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24 Cards in this Set
- Front
- Back
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testing for repeated miscarriage
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chomosome analysis on both partners
hysterosalpinogram antibody testing hormonal workup- decrease progesterone= increse infertility |
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causes of multiple miscarriages
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chromosome rearrangements
anatomic abnormalities immunologic problems hormonal causes |
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peak fertility
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age 16-24
decreased 25-35 severly diminished (2%) over 40 |
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etiology of infertility
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female- 50%
male-40% unexplained-10% |
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psychological factors of infertility
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identify couples
emotional support referall to clinical psychologist financial counseling |
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causes of female infertility
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tubal-blocked- Increased possibility from clamidia
hormonal-progesteron, anovulation age smoking obesity malnutrition endometriosis chromosomal-turners syndrome -no ovulation |
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causes of male infertility
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hormonal- increase ssh
environmental toxins-smoking drugs infection mechanical-ED, ejaculatory problems unexplained |
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Where to start with infertility
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BBT-basic body temp- .5 degree rise on ovulation day
monitor cycles urine ovulation predictor kits home sprm kits- not recommended |
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male evaluation
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semen analysis
sperm antibody testing assessment of reproductive health and risk factors, including current meds |
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normal semen analysis
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volume of 1.5-5 ml
concentration >20 M/ml motility >60% are moving morphology >10% able to penetrate |
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treatment options for abnormal semen
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meds
surgery Artifical insemination in vitro fert. donor insemination |
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Ovarian reserve testing
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cycle day 3 estradiol and FSH
21 yo- FSH is low to normal- easier to get pregnant |
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Candidates for ovarian reserve testing
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women >35
women who smoke abnormal mestrual cycles with ovarian endometriosis prior ovarian surgery unexplained infertility prior to in vitro fert. poor responder to gonadotropin stim. |
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Clomiphen citrate
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clomiphen probably induces ovulation by binding to brain estrogen receptors, fooling the brain into perceiving low serum estrogen levels and thus increasing FSH and LH secretion from pituitary
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clomiphene citrate and ovarian cancer
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possible association
when high possibility with other risk factors, limit to less than 12 cycles |
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female evaluation- chlomid
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starting does is 50 mg (start on days 3-7)
ovulation predictor kit US intercourse vs IUI |
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gonadotropin
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The body produces two types of gonadotropins: follicle-stimulating hormone (FSH) and luteinizing hormone (LH). After they are produced by the pituitary gland, gonadotropins trigger production of other sex hormones. Gonadotropins therefore play a part in egg and sperm production, as well as female and male physical traits such as voice, muscle, hair, and breast development.
daily injection US-monitor patients response |
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gonadotropin risks
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multiple births
ovarin hyperstimulation cancellation of cycle-too many follicles allergy to meds infections |
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IVF
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In Vitro Fertilization
9-12,000 dollars |
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indications for IVF
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absent or damaged fallopian tubes
endometriosis male factor failure to conceive with traditional ovulation induction/IUI immunologic infertility unexplained infertility |
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ICSI
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Intracytoplasmic Sperm Injection
a single sperm is injected into the egg |
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Indications for ICSI
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male factor infertility
-low count, poor motility, <4% normal morphology failed fertilization in a previous IVF cycle |
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Donor egg
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age 21-30
good general health interview psychological screening PE and infectious disease testing |
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indications for donor eggs
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Premature ovarian failure
IVF failures advanced reproductive age genetic |
