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Inability to conceive a child or sustain a pregnancy to childbirth Pregnancy has not occurred after at least 1 year of engaging in unprotected sexual intercourse Affects 14% of couples desiring children
Types of infertility:
Primary infertility - refers to a couple who has never established a pregnancy Secondary infertility - refers to couple who has conceived previously but are currently unable to establish a subsequent pregnancy
Male factor:
Obstruction in seminiferous tubules , duct, or vessels preventing movement of spermatozoa Qualitative or quantitative changes in the seminal fluid preventing sperm mobility (movement of sperm). Problem in ejaculation or deposition preventing spermatozoa from being placed close enough to the womans cervix to allow ready penetration and fertilization.
Obstruction or impaired sperm motility: Mumps or orchitis Anomalies of the penis Extreme obesity
Ovarian factor:
Anovulation- most common cause of infertility in women 1. genetic abnormality 2.hormonal imbalance 3. ovarian tumor 4. stress 5.decreased body weight
Tubal factor:
Pelvic inflammatory disease
Uterine factor:
Tumor ( fibroma) Congenitally deformed uterine cavity Endometriosis Inadequate endometrium formation
Cervical factor:
Characteristic of cervical mucus Infection/inflammation of cervix
Coital factor :
pH of the vagina: alkaline pH is optimum (8) Presence of sperm-immobilizing/sperm agglutinating antibodies
Fertility Assessment
Fertility testing
Semen analysis Ovulation monitoring Tubal patency assessment
Semen Analysis
Number of sperm Appearance of sperm Motility of sperm Sperm penetration
semen analysis:
count: 20 million / ml or 50 million /ejaculation volume: 2.5ml - 6 ml Motility: >75% Quality of motion: graded 1-4 (poor to excellent) Morphology: more than 70% normal
Ovulation Monitoring
Record basal body temperature Ovulation by test strip
Assesses upsurge of LH that occurs before ovulation
Tubal Patency
Sonohysterography
Ultrasound to inspect uterus
Hysterosalpingography
Radiologic exam of fallopian tubes
Infertility evaluation:
Male factor: Semen analysis Post-coital test-mucus is examined microscopically between 2- 12hrs after coitus Satisfactory test- many motile spermatozoa seen per high power field Unsatisfactory result: No spermatozoa are seen Majority of spermatozoa are immotile Very few spermatozoa are present
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Motility is characterized as shaking movement rather than forward movement Hostile cervical mucus is present
Test of fertilizing capacity of spermatozoa: Measurement of sperm acrosin-enzyme in sperm head that responsible for preliminary changes in the sperm zona-free hamster ovum penetration test Human ovum fertilization test Coital factor: Taking history of coital frequency, pattern and technique Anatomic evaluation of the position of the cervix with relationship to the vagina Post coital testing .
Cervical factor:
Cervix is the first major barrier encountered by sperm after arrival in the female reproductive tract 1.Abnormalities in the cervix or the cervical mucus Abnormal position of the cervix( prolapse or uterine retroversion Chronic infection Previous cervical surgery Presence of sperm antibody in the cervical mucus
Hysterography- visualize contour of the uterine cavity Hysteroscopy visualize uterine cavity to detect anomalous development, polyps or tumors
Tubal factor: - functions: 1.mechanical function- act to : -conveys recently ovulated ova into fallopian tube -permits spermatozoa to enter the oviduct -effects transfer of the blastocyst into the uterine cavity
*documentation of ovulation: a. basal body temperature records demonstrate a 14 day elevation of basal temp.( progesterone-thermogenic effect) b. Blood progesterone level c. endometrial biopsy- secretory endometrial pattern
Treatment : Correction of male factor: a. Medical - correction of underlying deficiencies - artificial donor insemination b. surgical - reversal of sterilization - varicocele surgery
c. assisted reproductive technologies 1. in vitro fertilization and embryo transfer IVF) 2. gamete intrafallopian tube transfer(GIFT) 3. assisted fertilization
Correction of ovarian factor: 1. induction of ovulation: - correction of underlying endocrine disorder - clomiphene citrate to correct hypothalamic function - human menopausal gonadotropin - bromocryptine for anovulation due to prolactin excess - glucocorticoids for androgen excess
Artificial insemination In vitro fertilization Gamete intrafallopian transfer Zygote intrafallopian transfer Surrogate embryo transfer
Artificial insemination instillation of sperm into the female reproductive tract to aid conception - technique of micromanipulation that thins the zona pellucida and inject sperm into the ovum in an effort to enhance fertilization In vitro fertilization (IVF) removing 1 or more mature oocytes from a womans ovary by laparoscopy and then fertilizing them by exposing them to sperm under laboratory conditions outside the womans body (placed on a dish together with the sperm)
Embryo Transfer (ET) ova transfer; insertion of laboratory grown fertilized ovum into the womans uterus approx. 40 hours after fertilization where 1 or more of them will implant and grow
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ARTIFICIAL INSEMINATION
IN VITRO FERTILIZATION
Surrogate embryo transfer oocyte from a donor is fertilized by the recipient womans male partners sperm and placed in the recipients uterus by ET or GIFT Intravaginal culture Blastomere analysis
END
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Terms
Biologic gender-chromosomal sex male: XY female: XX Gender identity/ sexual identity-inner sense of being a male or female Gender role- male or female behavior a
person exhibits
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Sexual Orientation
Heterosexuality-opposite sex Homosexuality- same sex Bisexuality- both sex Transsexuality- person of one biologic gender, feels as if he/she should be of the opposite gender
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Sexual Expression
Celibacy- abstinence from sex Masturbation-self stimulation for erotic pleasure Erotic stimulation-use of visual materials for sexual arousal Fetishism-sexual arousal from objects or situation
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Sexual Expression
Transvestism-dresses to take on the role of the opposite person Voyeurism-peeping tom Sadomasochism:sadism-inflicting pain;masochism-receiving pain
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Necrophilia sex with the dead Zoophilia/ Bestiality sex with animals Urophilia sex after urinating the partner Pedophilia sex with children Exhibitionism Cuprophilia sex after defecating the partner
Sexual Harassment
Unwanted, repeated sexual advances, remarks or behavior toward another
Offensive to recipient Interferes with job performance TYPES: 1. quid pro quo/equal exchange 2. hostile work environment
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