Factors and Treatment of Infertility

Factors Associated with Infertility

• Infertility can stem from hormonal and ovulatory issues, where females do not ovulate consistently
• Tubal and peritoneal factors can interfere with fertility, including tube malformation, STIs, scar tissue, and endometriosis
• Uterine or Vaginal-cervical factors, such as developmental anomalies, tumors, and abnormal pH, can lead to infertility

Infertility in Males

• Male infertility factors include poor sperm quality and Structural or hormonal disorders
• Medical factors like undescended testes, low testosterone, hypopituitarism, endocrine disorders, and genetic disorders contribute toward infertility

Infertility Treatment

• In Vitro Fertilization (IVF-ET) involves fertilizing sperm and egg outside the body and then injecting the embryo into the uterus
• Gamete intrafallopian transfer (GIFT) retrieves eggs, and places it with prepared sperm into fallopian tubes
• Zygote intrafallopian transfer (ZIFT) is an oocyte donation where the ovum is transferred

Tubal Ligation

• Tubal ligation is a permanent contraceptive surgical procedure for female sterilization - it is not for STI protection
• The procedure involves cutting, burning, or blocking fallopian tubes to prevent fertilization

Fetal Growth and Development

• Cell Division and Conception is the fertilization union of ovum and spermatozoon
• Implantation is the contact between the conceptus and uterine endometrium

Embryonic Stage (3-8 weeks)

• During the embryonic stage the developing cells are arranged into three primary layers:
  • Ectoderm (outer layer): forms the skin, nervous system, and external body parts
  • Mesoderm (middle layer): develops into the circulatory, urinary, and reproductive systems, muscles, and bones
  • Endoderm (inner layer): becomes the thymus, thyroid, digestive, respiratory systems, and GU system

Fetal Stage (9 weeks onward)

• Organ systems are complete at 12 weeks and gender is distinguishable

Hormones during Pregnancy

• Early pregnancy involves increased levels of estrogen and progesterone
• Human Chorionic Gonadotropin (hCG) is an important hormone that supports estrogen/progesterone production
• Progesterone and estrogen lead to decreased FSH/LH secretion

Diagnosis of Pregnancy

• Pregnancy is suspected after a missed menstrual period
• An early biochemical marker of pregnancy is human chorionic gonadotropin (hCG)

Estimating Date of Birth

• Nägele's rule: Subtract three months from the date of the last menstrual period, add seven days, and then add one year

Teratogens/Substance Use during Pregnancy

• Teratogens and substance use present risks for preterm labor and affect the fetus's biophysical profile

Umbilical Cord

• The umbilical cord averages 2 cm in diameter and 30-90 cm in length at term:
• Contains 2 arteries (carry deoxygenated blood from the embryo) and one vein (carries oxygenated blood to the embryo)

Amniotic Fluid

• Amniotic fluid is derived from maternal fluids by diffusion
• The fluid volume (700-1000ml) serves as an indicator of fetal well being

Placenta

• The placenta begins to form after implantation, and is where the maternal embryonic circulation/blood exchange from the placenta and mom happens

Physiological Changes during Pregnancy:

• Cardiac output increases by 30-50% and blood volume increases by 30-45%
• Musculoskeletal system: the patient gains weight and there are postural, and gait changes

Nutrition during Pregnancy

• A patient in their second trimester needs an additional 340 calories per day
• A patient in their third trimester needs an additional 450 calories per day

Biophysical & Biomedical Assessments

• Fetal kick counts involve monitoring fetal movement within a specified timeframe
• 10 movements between 12 hours is good

Maternal Serum Alpha-Fetoprotein

• Maternal serum alpha-fetoprotein (MSAFP) testing is performed between 15-20 weeks gestation to screen for neural tube defects
• Follow-up with targeted ultrasound for elevated AFP

Pre-eclampsia, GHTN

• Signs of pre-eclampsia include proteinuria, rising blood pressure, edema, headache, right upper quadrant pain, epigastric pain, visual disturbances, decreased urine output, hyperreflexia, and rapid weight gain

HELLP syndrome

• HELLP syndrome (hemolysis, elevated, liver enzymes, low platelets): this can be diagnosed by labs
• There's an increased risk for maternal death and adverse perinatal outcomes

Placenta Previa

• In placenta previa, the placenta is implanted in the lower uterine segment near or over the internal cervical os
• Painless, bright red vaginal bleeding are common symptoms of placenta previa

GDM (Gestational Diabetes Mellitus)

• Maternal risks: Elevated BP, frequent UTI, preeclampsia
• Fetal risks: congenital anomalies, birth in injuries, hypoglycemia

Hyperemesis Gravidarum

• Hyperemesis gravidarum Involves excessive vomiting plus dehydration
• A sign of hyperemesis is if pulse rate increases, and blood pressure decreases

Placental abruption

• Placental abruption Involves the premature separation of the placenta from the uterine wall before delivery

Fetal Valves:

• Ductus arteriosus: valve that shunts blood around the lung
• Foramen ovale: Valve allowing blood to flow directly from the right to left atrium
• Ductus venosus: Valve that shunts around the liver