CHAPTER 2-3 FSHN 322

Fertility

refers to the actual production of a child

Chance of conception in healthy couples

20-35% chance of conception within a given menstrual cycle.

Miscarriage

Loss of baby in the first 20 weeks of pregnancy.

Possible causes of miscarriage

Maternal infection, structural abnormalities of uterus, endocrine or immunological disturbances, low progesterone, unknown random events.

Subfertility

Women who have experienced multiple miscarriages or men with sperm abnormalities.

18%

Decline of fertility in males and females

age of 35.

Menstrual cycle hormones

GnRH FSH LH progesterone Esterogen

Follicular phase

The first half of the menstrual cycle focusing on follicle growth and maturation.

 Follicle and maturation

 Main hormones: GnRH, FSH, E, P

Luteal phase

The second half of the menstrual cycle after ovulation, marked by the formation of the corpus luteum.

 After ovulation

 Formation of corpus luteum

• Cells that form in ovary, temporary organ during menstrual cycle

 Decrease in estrogen and progesterone to stimulate menstrual flow

 Prostaglandins and cramps

Pelvic Inflammatory Disease (PID)

Infection of cervix, uterus, fallopian tubes, and ovaries

side effect of gonorrhea or chlamydia.

Endometriosis

 Painful, abnormal menstrual cycles

 Causes infertility in 30-40% of women

 Endometrial tissued embedded in uterine wall, ovaries, etc

Oligomenorrhea

Irregular or infrequent menstrual cycles.

Amenorrhea

Absence of menstrual cycle.

Polymenorrhea

Frequent menstrual cycles occurring more often than every 21 days.

Oxidative Stress

Occurs when reactive oxygen molecules exceed antioxidant defenses, damaging sperm and eggs.

Key antioxidants for fertility

Vitamin E, Vitamin C, Beta carotene, Selenium.

How zinc influences male fertility

Reduces oxidative stress, helps sperm maturation and testosterone synthesis.

Impact of body fat on esterogen and leptin levels

Higher body fat increases estrogen and leptin levels, which can influence fertility.

Bariatric surgery nutritional deficiencies

Deficiency risks for protein, calcium, iron, copper, zinc, thiamin, B vitamins, and vitamin D.

Hypothalamic amenorrhea

Absence of ovulation often caused by energy deficiencies.

Female Athletic Triad

Amenorrhea, disordered eating, and osteoporosis.

Teratogenic definition in pregnancy

High blood glucose levels during the first 2 months leading to congenital abnormalities.

PCOS management

Including insulin sensitizing drugs, diet adjustments, and weight loss.

PKU definition

Disorder causing elevated phenylalanine levels leading to risks like mental retardation.

Celiac Disease (CD)

Autoimmune disease linked to infertility; managed by eliminating gluten from the diet.

fecundity

refers to the biological ability to bear a child.

Gonadotropin Releasing Hormone (GnRH)

Stimulates pituitary to release FSH and LH

Follicle-Stimulation Hormone (FSH)

• Stimulates maturation of ovum and sperm

• Estrogen production

Luteinizing Hormone (LH)

• Stimulates secretion of progesterone and testosterone

Estrogen

• Stimulates release of Gn(RH) in follicular phase

• Stimulates follicle growth

• Stimulates maturation of follicle

• Stimulates vascularity & storage of glycogen & other nutrients in uterus

Progesterone (P)

• Prepares uterus for fertilized ovum

• Increases vascularity of endometrium

• Stimulates cell division of fertilized ova

What are the key nutrition-related disruptions of infertility?

o Undernutrition

o Weight Loss

o Obesity

o High Exercise Levels

o Intake of specific foods and food components

How does body fat influence estrogen and leptin levels?

o Higher levels with high body fat

o Both extremes lower fertility

At what BMI does infertility occur? At what % UBW?

o <20 BMI

o >30 BMI

o Folate & fertility

 Women:

• Decline in ovulatory infertility

• 400 mcg of folic acid

 Men:

• Improved sperm counts, motility, decreased abnormal forms of sperm

o Iron

• Lowers infertility rate

• Can affect ovulation

o   Alcohol

 Decrease estrogen and testosterone levels or disrupt menstrual cycles

 Reduces fertility in women w specific gene variant

o Lead exposure

 High levels of exposure -> lower levels of sperm, abnormal motility, shape

 Buildup of cadmium, molybdenum, manganese, boron, and other metals

 Men in factories

PMS

o Premenstrual syndrome

o Physiological and psychological changes in the luteal phase

o Affects 20-40% of women

o Symptoms disappear 2 days after menses onsets

PMS Symptoms

 Physical:

• Tender breasts

• Abdominal bloating

• Swelling

• Headache

 Psychological

• Angry outbursts

• Depression

• Irritability

• Confusion

• Anxiety

• Social withdrawal

PDD

o Premenstrual Dysphoric Disorder

o Severe form of PMS

o Related to abnormal serotonin activity following ovulation

PMS treatment

o Antidepressants containing serotonin uptake inhibitors (SSRI)

o Calcium (1200mg/day)

o Vitamin B6 (50-100 mg/day)

o Chasteberry (20 mg/day)

o Less coffee

o Vitamin D and Magnesium

central adiposity in men

 Reduced sperm count

 Abnormal sperm

 Impaired sperm

 Low testosterone

 High estradiol levels

central adiposity in women

 Anovulation

 Amenorrhea

 Reduced success with fertility treatment

 Higher testosterone

 High insulin levels, reducing SHBG

What are the primary weight reduction methods for treating obesity?

o   Focus on lifestyle changes

o   Decrease caloric intake

o   Increase physical activity

o   Weight loss surgery

metabolic syndrome criteria

o If 3 of 5 conditions exist

 Waist circumference

• >40 in men

• >35 in women

 Blood triglycerides >150 mg/dL

 HDL cholesterol

• <40 mg/dL in men

• <50 ,g/dL in women

 Blood pressure > 130/85 mm Hg

 Fasting Blood Glucose >100 mg/dL

How do EDs affect fertility? How can they be treated?

o Anorexia and bulimia -> hypothalamic amenorrhea (irregular/absence of period)

 More likely to miscarry, have preterm delivery, low birthweight infants (<5.5 LBS)

o Treated with weight gain

What are the three hallmarks of the female athletic triad? How is it treated?

o Amenorrhea

o Disordered eating

o Osteoporosis

o Triggered with energy intake is around 30% less than requirement

o Supplement with Vitamin D, Calcium

o Fix ED -> gain weight

Teratogentic

high blood glucose levels (>200 mg/dL) during the first 2 months of pregnancy

o 2-3x congenital abnormalities in newborn

o Malformations in pelvis, CNS, and heart in newborns

o Higher risk of miscarrage

type 2 during preconception

 Manage with:

• Diet

• Exercise

• OHA to increase insulin production and insulin sensitivity

• Individualized diet and exercise

• Weight loss (5-10%)

type 1 during preconception

 Manage with:

• Monitor blood sugar

• Optimizing medication

• Receiving prenatal care

How can you prevent GDM?

o Weight loss

o Increase fiber intake (+10 g/D)

o Exercise reduces risk of GDM (150 min/week)

o Diet with high intake of fruits and veg (low GI diet)

PKU

o Disorder of amino acid metabolism

o Causes elevation in blood phenylalanine levels due to low levels or lack of enzyme: phenylalanine hydroxylase

PKU risks

o Risks to child:

 Mental retardation

 Microcephaly

 Seizures, hyperactivity, abnormal behavior

PKU management

 PKU diet for life

 Blood phe 120-360

 Cannot eat meat, fish, eggs, wheat

 Diet high in veg, fruits, fats, sugars, high CHO foods, milk

 Supplemental DHA

Celiac disease

 Autoimmune disease, chronic inflammation of small intestine

o Sensitivity to glutenin wheat, rye, barley

o Malabsorption and flattening of intestinal lining

o Linked to infertility in some women and men

CD management

Eliminate gluten

·       Found in many non grain foods like hot dogs, deli meats, supplements, chips, bouillon, salad dressing

  Correction of vitamin and mineral deficiencies