INFERTILITY 11

Card Set Information

Author:
jeannette_ruiz
ID:
18406
Filename:
INFERTILITY 11
Updated:
2010-05-09 01:07:14
Tags:
INFERTILITY
Folders:

Description:
INFERTILITY 11
Show Answers:

Home > Flashcards > Print Preview

The flashcards below were created by user jeannette_ruiz on FreezingBlue Flashcards. What would you like to do?


  1. Infertility statistics
    • • 15% of married couples of child-bearingage in the USA are considered infertile
    • • 35% of cases are due to mother
    • • 35% of cases are due to father
    • • 20% of cases are due to both parents
    • • 10% of cases the cause is unknown
  2. INFERTILITY DIAGNOSED and TREATED
    • • Cause of infertility can bediagnosed in up to 90% of cases
    • • 50-60% of these cases can betreated successfully
  3. FEMALE INFERTILITY BTWN. 20-39
    • • 4.1% between 20-24 years
    • • 5.5% between 25-29 years
    • • 9.4% between 30-34
    • • 19.7% between 35-39
  4. WHAT ARE REASONS FOR FEMALE INFERTILITY?
    • • Failure to ovulate
    • • Tubal blockage
    • • Failure to implant
    • • Pregnancy loss (miscarriage)
    • • Reduced sperm transport
    • • Antibodies to sperm
  5. FAILURE TO OVULATE, why?
    main cause of infertility in women
    • • Main cause of infertility inwomen
    • • Hypothalamus (GnRH) orpituitary gland (LH, FSH) maynot be functioning adequately
  6. TREATMENT OF FAILURE TO OVULATE:
    • GnRH stimulatory agonists can induce ovulation
    • Anti-estrogen e.g., Clomiphene (clomid) istaken orally and it inhibits the negative feedback of estrogens on GnRH, FSH &LH secretion (30 - 50% success rate)
    • Human menopausal gonadotropin whichcontains LH & FSH followed by hCG (which has similar effect
  7. POLYCYSTIC OVARY DISEASE:
    • • Obesity
    • • Hirsutism
    • • Virilization
    • • Anovulation
    • • Infertility
    • • Amenorrhea or oligomenorrhea
    • • Often have anovulatory spontaneousuterine bleeding
    • • Increased insulin resistance and increasedrates of Type 2 diabetes mellitus
  8. POLYCISTIC OVARY DISEASE details:
    • • Combination of obesity and elevated levels of adrenal androgens leads to increased extraglandular aromatization to produce increased estrogen (estrone)
    • • The increased estrogen level causes a NEGATIVE feedback effect on FSH which prevents the maturation of follicles and hence there is NO graafian follicle formation and NO ovulation
    • • Simultaneously, it is believed that elevated estrogen causes a POSITIVE feedback on LH which results in an INCREASE in ovarian androgen production
    • • Hence, there is an increase in BOTH ovarian and adrenal androgens which causes hirsutism/virilization and leads to increased levels of extra-glandular aromatization to produce increased estrogen (estrone)
    • • The greater the obesity, the more strongly this sequence is perpetuated
  9. POLYCISTIC OVARY DISEASE effects:
    • • ↓ FSH
    • • ↑ LH
    • • ↑ adrenal and ovarian androgens
    • • ↑ acyclic estrone (produced by aromatization)
    • • ↓ cyclic estradiol
  10. What is TUBAL BLOCKAGE?
    • • 2nd leading cause of infertility in females
    • • Blockage in oviduct blocks the passage of sperm or ova
    • • Can be caused by scarring from sexually transmitted Infection e.g.,Chlamydia or Gonorrhea
    • • Endometriosis is a condition where endometrium tissue grows outside of the uterus, such as inside the oviduct where it can cause scarring and blockage
  11. TREATMENT of tubal blockage:
    • • Gas (CO2 or air) injected into tubes
    • • Transcervical balloon tuboplasty:balloon is inserted into obstructed tube and is inflated
    • • Surgical repair, usually by laparoscopy
  12. WHAT is absence of implantation and how is it treated?
    • • A normal preembryo may reach theuterus, but the uterine surface is notreceptive to implantation
    • • This problem can be treated effectivelyin some women by priming the uteruswith appropriate doses of estrogen andprogestogen
  13. Pregnancy loss/miscarriage
    • • 50 - 75% of all fertilized eggs do not complete development and many are lost before or soon after implantation, before the women realize that they are pregnant
    • • 15% of known pregnancies end in miscarriage
    • • Most early miscarriages occur because ofchromosomal abnormalities
    • • Other early miscarriages have normal chromosomes and may occur for immunological reasons. Research is being conducted to understand if the parental major histocompatibility(MHC) antigens play a role in this.
  14. Reduced sperm transport or antibodies to sperm
    • • Female reproductive tract may not allowtransport of sperm due to hostilecervical mucus. This condition may bealleviated with estrogen.
    • • Females vagina may be highly acidicwhich kills the sperm. This condition can be remedied with alkaline douches.
    • • Some women may produce antibodiesto their male partner’s sperm
  15. 2 reasons for MALE INFERTILITY:
    • • Low sperm count
    • • Poor sperm transport
  16. Male infertility from low sperm count
    • • Leading cause of infertility in men
    • • Inadequate functioning hypothalamusor pituitary gland may result inoligospermia (low sperm count) orazoospermia (absence of sperm)
    • • Can be treated with GnRH stimulatoryagonists, gonadotropins, or the antiestrogenclomiphene
    • Testes may not be capable of responding to gonadotropins because of damage from:
    • • physical injury
    • • cryptochodism (non-descended testes)
    • • past infection of testes (e.g., mumps)
    • • exposure to radiation or chemotherapy
    • • exposure to environmental toxins
    • • 8-13% of infertile men produceantibodies against their own sperm,because at some time sperm hadentered the body tissues outside ofreproductive tract
    • • 1 in 1000 men are infertile becausethey are missing part of the Ychromosome
  17. Causes of low sperm count
    • • Smoking
    • • Xenoestrogens
    • • Anabolic steroids
    • • Excessive alcohol consumption
    • • Tight underwear
  18. Male infertility from low sperm count
    • • 8-13% of infertile men produce antibodies against their own sperm,because at some time sperm had entered the body tissues outside of reproductive tract
    • • 1 in 1000 men are infertile because they are missing part of the Ychromosome
  19. Assisted reproductivetechniques (ART)
    • • Artificial insemination (AI)
    • • In vitro fertilization (IVF)
    • •Pre-implantation genetic diagnosis (PGD)
    • • Gamete or zygote intra-fallopian transfer(GIFT)
    • • Surrogate mothers and gestational carriers
  20. Artificial insemination (AI)
    • • When sperm are introduced into a woman’s reproductive tract by means other than coitus
    • • Donor sperm may be from mom’s partner
    • • Sperm may be donated from sperm bank
    • • Donors typically masturbate and put sperm into a vial or ejaculate into a special condom during intercourse
  21. In vitro fertilization (IVF) (Fig 16-3)
    • • Egg retrieval is achieved by ovarian stimulation with gonadotropins or clomiphene
    • • Ultrasound identifies mature follicles from which eggs can be harvested
    • • Mom’s egg is fertilized by sperm outside of the body in a petri dish
    • • Fertilized eggs are incubated for 5 days when the preembryo becomes a blastocyst
    • • 2-3 or more tiny preembryos are inserted throughthe cervix into the uterus
    • • Any remaining eggs and preembryos can befrozen for possible use in future IVF cycles
  22. In Vitro Fertilization success rates:
    • • Success rate per IVF cycle is 25 -30%
    • • 35 - 40 % of births resulting from IVFare multiple babies (twins or more)
  23. Preimplantation genetic diagnosis(PGD)
    • • Genetic testing of a single cell taken from apreembryo prior to transfer of the embryo to the uterus during IVF
    • • Used to screen preembryos for inheritedgenetic disorders
    • • Average cost of each IVF/PGD cycle is over$20,000
  24. Gamete (GIFT) or zygote (ZIFT)intrafallopian transfer (Fig 16-3)
    • • Used in women with blocked oviducts orinfertile couples who wish to avoid fertilization outside of the the body
    • • Via laparoscopy, egg and sperm or zygote are inserted into the oviduct proximal to thepoint of
    • blockage so that fertilization and implantation can occur
    • • Success rates for GIFT and ZIFT are 25 -30% which is similar to IVF
  25. Surrogate mothers &gestational carriers (Fig 16-3)
    • Surrogate mother is inseminated by sperm of donor father, gets pregnant and delivers the child, and gives the child to the couple with whom she has a contract
    • • Surrogate Mom is biological mother
    • Gestational carrier has a preembryo implanted in her uterus and she gestates and delivers this
    • baby for the couple or person with whom she has a contract
    • • Gestational carrier is not genetically related to the baby

What would you like to do?

Home > Flashcards > Print Preview