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What is an oocyte?
a female gametocyte that develops into an ovum after two meiotic divisions
Stories of 4 couples, all of whom want to be parents:
- a. Pam and Paulyoung couple in their 20sh, Paul diagnosed with testicular cancer-> bank the sperms
- b. Elaine and Bobboth found each other later in life while in their 40s -> testing, donor egg
- c. Kathysingle, 33, and wants to be a parent, no male partner. -> donor sperm
- d. Larry and Mary, late 30s, 2nd marriage, and one (or both) had sterilization procedure. -> if Mary sterilized, IVF the egg can be retrieved; if Larry is sterilized, reverse (very dificult) or extract sperms for IVF
Events leading to pregnancy
- Fertilization started 2 weeks after the last normal menstrual period in a 28-day cycle
- Takes place in outer third of the ampulla of the fallipian tube
- Events of pregnancy:
- - Sperm production
- - Emission & ejaculation
- - Cervical mucus penetration
- - Uterine/tubal transport
- - Egg penetration
- - Fertilization
- - Embryo survival/implantation
Causes of infertility
- 40 % are female factors, 40 % are male factors, and 20% are a combination.
- - egg production: egg quantiy & quality; age over 35 (not the quantity not the quality)
- - ovulating: ovarian dysfunction PCO(polycystic ovarian syndrome: physical appearance : facial hair - hirsutism, acne, apple shape, overweight), irregular menstrual cycle (progesterone & estrogen imbalance)
- - Hx of PID, cervical cancer/inflammation
- - Pelvic structure
- - Sperm: quantity (low sperm count), direction (circular motion), full shape (healthy, mature), motility
- - Viscosity of seminal fluid
- - Erectile dysfunction
- - Exposure toxins
- - Underdescended testes
- - Overheated gonad: bicycling, sauna, hot tub, tight brief
Review PCO, think about how, in addition to infertility, this syndrome may affect aspects of a womans later life.
- PCO: multiple inactive cysts in the ovary, that interfere with ovarian function
- Affect aspects of a womans later life: increased risks of anovulation (75%), cardiovascular disease, HTN, dyslipidemia, type 2 DM, & cancer: endometrial, breasts, ovarian
With the ovulation predictor kit (OPK), what hormone is measured to indicate ovulation?
LH (LH surge indicates the most fertile day of the month)
In finding the optimum time to get pregnant, several different methods may be used. With the basal body temperature (BBT) what changes occur around ovulation?
Temp rises within a day or two after ovulation & elevated for about 2 wks
What is the name of the only oral medication used in fertility treatment to stimulate the ovary? This super-ovulatory drug is
Clomid, Anti-estrogen to stimulate ovulation, nurse advises couple to have intercourse every other day after day 5 of medication
what is the nursess role in artificial insemination?
- The nurse before inserting the semen has to have the female ID the semen
- Advise the couple that the procedure might need to be repeated if not successful
How is that role different in IVF (in vitro fertilization)?
Nurse advised woman to take med to stimulate ovulation so the mature ovum can be retrieved by needle aspiration
What is a donor gamete and give one example.________________
Eggs or sperm are retrieved from a donor & the eggs are inseminated; resulting embryos are transferred via IVF. For women older than 40 & those with poor quality eggs
Side effects of estrogen:
Eye: visual changes
Stress, severe leg pain (SVT, DVT)
contraception missing pill scenario
Miss 1 pill: use another method, take that pill asap, continue the next pill; depends where you are in the cycle
Miss 2 pills: start over with a new pack