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39 Cards in this Set

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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