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50 Cards in this Set
- Front
- Back
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What is the definition of infertility?
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Heterosexual couple who have
had regular (three times a week) unprotected sex for a year or more without getting pregnant or being unable to maintain a pregnancy |
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What % of married couples of child bearing age in the USA are infertile?
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15%
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What % of cases of infertility are due to the mother?
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35%
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What % of cases of infertility are due to the father?
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35%
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What % of cases of infertility are due to both parents?
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20%
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What % of cases of infertility are due to an unknown cause?
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10%
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What % of cases of infertility can be diagnosed? What % of these cases can be treated successfully?
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90% of cases can be diagnosed and 50-60% can be treated successfully
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What % of females are infertile in the age groups 20-24? 25-29? 30-34? 35-39?
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• 4.1% between 20-24 years
• 5.5% between 25-29 years • 9.4% between 30-34 • 19.7% between 35-39 |
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What are some reason for female infertility?
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• Failure to ovulate
• Tubal blockage • Failure to implant • Pregnancy loss (miscarriage) • Reduced sperm transport • Antibodies to sperm |
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What is the main cause of infertility in women?
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Failure to ovulate. Hypothalamus (GnRH) or pituitary gland (LH&FSH) may not be functioning adequately
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What are the treatments for failure to ovulate?
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• GnRH stimulatory agonists can induce ovulation
• Anti-estrogen e.g., Clomiphene (clomid) is taken orally and it inhibits the negative feedback of estrogens on GnRH, FSH & LH secretion (30 - 50% success rate) • Human menopausal gonadotropin which contains LH & FSH followed by hCG (which has similar effect as LH) results in 50-70% success rate |
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What are some examples of polycystic ovary diseases?
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• Obesity
• Hirsutism • Virilization • Anovulation • Infertility • Amenorrhea or oligomenorrhea • Often have anovulatory spontaneous uterine bleeding • Increased insulin resistance and increased rates of Type 2 diabetes mellitus |
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How does polycystic ovary disease affect infertility?
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• 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 |
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How does polycystic ovary disease affect infertility? (Cont...)
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• 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 |
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In polycystic ovary disease, what happens to the levels of FSH, LH, adrenal and ovarian androgens, acyclic estrone, and cyclic estradiol?
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• ↓ FSH
• ↑ LH • ↑ adrenal and ovarian androgens • ↑ acyclic estrone (produced by aromatization) • ↓ cyclic estradiol |
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What is the 2nd leading cause of infertility in females?
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Tubal blockage
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What is tubal blockage caused by?
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Scarring from sexually transmitted infections, either chlamydia or gonorrhea, Endometriosis can also cause tubal blockage.
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What is endometriosis?
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a condition where endometrium tissue grows outside of the
uterus, such as inside the oviduct where it can cause scarring and blockage |
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What are the treatments for tubal blockage?
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• Gas (CO2 or air) injected into tubes
• Transcervical balloon tuboplasty: balloon is inserted into obstructed tube and is inflated • Surgical repair, usually by laparoscopy |
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What happens in absence of implantation?
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• A normal preembryo may reach the uterus, but the uterine surface is not receptive to implantation
• This problem can be treated effectively in some women by priming the uterus with appropriate doses of estrogen and progestogen |
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What % of fertilized eggs do not completely development?
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50-75%, before the women even realizes their pregnant
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What % of known pregnancies end in miscarriage?
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15%
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Why do most early miscarriages occur?
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Chromosomal abnormalities
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What happens to sperm when there are hostile cervical mucus? How is this alleviated?
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Female reproductive tract may not allow transport of sperm due to hostile cervical mucus. This condition may be alleviated with estrogen.
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What does a highly acidic vagina do to sperm? How can this be remedied?
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Females vagina may be highly acidic which kills the sperm. This condition can be remedied with alkaline douches.
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T/F, some women may produce antibodies to their male partner's sperm.
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True
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What are reasons for male infertility?
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Low sperm count and poor sperm transport
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What is the leading cause of infertility in men?
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Low sperm count
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How does oligospermia (low sperm count) or azoospermia (absence of sperm) occur? How can it be treated?
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Inadequate functions of hypothalamus or pituitary gland may result in these symptoms. These symptoms can be treated with GnRH stimulatory agonists, gonadotropins, or the antiestrogen clomiphene
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What are some reasons testes may not be capable of responding to gonadotropins?
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• physical injury
• cryptochodism (non-descended testes) • past infection of testes (e.g., mumps) • exposure to radiation or chemotherapy • exposure to environmental toxins |
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What are some causes for low sperm count?
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• Smoking
• Xenoestrogens • Anabolic steroids • Excessive alcohol consumption • Tight underwear |
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What % of infertile men produce antibodies against their own sperm? How does this happen?
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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 |
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What fraction of men are infertile because they are missing part of the Y chromosome?
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1 in 1000
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What is artificial insemination?
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• 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 |
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In IVF, how is egg retrieval achieved?
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By ovarian stimulation with gonadotropins or clomiphene
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In IVF, how are mature follicles from which eggs can be harvested identified?
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Ultrasound
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In IVF, where is mom's egg fertilized by the sperm?
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Outside in a petri dish
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In IVF, how long are fertilized eggs incubated for before the preembryo becomes a blastocyst?
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5 days
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In IVF, how many tiny preembryos are inserted through the cervix into the uterus?
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2-3 or more
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In IVF, how are the left over eggs preserved?
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They are frozen for possible use in future IVF cycles
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What is the success rate of IVF?
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25-30%
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What % of IVF births result in multiple babies?
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35-40%
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What is preimplantation genetic diagnosis (PGD)?
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• Genetic testing of a single cell taken from a preembryo prior to transfer of the embryo to the uterus during IVF
• Used to screen preembryos for inherited genetic disorders |
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What is the average cost of each IVF/PGD cycle?
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Over $20,000
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How can women with blocked oviducts or infertile couples who wish to avoid fertilzation outside of the body get pregnant?
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Gamete or Zygote intrafallopian transfer.
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How does Gamete/Zygote intrafallopian transfer (GIFT/ZIFT) work?
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• Via laparoscopy, egg and sperm or zygote are inserted into the oviduct proximal to the
point of blockage so that fertilization and implantation can occur • Success rates for GIFT and ZIFT are 25 - 30% which is similar to IVF |
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What is a surrogate mother?
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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
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Is the surrogate mother the biological mother?
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Yes
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What is a gestational carrier?
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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 |
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Is a gestational carrier genetically related to the baby?
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No
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