronucleus of ovum and pronucleus of sperm fuse to form zygote zygote divides by mitosis in fallopian tubes day 3-4= morula 16 cells 5= blastocyst 7/8= implantation, blastocyst burrows into uterine lining
92
define different sperm parameters

Medicine: PBL wrap-ups (21 decks)

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