Menstruation and Infertility

Menstruation

It is the woman’s monthly bleeding or regular discharging of blood and other materials from the lining of the uterus

Culture

It refers to knowledge, beliefs, customs, and values acquired as members of a racial, ethnic, religious, or social group

• Follicular phase (day 1-13)

• Ovulation phase (day 14)

• Luteal phase (day 15-28)

What are the menstrual phase?

Follicular phase (day 1-13)

In this phase, the lining of the uterus called endometrium becomes thicker in preparation for implantation of the fertilized egg

Ovulation phase (day 14)

In this phase, the pituitary gland secretes a hormone that causes the ovary to release the mature egg cell

• released of oocytes

Luteal phase (day 15-28)

In this phase, the follicle develops into a hormone-producing structure called the corpus luteum (production of estrogen and progesterone)

Amenorrhea

Type of irregular periods

• when a woman stops getting her menstrual cycle for three or more months

• means the woman is not ovulating and has infertility

Oligomenorrhea

Type of irregular periods

• infrequent periods

• menstrual cycle length of greater than 35 days

Menorrhagia

Type of irregular periods

• heavy or prolonged menstrual bleeding

• caused by hormone problems, problems with the uterus and other health conditions

Metrorrhagia

Type of irregular periods

• irregular vaginal bleeding

• vaginal bleeding that occurs at irregular times not associated with the menstrual cycle

Infertility

Couple’s inability to achieve pregnancy after 1 year or longer of unprotected penile-vaginal intercourse

Serum progesterone test

It is a test to measure the amount of progesterone in the blood

Progesterone

In men, this is involved in the creation of sperm, or spermatogenesis.

In women, it helps prepare the uterus for a fertilized egg

1 ng/mL or under

Normal serum progesterone level

• Men, postmenopausal women, and women at the beginning of their menstrual cycle

5 to 20 ng/mL

Normal serum progesterone level

• Women in the middle of their menstrual cycle

11.2 to 90 ng/mL

Normal serum progesterone level

• Pregnant women in the first trimester

25.6 to 89.4 ng/mL

Normal serum progesterone level

• Pregnant women in the second trimester

48.4 to 42.5 ng/mL

Normal serum progesterone level

• Pregnant women in the third trimester

Ovulation Index

A test that involves a urine dipstick test to determine whether the surge in LH (Luteinizing Hormone) that precedes follicular rupture has occurred

Hysterosalpingogram (HSG)

is used to rule out uterine and tubal abnormalities

• A contrast agent injected into the uterus through the cervix produces an outline of the shape of the uterine cavity and the patency of the tubes.

Laparoscopy

It is a test that permits direct visualization of the tubes and other pelvic structures and can assist in identifying conditions that may interfere with fertility (e.g., endometriosis)

Sperm analysis

A test that provides information about the number of sperm (density), percentage of moving forms, quality of forward movement (forward progression), and morphology (shape and form)

60 to 100 million soerm/mL

What is the normal count of sperm?

Clomiphene

Many women with ovulation disorders have polycystic ovary syndrome (PCOS) and may be treated with 5 days of what medicine to induce ovulation?

Dopaminergic drugs

Some women have high prolactin levels, which inhibit ovulation, and they are treated with what drugs after a pituitary adenoma is ruled out by MRI?

Ovarian hyperstimulation syndrome (OHSS)

This condition is characterized by enlarged multicystic ovaries and is complicated by a shift of fluid from the intravascular space into the abdominal cavity

Artificial insemination

This is the deposit of semen into the female genital tract by artificial means

In Vitro Fertilization (IVF)

refers to a set of procedures that, if successful, results in a pregnancy. These procedures involve ovarian stimulation, egg retrieval, fertilization, and embryo transfer

Gamete intrafallopian transfer (GIFT)

a variation of IVF, is the treatment of choice for patients with ovarian failure

Intracytoplasmic sperm injection (ICSI)

A treatment where an ovum is retrieved, and a single sperm is injected through the zona pellucida, through the egg membrane, into the cytoplasm of the oocyte.

• The fertilized egg is then transferred back to the donor

Tubal embryo transfer (TET)

A treatment that involves the placement of fertilized eggs or embryos into the fallopian tube

Clomiphene citrate

This medication stimulates follicles in the ovary. It is usually taken for 5 days beginning on the 5th day of the menstrual cycle. Ovulation should occur 4 to 8 days after the last dose

Menotropins

These agents are used for women with deficiencies in FSH and LH

• Follitropin alfa

• follitropin beta

• urofollitropin

may be used to treat ovulation disorders or to stimulate a follicle and egg production for intrauterine insemination or in vitro fertilization or other assisted reproductive technologies

Gonadotropin-release hormone agonists (Leuprolide and Nafarelin acetate)

Medication that suppress FSH, prevent premature egg release, and shrink fibroids

Bromocriptine

Medication that may be used in treatment for infertility due to elevated prolactin levels

Chorionic gonadotropin

Medication which mimics LH, releases an egg after hyperstimulation and supports the corpus luteum

Metformin

Medication that may be used in polycystic ovarian syndrome to induce regular ovulation

Aspirin and heparin

Medication that may be used to prevent recurrent pregnancy loss in patients with elevated antiphospholipid antibodies

Mumps orchitis

testicular inflammation and scarring due to mumps virus

Sterility

inability to conceive because of a known condition, such as the absence of a uterus

Hypospadias or epispadias

This may cause deposition of spermatozoa too far from the cervix to allow for cervical penetration

Erectile dysfunction

Formerly called impotence or inability to achieve an erection

Primary erectile dysfunction

the man has never been able to achieve erection and ejaculation

Anovulation

Faulty or inadequate production of ova

• Most common cause of infertility in women

Endometriosis

It is the implantation of uterine endometrium, or nodules that have spread from the interior of the uterus to locations outside the uterus