Reproduction, Conception, & Infertility
Terms
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- Mensturation Cycle Length
- 1st day of one period to first day of next period (21-35 days)
- Amount of menstural flow
- 25-60ml per period
- Length of menses
- 2-8 days usually (this may vary)
- menstruation controlled by feedback system of 3 cycles
- endometrial hypothalmic-pituitary ovarian
- endometrial cycle - 4 phases
- menstural proliferative secretory ischemic
- Hypothalamic-pituitary
- Hypothalamic releases gonadotropin-releasing hormones (GnRH) due to low levels of estrogen and progesterone stimulating the pituitary to release Follicle stimulating hormones (FSH) starting the follicular phase (days 1-14), and then the lutenizing hormone is released starting the luteal phase (days 15-28)
- follicular phase
- days 1-14
- luteal phase
- days 15-28
- Ovarian Cycle
- the follicular phase matures the follicle and near ovulation there is an estrogen surge. This phase varies the most in length. Once ovulation has occurred the progesterone is increase in preparation of a pregnancy this is the luteal phase which maintains the corpus luteum
- Estrogen
- secreted in large amounts by the ovaries in non-pregnant women. Controls the development of the female secondary sex characteristics: breast, hips, and fatty deposits. Assist in maturation of ovarian follicles Cause uterus to increase in size and wt. Estrogen inhibits FSH production and stimulates LH production.
- Progesterone
- secreted by the corpus luteum and is found in greatest amounts during the secretory phase. Decreases uterine motility and contractility preparing uterus for implantation. Prepares breasts for lactation (Temp rise in ovulation due to progesterone)
- Increases in ______ ______ is essential to ovulation
- follicular maturation
- primary amenorrhea
- not established <16yrs of age or 4 yrs of breast development
- secondary amenorrhea
- may be caused by pregnancy, lactation, hormonal imbalances, poor nutrition, exercise, etc.
- Dysmenorrhea
- painful menstruation
- Premenstrual syndrome
- associated with luteal phase (2 wks prior to onset)
- Endometriosis (med)
- Danazol
- Menorrhagia
- Abnormal Uterine bleeding
- Sexually Transmitted diseases
- Chlamydia; Chlamydia- may cause infection in neonates Gonorrhea- may lead to PID or pelvic abscess leading to infertility; asymptomatic Pelvic Inflammatory disease Human papillomavirus (genital warts) - linked to ca of cervix, vagina, vulva, anus and penis. May impede vaginal delivery Herpes Simplex Virus Type 2 Infection- may recur throughout lifetime linked to cervical ca. Viral Hepatitis HIV- increasing in heterosexual population; perinatal transmission may occur. Vaginitis- Trichomonas, Gardnerella, and Candida albicans (thrush). Vaginal discharge, itching, burning Human papillomavirus (genital warts) - linked to ca of cervix, vagina, vulva, anus and penis. May impede vaginal delivery Herpes Simplex Virus Type 2 Infection- may recur throughout lifetime linked to cervical ca. Viral Hepatitis HIV- increasing in heterosexual population; perinatal transmission may occur. Vaginitis- Trichomonas, Gardnerella, and Candida albicans (thrush).
- Vaginitis- Trichomonas, Gardnerella, and Candida albicans (thrush).
- Vaginal discharge, itching, burning
- Chlamydia
- may cause infection in neonates
- Causes of infertility
- - delayed age for family - genetic and chromosomal abnormalities - environmental factors: radiation, drugs, smoking, etc.
- PRIMARY infertility
- inability to conceive
- SECONDARY infertility
- inability to conceive after one or more successful pregnancies
- STERILITY
- absolute inability to conceive
- FEMALE factors associated with infertility
- - infections: adhesions, scarring - endometriosis: presence of endometrial tissue outside uterine cavity - structural disorders: bicornate, septate uterus - ovulatory factor: anovulation - cervical factor: poor cervical mucus
- MALE factors associated with infertility
- Sperm production - decreased, may be due to infection, mechanical problems, environmental influences - sperm motility and transport
- Assessment Dx for infertility
- Physical exam, semen analysis, post coital test, sperm penetration assay Evaluation of ovulation Basal body temperature Endometrial biopsy Mittelschmerz, spinnbarkeit & fern test Evaluation of pelvis Hysterosalpingogram (HSG) Laparoscopy
- Treatment of infertility (1)
- Pelvic factor etiology Medical; Danazol (synthetic androgen) Surgical: Obliteration endometrial implants Ovulatory factor etiology Pharmacological- includes clomiphene citrate (Clomid), human menopausal gonadotropin (hMG, Pergonal), Palodel, Metrodin (FSH) Cervical factor etiology Estrogen- increases cervical mucus Male factor infertility Lifestyle/environmental changes Surgery (varicocele) Artificial insemination (for low sperm count)
- Treatment of infertility (2)
- Assisted reproductive technology In vitro fertilization- embryo transfer Ovum transfer- donor female Gamete intrafallopian transfer (GIFT) Zygote intrafallopian transfer (ZIFT) Psychologic & cultural aspects of infertility Emotions include: surprise, denial, anger, guilt, grief, isolation Infertility represents a major life crisis for families Religious and family beliefs National support groups such as RESOLVE, exist to assist couples in dealing with infertility Components of Sexual History General physical, developmental, lifestyle factors Psychosocial factors Past sexual activity Current sexuality related to childbearing Adoption Surrogate mothers
- Rhythm method
- identify the fertile phase
- Cervical mucus method
- assessment of cervical mucus changes. At ovulation, mucus is clearer, and stretchy (spinnbarkeit) and more permeable to sperm. Luteal phase, mucus is thicker trapping sperm.
- Douching after intercourse
- not recommended. May push sperm higher.
- Emergency contraception
- Previn & Plan B
- First Trimester Abortion
- Vacuum aspiration, Methotrexate & Misoprostal (RU 486) prevents implantation
- Second Trimester Abortion
- Dilate & Evacuate Hypertonic and uterotonic agents- Saline solutions
- Ovum (oocyte) survives ___ hours
- 12-24
- Sperm survive up to ___ hrs in the female reproductive tract
- 72
- Ovum contains __ autosomal chromosomes plus one ___ sex chromosome.
- 22; X
- Sperm contains __ autosomal chromosomes plus one ____ chromosome.
- 22; X or Y
- Amnion
- fluid filled sac surrounding embryo
- Chorion
- develops from chorionic villi; inner layer adheres to amnion; outer layer adheres to decidua
- Germ Layers
- all tissues and organs develop from the ectoderm, endoderm, and mesoderm
- ____ carries oxygenated blood from placenta to fetus
- vein
- ____ carries deoxygentated blood from the fetus to the placenta
- arteries
- ______ surrounds the blood vessels in the placenta
- wharton\'s jelly
- EMBRYONIC PERIOD
- Development is cephalo-caudal pattern. Tubular heart begins beating by end of 4th week. Organogenesis: Marks the period from 4th-8th weeks- major organ formation occurs; embryo most vulnerable to toxic substances. Most congenital malformations occur at this period
- FETAL PERIOD
- End of the 8th week to birth. Characterized by maturation of tissues, organs and rapid body growth.
- Weeks 9-12
- human appearing face, sex determination apparent
- Weeks 13-16
- lanugo develops, increased fetal activity, urine formed by kidneys
- Weeks 17-20
- Quickening occurs, vernix caseosa and brown fat form
- Weeks 21-24
- Alveoli develop
- Weeks 25-28
- Survival possible
- Weeks 29-32
- increased subcutaneous fat
- Weeks 33-36
- Surfactant maturity
- Weeks 37-40
- Full term at 38 weeks
- Dizygotic (fraternal)
- 70%; originate from 2 separate zygotes
- Monozygotic (identical)
- 30%; result from fertilization of one ovum which splits to form 2 separate zygotes