Infertility

disease

• a pathological process

• involves some abnormality

• cellular or subcellular level

illnesses; diseases

patients suffer ___; doctors diagnose and treat ___

illness

• social and psychological phenomena

• directly influenced by disease

• involves perception, behavior, and experience

acute illness

• disease with an abrupt onset and usually a short course

• illness of short duration, rapidly progressive, and in need of urgent care

• usually isolated to one bodily area

• responds to treatment

• requires less care and resources because it is temporary

  defining characteristics:

• starts suddenly and are short lived

• “runs it course” regardless of drug intervention

chronic illness

• illnesses that are prolonged, do not resolve spontaneously, and are rarely cured completely

• a disease or disorder developing slowly and persisting for a long period of time, often for the remainder of the individual

• frequently involve multiple systems

• uncertain future

• requires more care and resources to normalize lifestyle

  defining characteristics:

• develops slowly and are long term

• multiple chronic illness

• uncertainty

• intrusiveness

• cost

• need for a wide array of services

• requires medical supervision

• medicine is usually regulated as “prescription only”

• coughs

• colds

• sleeplessness

• flu

examples of an acute illness

• cancer

• AIDS

• kidney disease

• diabetes

examples of a chronic illness

coping style

the only factor chronic and acute illness are similar

pathogenesis

• is studying how a disease infects an individual after exposure

• the development of a disease

pathophysiology

• studies the resulting effects and symptoms due to the disease

• the physiological response to a disease

signs

• physical ___

• objective findings of the doctor on the pt.

• based on analysis of observation only

• can be observed by others

• estimated visibly by using instruments (e.g., TPR, bp, blood sugar, Fx, CA, AIDS, TB)

symptoms

• subjective complaints of the pt. about a dse.

• personal perspective of a person

• experienced by pt. only

• cannot be estimated

• only pt. can express how he feels

• ex.: pain, nausea, fatigue, anxiety

10/100,000 pregnant women

Maternal Mortality of high risk pregnancies

Hemorrhage, Infection, Preeclampsia

Leading Cause of high risk pregnancies

1. maternal age

2. parity factors

3. medical-surgical history

risk factors of a high risk pregnancy

maternal age

<15 & >35 у.о.

parity factors

• (5 or more- great risk)

• (PP hemorrhage)

• (New pregnancy within 3 months)

medical-surgical history

(hx of previous uterine surgery &/or uterine rupture, DM, Lupus, Cardiac Dse. and PIH

• primary subfertility

• secondary subfertility

problems with infertility (2 types)

primary subfetility

refers to couples who have not become pregnant after at least 1 year having sex without using birth control methods.

secondary subfertility

refers to couples who have been able to get pregnant at least once, but now are unable.

1. varicocele

2. low sperm count

3. movement of sperm

4. cystic fibrosis

causes of subfertility in males (VLMC)

varicocele

the veins of a man's testicles are too large, this heats the testicles affecting the number or shape of the sperm.

low sperm count

or absence of sperm (aspermia)

• normozoospermia

• polyzoospermia

• azoospermia

types of sperm quantity condition

movement of sperm

caused by shape of the sperm, injury or damage to the reproductive system that blocks the sperm

cystic fibrosis

accumulation of thick tenacious mucus that obstructs the tubular structures--urinary bladder

1. Heavy alcohol consumption

2. Drug use

3. Cigarette smoking (OXIDATIVE STRESS)

4. Age

5. Environmental toxins (pesticides & lead)

6. Health problems (mumps- ORCHITIS, kidney disease)

7. Radiation treatment & chemotherapy (CYTOTOXIC)

risk factors for males (HDCAEHR)

1. ovulation problems

2. blocked FT

3. uterine fibroids

causes of subfertility among females

PCOS (polycystic ovarian syndrome)

a hormone imbalance in women between 15-30 years old characterized by large polycystic ovaries with small follicles that do not mature enough to ovulate.

POI (primary ovarian insufficiency)

a woman's ovaries stop working normally before she is 40

blocked FT

due to PID, endometriosis, ectopic pregnancy

uterine fibroids

non-cancerous clumps of tissue & muscle on the walls of the uterus

1. Abnormal periods (Menorrhagia; Oligomenorrhea; Polymenorrhea)

2. Irregular periods (Metrorrhagia)

3. No periods (Amenorrhea)

4. Painful periods (back pain, pelvic pain, cramping)
   

symptoms for females (AINP)

1. Age

2. Smoking

3. Excessive alcohol consumption

4. Stress (Cortisol)

5. Poor diet

6. Overweight or underweight (Adipokines)

7. STI

risk factors for females (ASESPOS)

1. infertility checkup

2. sperm count

3. ovulation check

4. hyterosalpingography (HSG)

5. laparoscopy

diagnosis/ how to diagnose infertility (ISOHL)

infertility checkup

(type of dx test) PE, health & sexual histories- Thelarche, Menarche, Coitarche) UTZ Blood test

hyterosalpingography (HSG)

(type of dx test) an x-ray of the uterus & fallopian tube with the use of dye helps find physical blocks causing infertility

laparoscopy

(type of dx test) a minor surgery using a laparoscope by making a small cut into the lower abdomen to check the ovaries, FT, & uterus

1. clomid

2. FSH

3. gonadotropin

4. metformin

5. bromocriptin (PARLODEL)

treatment for women (fertility drugs) (CFGMB)

clomid

a medicine that causes ovulation by acting on pituitary gland - PCOS (oral)

FSH

causes the ovaries to begin the process of ovulation -- injectable

gonadotropin

• medicines often use for women who do not ovulate regularly each month injectable

• releasing hormones GnRH

metformin

for insulin resistant women or PCOS, it helps lower the high levels of hormones among women-oral

bromocriptin (PARLODEL)

used for women with ovulation problems due to high levels of prolactin

• Behavioral therapy-Sexual Stimulation techniques, Penile Exercise, Sensate Focus

• Cognitive Behavioral Therapy (CBT)

• Psychoeducation

• Bibliotherapy

(treatment for males) sexual problem

• AB therapy

• hormone treatments

(treatment for males) too few sperm

• maintain a healthy weight

• healthy diet

• prevent STI

(treatment for males) sperm movement

preparatory phase

the medical center will take a careful medical history, perform a physical examination, and take informed consent from both partners. In addition, various blood tests may be ordered to exclude or detect various infections, especially those which are blood-borne or sexually transmitted

Suppressing (downregulating) the natural hormone cycle

Women who are ovulating are treated with hormones at a suppressive dose, either in the form of a self-administered daily or nasal spray, for about two weeks.

Controlled ovarian hyperstimulation

1. long-acting gonadotropin-agonist (Lupron)

2. daily

3. 12

4. human chorionic gonadotr0pin (hCG)

5. luteinizing hormone (LH)

6. oocyte retrieval in about 36 hours

• Various protocols are used to stimulate multiple ovulations to help produce multiple embryos. In order to prevent premature ovulation due to the secondary over-secretion of gonadotropin hormones, pituitary suppression of these hormones is first achieved by pre- treatment with a (1) ___

• When measurements show that suppression has been optimally achieved, daily gonadotropins are injected (2) __ to stimulate ovarian follicular development. The growth of the follicles is followed up carefully with ultrasound imaging and hormone level assays.

• Once the lead follicle is big enough, which usually occurs after about (3) __ days, (4)____ is administered to simulate the (5) _____ surge which triggers ovulation in the natural setting. The stage is now set for (6)______

oocyte retrieval

1. 5

2. incubator

Under ultrasound guidance, transvaginal follicular aspiration is performed to retrieve the oocytes from the follicles in both ovaries. The procedure is done under sedation. Side effects include mild cramping and soreness, with some vaginal bleeding. After oocyte retrieval, progesterone pessaries, injections, or gels, are prescribed to prepare the endometrium for implantation within (1) __days of fertilization. The oocytes are cultured in a special media within an (2) __ until they are ready for insemination

fertilization

1. 50,000 to 100,000

2. standard insemination

3. intracytoplastic sperm injection (ICSI)

4. cytoplasm

5. high-power microscope

6. aspirated

7. testicular tissue

• In this stage the oocytes and sperms are mixed and left alone for fertilization to occur, in a special medium. The method of fertilization used depends on the sperm used. Provided normal sperm is available from the partner, about (1)__ motile sperm are placed into the dish containing the oocytes. This is called (2)__.

• On the other hand, if normal motile sperm are not available, the (3)__ technique is preferred. Here, single sperm are picked out using microneedles, and directly injected into the (4)__ of the oocyte under a (5)__microscope.

• This allows fertilization to proceed even in the presence of oligospermia or azoospermia, asthenospermia, or teratozoospermia. Sperm may be (6)__ directly from the (7)__ if they are absent in the sperm sample. Such sperm are always used via ICSI for fertilization in IVF because they are immature when retrieved

1. 16-20

2. 5

3. blastocysts

4. fluid

5. expand

(fertilization stage)

• After (1)__ hours the oocytes are examined for the success of fertilization. All the embryos formed at this stage are allowed to grow in a laboratory incubator for up to (2)__ days. At this stage they have become (3)__.

• Blastocysts are a ball of cells, much larger than the zygote, and which contain (4)__. The better they (5) __, the higher their quality and the more chance there is that implantation will succeed.

embryo transfer

1. 5

2. cleavage stage

3. four and eight

4. number of cells, their distribution, presence of fragmentation

• Blastocyst transfer is carried out to increase the chances of successful implantation, since natural implantation occurs at the blastocyst stage (day (1)_ following fertilization). This also makes it possible to transfer one or two embryos rather than three or more, since implantation is more likely at this stage.

• In contrast, if the embryos are of low quality or the level of fertilization is low, transfer is done on the second or third day itself, which is called the (2) __. The embryo has between (3)__ cells. Embryo quality is assessed based on the (4)__, __, __

1. healthiest

2. three

3. two

4. single

5. speculum

6. urinary bladder

7. distended bladder

(embryo transfer)

• The (1)__ embryos are then selected for embryo transfer. Any remaining healthy embryos may be frozen and stored for use in later cycles, if required.

• The number of embryos used for transfer depends upon the age of the woman. For those over 40 years, up to (2)__ embryos may be transferred into the uterus. For women younger than this, only up to (3)__ embryos are used per cycle to reduce the risk of multiple pregnancy. (4)__ embryo transfer is the recommended procedure in many cases.

• During this procedure, the vagina is visualized with a (5)__ and the embryos passed down a fine catheter into the uterus, through the cervix, under ultrasound guidance. The (6)__ is kept full in order to achieve a clear ultrasound picture. While no pain is expected during embryo transfer, the (7)__ may cause some discomfort.

1. progesterone supplementation

2. 12-14 days

3. freezing and storage

(embryo transfer)

• (1)__ is continued until the pregnancy is confirmed, typically by testing within (2)__ of embryo transfer.

• (3)__ of any unused embryos is then performed after the best ones have been transferred

IVF - male component

1. sperm

2. active or motile

3. separation

• A sample of (1)__ is asked for, and the sperm are washed and prepared for separation. During this process, the (2)__ sperm are separated for use from the poor-quality sluggish ones.

• At this time, if samples had already previously been given for freezing and storage, they are thawed and prepared for (3)__of the best quality sperm from the specimen.

reproductive health

Includes menstruation, pregnancy, birth control, and fertility conditions