Infertility

define infertility

inability to carry a pregnancy to a live birth

inability to conceive after ______ months of unprotected intercourse is considered infertility

12

if 35+ infertility is considered inability to conceive after ___ months of unprotected intercourse

6

define primary infertility

when a woman has never been able to get pregnant

define secondary infertility

when a woman has been pregnant before but can’t get pregnant again

what are the three kinds of stress that can come from infertility (in a relationship)

mental, financial, emotional

how can delayed childbearing increase chances of infertility

decrease in hormones and egg count

define azoospermia

when there are no sperm at all

define oligospermia

very minimal sperm

what are some acute/chronic illnesses that can cause sperm abnormalities

mumps, cirrhosis, renal failure

elevated scrotal temperature can cause

sperm abnormalities

exposure to toxins, lead, pesticides, or chemicals (in men) can cause

sperm abnormalities

define varicocele

enlarged veins in the testicles

how can varicocele affect fertility

it raises temp of scrotum and decreases blood flow

abnormal hormone stimulation can cause

sperm abnormalities

the sperm needs ________ __________ to penetrate the egg

forceful action

define cryptorchidism

one or both testes fail to descend into the scrotum

drugs, alcohol, and tobacco can cause issues with sperm

mobility

central or autonomic nervous system problems can cause

abnormal erections

surgery, PVD, anti-hypertensive meds, and antidepressants can cause

abnormal erections

define retrograde ejaculation

ejaculation moves backwards towards bladder

spinal cord injuries, alcohol, and illicit drugs and premature ejaculation can cause

abnormal ejaculations

define hypospadias

when the urethral opening is on the underside of the penis

what is the function of seminal fluid

nourishes, protects and carries sperm into the vagina

thick seminal fluid can cause issues with fertility because

the sperm cannot separate so they can pass through the cervix

define liquefaction

semen changes from gel to liquid after ejaculation to allow sperm movement

seminal fluid should have what pH and why

slighlty alkaline so that it can protect the sperm from acidic vaginal secretions

obstruction, infection of the genital tract and inflammation can cause (in men)

abnormalities in seminal fluid

only the _______ goes past the cervix while the _______ stays behind

sperm; seminal fluid

what is the first route of diagnostic testing when looking into infertility

semen analysis

semen analysis checks what three things

sperm motility, strength, and numbers

when doing endocrine testing (on men) while testing for infertility we look for what 3 hormones

LH, FSH, testosterone

what does the luteinizing hormone do for men in regards to fertility

stimulates testosterone to increase

what does the follicle stimulating hormone do for men in regards to fertility

stimulates testes to produce sperm

what three things does testosterone do for men in regards to fertility

stiumlate sperm production, keep testes working, maintain libido

what can an ultrasonography do when looking at fertility issues in men

look for blockage/structural issue

what can a testicular bx do when looking at fertility issues in men

check hormone levels, look for CA

what is the sperm penetration assay also called

“hamster test”

female fertility is dpendent upon what three things

normal ova, patent female structures, healthy lining to support after implantation

what two brain structures are looked at when looking into female fertility issues

hypothalamus and pituitary gland

what two hormones are looked at when looking into female fertility issues

LH and FSH

what is the most common reason ovaries don’t respond to FSH or LH

PCOS

cranial tumors, stress and obesity or anorexia are examples of

ovulation issues

what are some abnormalities in ovaries or endocrine glands that can cause ovaries not to respond to FSH or LH, why

polyps > scarring > hostile environment

systemic diseases and premature ovarian insufficency (premature menopause) can cause

ovulation issues

< ____ years old is considered premature menopause

40

climacteric means

end of fertility in women

___+ years old is considered a “geriatric pregnancy”

35

what are three factors that can cause decreased ovarian reserve

chemo agents, excessive alcohol, cigarette smoking

at least one __________ ______ is required for natural conception and implantation to occur

fallopian tube

____ are a common infection that can cause blockages in the fallopian tubes

STIs

define endometriosis

uterine lining tissue grows outside uterus causing adhesions

endometriosis can lead to what two pregnancy complications

miscarriage or ectopic pregnancy

pelvic surgery, ruptured appendix, ovarian cysts, or peritonitis can cause

adhesions

abnormal cerival mucus affects fertility by

preventing sperm from moving through cervix into uterus and fallopian tubes

low estrogen levels can lead to what kind of cervical mucus

thick and sticky

polyps, cervical scarring, and infection can lead to

cervical mucus abnormalities

fetal chromosomal abnormalities can cause

spontaneous abortions

fetal chromosomal abnormalities, abnormal cervix/uterus, endocrine abnormalities in women can cause

recurrent pregnancy loss

immunologic factors, thrombotic factors, environmental agents and infections can cause (in women)

recurrent pregnancy loss

after implantation if there is not enough of the ________ (hormone) it can result in pregnancy loss

progesterone

define incompetent cervix

cervix opens too soon in pregnancy

if a woman has a short cervix her HCP can do a _________ to keep the cervix closed so that they baby isn’t born preterm or result in a miscarriage

circlage

what are two examples of an immunologic factor that can lead to recurrent pregnancy loss

differing antigens; lupus

what is the first thing that will be done when performing diagnostic testing for female fertility issues

H&P

in the H&P when looking at female fertility issues we will look at

family hx, GTPALM, STI hx, CA screening, meds/drugs/alcohol, birth control, chemicals

what are some examples of ovulation predictors

BBT, cervical mucus

when looking at fertility issues in women the ultrasonography looks at the _______ ______ and also looks for a _______ pregnancy

pelvic organs; molar

a hysterosalpingogram uses ___ to look for ______

dye; blockage

what kind of lubricant should be used during intercourse so that it does not alter cervical mucus

water soluble

what are some alternative therapies for PCOS

eat healthy, exercise and lifestyle changes

laser surgical techniques can help facilitate pregnancy by

decrease inflammation/get rid of adhesions

microsurgical tecniques can help facilitate pregnancy by

getting rid of varicocele

the transcervical balloon tuboplasty helps facilitate pregnancy by

inflating a balloon in the fallopian tube to remove blockage

with a hysterosalpinogram it is important to ask the patient if they have any

allergies to iodine or shellfish

what are the two most common medications prescribed to help facilitate pregnancy

climphene citrate and letrozole

with clomiphene citrate or letrozole there is a very high chance of having

multiples

what are the three supplements women might be prescribed when struggling with fertility

follitropin, goserelin, progesterone

clomiphene citrate is _____ toxic

liver

metformin would be used in conjunction with other therapies for women who have ______ in order to ________ ________

PCOS; restore ovulation

what two meds might men take if struggling with erections

sildenafil and tadalafil