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21 Cards in this Set
- Front
- Back
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What is the definition of infertility, vs. fecundability and fecundity?
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infertility: inability to conceive after one year of trying
fecundability: probability, population-wide, or becoming pregnant within one menstrual cycle (20-25 % in US) fecundity: ability to achieve a live birth in one menstrual cycle |
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What's the incidence of infertility in AMerican couples 15-45 yo?
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10-15 %
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What are causes of infertility?
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Aging
Tubal/pelvic disease (40% of women) Ovulatory dysfunction (40%) Unexplained (10%) Male problem Endometriosis Uterine disorders |
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How does aging cause infertility?
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after 30 yo, pregnancy declines 3.5% per year, number and quality of follicles decline, rate of spontaneous abortions increase with age to 75% over age 40. Many are due to chromosomal abnormalities.
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What ovulatory disorders can cause infertility?
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PCOS: oligoovulation and hyperandrogenism. Often w/ obesity, multicystic ovaries, insulin resistance.
Hypothalamic dysfxn (severe stress, anorexia, excessive exercise) Lesions of hypothalamus/pituitary (surgery, tumors, trauma, CVA) Endocrine lesions (hyperprolactinemia, thyroid abn) Ovarian lesions (menopause, severe infection, bilat tumor) Inadequate luteal phase (corpus luteum doesn't secrete enough progesterone to support blastocyst) |
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How do you evaluate for an ovulatory disorder?
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menstrual history, BBT record, endometrial biopsy to find progesterone, serum progesterone (> 3 on day 21 is okay, should be 15-25), urinary LH (ovulate the day after a surge)
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How do you treat an ovulatory disorder?
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1. clomiphene citrate: non-steroidal SERM, blocks hypothalamus estrogen-R --> more FSH/LH --> ovarian stimulation. only works with intact hormonal axis. 50-70% success, 5 % twinning.
2. gonadotropins: if axis isn't fxnal. hCG: egg release. hMG: follicular growth and maturation, then hcg. FSH: follicular growth then hcg. 60-70% success, expensive, hard, many twins. 3. GnRH antagonist: allows better response to administered gonadotropins because ovaries only respond to injections (hMG) |
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How do you evaluate for aging as the cause for infertility?
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FSH levels (test on day 3 of cycle). If FSH > 15 mU/mL, there's a low probability of pregnancy.
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How do you treat infertility due to aging?
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eggs from a younger donor + the partner's sperm. A pregnancy can be supported with the help of supplemental hormones.
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What tubal disorders contribute to infertility?
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PID: gonorrhea/chlamydia then a superinfection by enteric bacteria. leads to mechanical obstruction of the tubes or interferes with sperm/egg transport
Intraperitoneal infection, eg appendix abscess can rupture, can involve tubes Fibrosis/adhesions from prior surgery |
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How can you evaluate tubal disorders as a cause for infertility?
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-hysterosalpingogram: radioopque dye to see uterus and tubes, no info on pelvi adhesions/disease. Can clear out tubes and lead to pregnancy.
-laparoscopy: gives more information about endometriosis, concurrent corrective procedure is possible. uncomfortable, risky and expensive. |
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How can you treat infertility due to a tubal disorder?
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1. tubal surgery- 20% pregnancy rate because patency isn't enough, and motion can't be returned.
2. IVF- Gn hyperstimulation, fertilization, blastocyst injection. 35% pregnancy rate per cycle. |
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How does endometriosis cause infertility?
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fibrosis/adhesions, interferes with tubal function and ovary access, increases PG and/or macrophages in peritoneal fluid.
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How do you evaluate for endometriosis?
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laparotomy or laparoscopy
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How do you treat endometriosis?
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1. surgery (40-50% effectiveness)
2. GnRH agonists (controversial) 3. IVF |
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What uterine disorders can cause infertility?
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congenital abnormality, fibroids, intrauterin scar tissue (Asherman's). This is uncommon as a cause for infertility.
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What behavioral problems may lead to infertility?
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erroneous coital timing, technique, and use of spermicidal lubricants
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What male disorders can cause infertility in a couple?
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testicular disease, prostatitis, endocrine, drugs, trauma, surgery, congenital abnormality, varicocele.
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How do you evaluate a man for infertility?
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semen analysis for number, motility and morphology, as well as volume
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How do you treat a couple for male infertility?
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1. artifical insemination
2. ligation of varicocele 3. IVF/ovarian hyperstimulation |
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What often happens if docs can't find a reason for your infertility?
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You get pregnant eventually. Can also increase fertility with ovarian hyperstimulation and intrauterine injection of blastocyst.
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