CHAPTER 2-3 FSHN 322

22. What’s the difference between fertility and fecundity? What are the chances of conception for healthy couples during each menstrual cycle?

o Fertility: actual production of a child

o Fecundity: biological ability to bear child

o 15% of couples are infertile

 44% of infertile will eventually conceive naturally

o 55.8 births out of 1,000 birth rate in women 15-44

o 30-50% of conceptions are lost by resorption into the uterine wall within the first 6 weeks

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

23. Define miscarriage and the possible causes of miscarriages.

o Miscarriage: loss of baby in the first 20 weeks of pregnancy

o Causes: : maternal infection, structural abnormalities of uterus, endocrine or immunological disturbances, low progesterone, and unknown random events

24. How does this relate to subfertility?

o Subfertile: women who have experienced many miscarriages (2-3), men who have sperm abnormalities (low sperm count/density, malformed sperm, immobile sperm), women who ovulate infrequently

o 18% of couples

25. When does fertility start to decline in males and females?

o After 35 years

26. Describe the action of the hormones that regulate fertility processes.

o Menstrual cycle hormones:

 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 (E)

• 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

27. What happens during the follicular and luteal phases of the menstrual cycle?

o Follicular phase (first half)

 Follicle and maturation

 Main hormones: GnRH, FSH, E, P

o Luteal phase (last half)

 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

28. Discuss the basics of PID and Endometriosis.

o Pelvic Inflammatory Disease (PID)

 Infection of cervix, uterus, fallopian tubes, ovaries

 Side effect of gonorrhea or chlamydia

o Endometriosis

 Painful, abnormal menstrual cycles

 Causes infertility in 30-40% of women

 Endometrial tissued embedded in uterine wall, ovaries, etc

29. 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

30. What are the differences between oligomenorrhea, amenorrhea, and polymennorhea?

o Amenorrhea: absence of menstrual cycle

o Oligomenorrhea: irregular or infrequent menstrual

o Polymenorrhea: frequent (more often than every other 21 days) menstrual

31. How does body fat influence estrogen and leptin levels?

o Higher levels with high body fat

o Both extremes lower fertility

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

o <20 BMI

o >30 BMI

33. What is oxidative stress? How does it affect fertility in men and women?

o Oxidative Stress:

 Occurs when production of potentially destructive reactive oxygen molecules exceeds body’s own antioxidant defenses

o In men:

 Reactive oxygen molecules attack polyunsaturated fatty acids in sperm membrane, decreasing sperm mobility and reduces ability of sperm to fuse with egg

 Oxygen cells can damage dna -> defective dna during conception

o In women

 Harms egg and follicular development

 Interfere with corpus luteum function and implantation of egg in uterine wall

34. What are the four key antioxidants for fertility? Name some food sources.

o Vitamin E

o Vitamin C

o Beta carotene

o Selenium

o All found in vegetables and fruits

35. How does zinc and soy influence male fertility?

o Zinc:

 Reduces oxidative stress

 Helps sperm maturation

 Helps testosterone synthesis

o Soy:

 Decrease levels of estradiol, progesterone, LH

 Related to reduced sperm count in obese men

 90% of men with high soy diets still have regular sperm count

o Take 10 mg Zn supplements with Vitamin C & Vitamin E for healthy strong sperm

36. How does a low fat, low fiber affect fertility?

o Low fat, high fiber linked to irregular menstrual cycles

 <20% of fat in diet lengthens menstrual cycles

37. Describe how folate, iron, caffeine, alcohol, and lead affect fertility.

o Folate:

 Women:

• Decline in ovulatory infertility

• 400 mcg of folic acid

 Men:

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

o Iron

 Women

• Lowers infertility rate

• Can affect ovulation

o Caffeine

 Mixed results

 Some show that increased time to conception

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

39. Describe PMS. What are some common symptoms?

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

 Physical:

• Tender breasts

• Abdominal bloating

• Swelling

• Headache

 Psychological

• Angry outbursts

• Depression

• Irritability

• Confusion

• Anxiety

• Social withdrawal

40. What is PDD? How do you treat it?

o Premenstrual Dysphoric Disorder

o Severe form of PMS

 Physical symptoms:

• Breast tenderness

• Headache

• Join and muscle pain

 Psychological

• Mood swings

• Depressed mood

• Irritability

• anxiety

o Related to abnormal serotonin activity following ovulation

41. What supplements could you use to treat PMS?

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

42. How does central adiposity affect fertility? How does it influence men and women?

o Weight loss can reduce or eliminate fertility problems

o Men:

 Reduced sperm count

 Abnormal sperm

 Impaired sperm

 Low testosterone

 High estradiol levels

o Women:

 Anovulation

 Amenorrhea

 Reduced success with fertility treatment

 Higher testosterone

 High insulin levels, reducing SHBG

43. 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

44. Describe metabolic syndrome and the criteria for diagnosis.

o Cluster of conditions that increase risk of developing chronic disease like heart disease, stroke, type 2 diabetes

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

45. What are the significant nutritional deficiencies after bariatric surgery?

o Risk for protein, calcium, iron, copper, zinc, thiamin, vitamin B6, vitamin B12, and vitamin D deficiency

46. What is hypothalamic amenorrhea?

o AKA functional hypothalamic amenorrhea OR weight related amenorrhea

o Absence of ovulation

o Caused by deficits in energy (cal) and nutrients

o Suppression of GnRH

47. 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

48. 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

49. What does teratogenic mean in terms of diabetes and pregnancy?

o 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

50. How should Type 1 and Type 2 DM be managed during preconception?

o Type 2:

 Manage with:

• Diet

• Exercise

• OHA to increase insulin production and insulin sensitivity

• Individualized diet and exercise

• Weight loss (5-10%)

o Type 1:

 Manage with:

• Monitor blood sugar

• Optimizing medication

• Receiving prenatal care

51. 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)

52. What is PCOS? How do you manage PCOs nutritionally?

o Abnormal sacs with membranous linings

o Androgen excess, polycystic ovaries, ovulatory dysfunction

o Leading cause of female infertility

o Insulin resistance, strong genetic component -> family history of infertility, menstrual problems type 2 DM

o Manage with:

 Clomid to stimulate ovulation

 Increase insulin sensitivity

• Insulin sensitizing drugs (metformin)

 Diet

• Lean protein

• Whole grain

• Fruit and veg

• Regular meals

• Nonfat dairy

• Low GI diet

 Weight loss and exercise

53. What is PKU? What risks does it pose to the infant? How do you manage PKU nutritionally?

o Disorder of amino acid metabolism

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

o Risks to child:

 Mental retardation

 Microcephaly

 Seizures, hyperactivity, abnormal behavior

o Nutritional 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

54. What is CD? How do you manage it nutritionally?

o 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

o Manage by:

 Eliminate gluten

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

 Correction of vitamin and mineral deficiencies