Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
39 Cards in this Set
- Front
- Back
|
infertility definition
|
unable to conceive or carry to term
|
|
|
what is primary infertility
what is secondary infertility |
primary-never able to conceive
secondary-h/o conception, now unable after a year of trying |
|
|
what is sterility
|
absolute infertility
|
|
|
factors leading to increased incidence
|
AGE- delayed childbearing, fertility decreases at 27 and rapidly < after 40
STD- silent PID, esp chlamydia INCREASED REPORTING |
|
|
FACTORS neccesary for conception
|
reg production of ovum
sperm in adequate numbers and morphology clear pathway for spern and ovum to meet prepared endometrium for implantation |
|
|
most common causes of infertility
|
scarring and infection or anatomic defects of fallopian tubes
decreased sperm count |
|
|
Male: problems of production or maturation
|
mumps
undescended testes(must be down by age 7) febrile illness-not permanant environmental-DES, agent orange, chemo, gulf war syndrome Genetic-klinfelter syndrome circulatory age-after 40< amt though never ceases completely |
|
|
Sperm motility
|
Infection-esp STDs, prostate, epidydeis can cause increase in viscocity so decrease in motility
Sperm antibodies may be formed after vasectomy when sperm is ejaculated into body and body sees as foriegn object and creates antibodies |
|
|
Conduction
BLockage |
scarring
absence of vas deferens vasectomy |
|
|
Deposition
|
must deposit sperm at cervical opening.
sexual function-Ed or premature ejaculation Congenital neuro/metabolic such as spinal cord injuries, MS or DM which causes retrograde ejaculation |
|
|
Male assessment
|
hx- job, smoking, exposure
semen analysis testicular biopsyvasofraphy-view the circulation system suppling the testicles |
|
|
what four things do they look at when examinig sperm?
|
1/ count
2. motility 3. volume 4. liquidfication |
|
|
sperm morphology
|
should have one head, one body and one tail.
|
|
|
Male interventions
|
avoid high temperatures
medications: metrodin which increased testosterone pergonal-increases testosterone clomid-increases sperm count |
|
|
Female-mechanical
|
adhesions- from infections. either cervical or PID
Cervical factors- cercicitis causes thicken mucous, cervical stenosis, polyps or acidic cervix. some form antibodies to partners sperm endometriosis |
|
|
ENDOMETRIOSIS
|
don't know why it occurs
implantation of endometrial tissue outside uterine cavity. > incidence of infertility with age and duration of disease, NOT severity. the spread is still affected by hormones difficult to dx ususally by lapriscopic |
|
|
ENDOCRINE
|
Annovulation-
hypothalamus and pituitary level-decreased Lh and FSH Ovarian level-turner syndrome, premature ovarian failure(early menopause, polycystic ovaries Other- < estrogen production caused by < in fat. obesity progesterone deficincy hypothyroid adrenal tumor |
|
|
Structural defects
|
uterine- bicornate uterus
fibroids Cervical- recurrent spontaneous abortion due to weakening of cervix tx is circlage |
|
|
Bicornate uterus
|
septum- could possible go all the way down to the cervix. can sometimes be corrected with surgery. sometimes the result of exposure to DES
|
|
|
Female Assessment
|
hx-esposures, reg periods?
physical exam basel body temp |
|
|
what is ferning and spinbarkitt?
|
ferning is what happens to ovulatory mucous if it has estrogen
spinbarkitt-change in cervical ucous at ovulation making it stretchy |
|
|
What is a basel body temp graph looking for?
|
bi-phasic ovaluatory cycles. Temperature rises after ovulation
|
|
|
post cotial exam
|
w/i several hours of intercourse look for interaction of sperm with mucous
|
|
|
endometrial biopsy
|
A catheter is inserted into uterus through vagina to remove cells from the uteringe lining for examination-checking quality
|
|
|
hysterosalpingogram
|
dye sent through cervix watch on X-ray to see if there is blockage. can be diagnostic and THERAPUETIC
|
|
|
Pelvic laparoscopy
|
used to dx adhesions and endomeitriosus. may also be therapuetic
|
|
|
ND for infetility
|
sorrow-chronic
self-esteem-situational low body image disturbed sexuality pattern ineffective knowledge deficit decisional conflict-when do you stop? |
|
|
non-medical interventions
|
antibodies to sperm use condoms and/or bypass cervix
|
|
|
Medications
|
clomid, serophene-stimulates release of FSH and LH
pergonal and profasi given at same time to produce ovarian follicle growth. risk of multi birth DANAZOL-danocrine- GnRH agonists treat endomeitrosis progesterone-treats luteal phase inadequacy polycystic ovary diseas-purified FSH/metrodin |
|
|
side effects of med
|
there are many don't make you feel good.
|
|
|
Artificial insemination
|
done at cervix or bypassing cerivx
|
|
|
Assisted Reproductive technologies ART
|
IVF
retrieval of egg which has been stimulated by meds eggs and sperm cobined outside body embryo is transferred to body of uterus via cervix, esp useful is nonpatent fallopian tube |
|
|
other ART therapies
GIFT |
GIFT- gamete intrafallopian transfer-eggs fertilized outside then immediately transfered to fimbriated end of tube
|
|
|
other ART therapies
ZIFT |
zygote intrafallopian tranfer- zygote transfered to fallopian tube several day laters
|
|
|
other ART therapies
|
donor oocyte, embryo or embryo host
therapeutic donor insemination |
|
|
Intracytoplasmic sperm injection or hatching
|
sperm cell is injected directly to achieve fertilization
used with IVF to increase chances of working |
|
|
sucess rate of ART
|
25% live birth rate
higher level of miscarriage >risk of multiple births > risk of brain tumor 2x many congentital anomolies and low birth weight |
|
|
Ethical issues
|
how long to continue
how old is too old how many eggs should be fertilized should insurance cover? |
|
|
psychological impact
|
stages of grieving
shock/denial anger bargaining depression acceptance invasion of privacy pain/discomfort of tests expense stress on relationship |
