Chapter 147: Fertility PDF

Chapter 147: Fertility Infertility- inability to conceive after 1 year of trying. Causes of infertility- malfunction of fallopian tubes, ovaries, uterus. Ovulatory predictor kit and blood test to check progesterone level on day 21 of menstrual cycle- to evaluate ovulation, as well as FSH (value o...

Chapter 147: Fertility Infertility- inability to conceive after 1 year of trying. Causes of infertility- malfunction of fallopian tubes, ovaries, uterus. Ovulatory predictor kit and blood test to check progesterone level on day 21 of menstrual cycle- to evaluate ovulation, as well as FSH (value on day 3-5), antimalarian hormone value (AMH) and antifollicular count (AFC) using a transvaginal ultrasound to determine if ovulation is occurring. PCOS- causes women to not ovulate or ovulate irregularly. - Most common cause of female infertility DOR- Diminished ovarian reserve- number of eggs are less than expected - Can be congenital - May be able to conceive naturally FHA- Functional hypothalamic amenorrhea- caused by exercise, weight loss, stress or combination, sometimes associated with eating disorders Improper function of pituitary/hypothalamus- these both produces hormones that maintain normal ovulation function. - Too much prolactin from pituitary gland can be from pituitary tumor - May cause woman not to ovulate POI- Premature Ovarian insufficiency- women's ovaries fail before 40 years old - Exposure to chemo/radiotherapy or certain medical conditions - 5-10% conceive naturally and have normal pregnancies Menopause- natural decline of ovarian function that occurs around age 50. - No period for an entire year. - Experience hot flashes, mood changes, difficulty sleeping. When stressed and trying to conceive, and start to relax and decrease stress, women can become pregnant (cortisol level can have impact on ovulation issues). Fallopian Tube obstruction- Hx of pelvic infection, ruptured appendix, gonorrhea, chlamydia, endometriosis, prior abdominal surgeries. - Evaluated by hysterosalpingogram (xray of uterus and fallopian tubes with dye) and chromopertubation (in OR at time of laparoscopy, blue dye to evaluate open or dilated enough). Uterus can be evaluated by transvaginal ultrasound to assess for polyps, fibroids, lesions, etc. Sonohystogram/hysteroscopy- look at structure of uterus Risk factors- Age causes infertility (egg quality declines over time), age can increase miscarriage risk, smoking, alcohol, overweight/underweight, extreme weight loss/gain, emotional stress that results in amenorrhea. Men and Infertility- Do semen analysis, which helps determine if male factors are contributing to infertility issues. - Varicocele- can affect number or shape of sperm - Trauma to testes- affect sperm production - Alcohol/smoking/drugs/steroids - Chemo/radiation on testes - Diabetes, CF, autoimmune/infections can cause testicular failure - Hormonal- improper function of hypothalamus/pituitary gland. Too much prolactin (benign or malignant pituitary tumor, hyperplasia, too much testosterone, Cushings). - Genetic- Klinefelter's syndrome can decrease sperm production Interview both individuals together and separately. - How long has infertility been going on - Pregnancy history - Ages of partners - Family hx of early menopause/infertility - DES exposure, lupus Male physical exam- shape and size of testes Female physical exam- thyroid exam, breasts, vagina Diagnostics- semen analysis, menstrual calendar, basal thermometer, urinary LH, woman \> 35: 3 FSH and estradiol levels during menstrual calendar Differential Dx: STIs, Cancer (radiation/chemo), BMI, personal behavior (alcohol/smoking/drugs), medications, sexual dysfunction, antisperm antibodies, previous genital surgeries. Management- IVF (ARTs), GnRH (males) Meds- Clomid (causes ovulation by acting on pituitary gland, increases number of eggs)