OBGYN - Infertility
From Iusmicm
Revision as of 23:35, 12 December 2011 by 149.166.35.170 (Talk)
Note that the testable material is in a doc on angel; this stuff from lecture is simply what she went over verbally.
Contents |
Infertility
Causes and Diagnosis
Objectives
- To become acquanted with:
- prevalence of infertility in the general population
- the causes of female and male infertility
- A systematic approach to the evaluation of the infertile couple
Definition
- Infertile is one year of unprotected sex without pregnancy.
- Women are most fertile 15-25 yo.
- The timing is important.
- Not so exquisite that you must be down to the minute.
- Those expensive kits aren't worth it.
- Sperm will stick around a fair bit.
Prevalence
- 20% of couples after 1 year of unprotected sex.
- Has stayed the same over many decades.
- Now, however, people don't get married because they have birth control and then get married later and have more trouble as 30 yos getting pregnant.
- 33% of the female partner is over the age of 35.
- No appreciable change since the 1950s but more treatment are available.
What does it take to get pregnant
- Three ways to show that a woman can ovulate:
- look at the corpus luteum via lapro
- wash the egg out of the reproductive tract (don't do that anymore)
- she gets pregnant
- Sperm have to be able to get to the ovum.
- And the people have to have sex.
- Much of infertility is and is not practical.
- Wedge shaped pillows do not help.
- Timing and intention are important: Intercourse 2-5 / week should give reasonable chances for getting pregnant.
Components of Normal Fertility
- Woman must ovulate (follicle erupting, corpus luteum, oocyte released), fillopian tube must be intact, egg must be competent enough to pass egg into fallopian tube, sperm must meet the egg.
- Million of sperm at the cervix, only about 1000 at the distal fallopian tube.
- So we often try interuterine insemination to increase the numbers.
- Implantation requires that the endometrium have a nice mucus layer.
- Requires cycling of estradiol from the corpus luteum.
- Thick mucus is a good sperm trap.
- Recall, however, tha the vagina is a sperm killer because of the pH being low.
- Also requires proper coitus and high frequencey
Pathophys of Female Infertility
EStrogen Deficiency
- Without estrogen (from the ovary, the follicle), they don't ovulate.
- Check FSH levels:
- Low: that's why they aren't ovulating
- High: follicle is not responding
FSH
- This is themost reliable test to determine if the ovary is functioning.
Polycystic ovaries
- Hirsutism, diabetes, acanthosis nigricans, receading hair line.
- FSH levels are low, relative to the LH levels.
- Her granular cells are making testosterone.
- The follicles of PCOS are defuct.
Lean Anovulation
- Kenyan Runner propably has mean PCOS.
- Measure both FSH and LH (2:1, 3:1, or 4:1)
- Functional chronic anovulation may occur in anorexic women or highly trained athletes.
The normal menstrual cycle
- Length of the post-ovulatory phase should average 14 days (at least 12).
- We don't want post-ovul to take place at the cost of the pre-ov phase.
- Short post-ov indicates a luteal phase defect.
- We use "ovulationn prediction kit" which measures urine LH.
35 yo over achiever
- This is the usual suspect now-a-days.
- Fertility declines after the age of 35.
- Eggs: 6 million in utero, 1 million at birth, ...
Male Infertility
- Azoosperm = no sperm at al.
- Oligo-asthenospermia = few sperm, don't work well.
- Associated with increased scrotal heat.
- Expsoure to meds / Radx.
- Congenital
- Erectile and ejaculatory dsyfunction
Treatable Azoospermia
- Look for incomplete androgen sensitivity.
- If biopsy shows sperm we can extract and use it for insemination.
- If not, get a donor.
Menopause onset
- Mother's age of menopause is a good predictor of when the pt will commence menopause.