Project 1 - Fertility Basics and Diagnositics

Reproductive Anatomy for Individuals Assigned Female at Birth

Ovaries, Fallopian Tubes, Uterus, Endometrium, Cervix, Vagina

Ovaries

produce follicles/eggs, contain PRIMORDIAL FOLLICLES

ovulation occurs here when the egg leaves the follicle

Fallopian Tubes (2)

Egg’s path to the uterus - fertilization occurs here

Uterus

Where a pregnancy grows if a fertilized egg implants in the endometrium

Endometrium

The uterine lining - thickens in preparation for implantation and sheds if not pregnant (period/menstruation)

Cervix

separates the vagina and uterus

Vagina

the vaginal canal

How the female reproductive system works together

Ovaries - few follicles become available, one follicle becomes dominant. matures, and ovulates

Fallopian tube - egg is picked up and it can be fertilized here within 12-24 hours after ovulation. If fertilized, travels through for 7 days while growing into a blastocyst embryo.

Uterus - blastocyst will reach the uterus and will then implant into the ENDOMETRIUM

Endometrium - ^^ if no implantation, endometrium will shed as a menses

What are the four distinct phases of the menstrual cycle?

Menses, Follicular Phase, Ovulation, Luteal Phase

Menses

shedding of the uterine lining signifies the start of the FOLLICULAR phases

Follicular Phase

Follicle is growing and approaching ovulation, as it grows it produces ESTROGEN/ESTRADIOL (NFB FSH), uterine lining begins to thicken as it nears ovulation. LH surges due to high estradiol triggering ovulation

Ovulation

follicle ovulates, egg leaves the follicle

Luteal Phase

Empty follicle becomes corpus luteum, starts producing PROGESTERONE and a little bit of estrogen. Hormones work together to help endometrium optimize for implantation. Stay for 2 weeks to detect HCG (would come from an embryo), drop in hormones if no embryo detected (menses)

HPO Axis

Hypothalamus secretes GNRH, picked up by anterior pituitary gland, which secrets FSH to the ovaries, ovaries grows a follicle which secretes E2, E2 goes back to the anterior pituitary gland, FSH decreases triggering LH

HCG

embryo will produce this if egg is fertilized, 7-8 days after fertilization. If HCG is present, CL continues to produce E2/P4 until placenta takes over

Understanding E2 and P4 Levels

E2 - less than 80 (no follicle growth, early follicular phase)

E2 - 100-200 (follicle growing and approaching ovulation)

P4 - less than 1.5 (not ovulated yet)

P4 - greater than 2.5 (they have already ovulated, raises indicating luteal phase)

Male Reproductive Anatomy

Testes - spermatogenesis occurs here

Vas deferens - transports sperm form testes to urethra

Urethra - transports sperm out of the body

Penis - organ that deposits semen into the vagina

Spermatogenesis

Production of sperm, occurs in the testes and takes about 2-3 months, 74 days

Bloodwork for the Sperm Source

Hep B Antigen

Hep C Antibody

HIV 1&2

RPR

HTLV 1&2 - T cell virus, can be transmitted via cells found in semen

Bloodwork for the Egg Source

CBC, ABO/RH, RBC Antibody Screen - hormones related to gen health

AMH, FSH, Estradiol - test immunity results

TSH, Free T4, TPO - thyroid health

Rubella, Varicella - infectious dz’s

Hep B, Hep C, HIV 1&2, RPR - infectious dz’s

Evaluations for assessing DOR

Diagnosed by combination of AFC and bloodwork (AMH), may be suspected if AFC < 5

Abnormal semen analysis

Azoospermia - no sperm in sample

Guidelines for booking a semen analysis

Patients must abstain from ejaculation at lease two days but no more than 5 days, avoid hot tubs/saunas

Guidelines for booking a uterine evaluation

Scheduled between cycle day 5-12 (after bleeding and before ovulation)

guidelines for booking a tubal evaluation

done between cycle day 5-12 (after bleeding, before ovulation)

HSG

X-ray to see if tubes are open (the dye test)

• 15-30 minutes, results during procedure

• confirm negative pregnancy test prior

HyCoSy

Assess uterine cavity and tubal patency using foam solution

• 30 mins

• results during procedure

• patient to have moderately full bladder, confirm negative HPT

Genetic Carrier Screening

Scans for genetic risk to offspring by scanning recessive mutations.

• only scans for recessive inheritance

X-linked recessive conditions where the mother is a carrier for a condition

PGT-M - Preimplantation Genetic Testing for a monogenic condition

screens embryos for specific inherited conditions of carrier

PGT-M and genetic carrier screening relationship

Preimplantation genetic testing - Different types and purpose?

PGT-A

• aneuploidy, missing or extra chromosomes of standard 46

• high risk of miscarriage

• can be done in tandem with PGT-M

PGT-SR

• Structural Rearrangement, translocation or inversion

• will order karyotype testing for patient and partner

• checks embryos for chromosomal rearrangement, run in tandem with PGT-A