Infertility
Overall pregnancy rate by IVF is
38% to 42% per treatment
ZIFT differs from GIFT in that
With ZIFT, fertilization takes place outside the body, allowing HCPs to be certain that fertilization has occurred before the growing structure is reintroduced
infection of inflammation of the cervix
erosion
if a women is younger than 35 years of age, it is usually suggested that she have an evaluation after ____ of subfertility; if older than 35, after ___ of subfertility
1 year; 6 mos
A temp rise should last approximately
10 days
Endometrial biopsies are done ___ before expected menstrual flow
2 to 3 days
the semen analysis may need to be repeated after ____ because spermatogenesis is an ongoing process, and _____ is needed for new sperm to reach maturity
2 to 3 months; 30 to 90 days
For a semen analysis, after ___ of sexual abstinence
2 to 4 days
normal amount of sperm in mL of seminal fluid
20 million
Therapeutic insemination takes an average of
6 months to achieve conception
In IVF occytes are incubated for at least ___ to ensure viability while the husband donates a ____
8 hours; fresh semen specimen
How long/how many courses of clomid are prescribed with no success prior to discontinuing
Approximately 90 days or three courses
To determine this, a women takes her temp each morning, before getting out of bed or engaging in any activity, eating, or drinking, using a special thermometer.
BBT
___ test tests FSH the 3rd day of a woman's menstrual cycle and a sperm motility test for the male
Ferrell
Procedure in which ova are obtained from ovaries as in IVF, both ova and sperm are instilled within a matter of hours, using a laparoscopic technique, into the open end of a patent fallopian tube where fertilization then occurs and the zygote moves to the uterus for implantation
GIFT (gamete intrafallopian transfer)
Most often used for couple who have not been able to conceive because a woman has blocked or damaged fallopian tubes or when a man has oligospermia (low count of sperm)
IVF
may be helpful to couples when an absence of cervical mucus prevents sperm from traveling to or entering the cervix or antisperm antibodies cause immobilization of sperm
IVF
A procedure in which one or more mature oocytes are removed from a woman's ovary by laparoscopy and fertilized by exposure to sperm under laboratory conditions outside a woman's body, approximately 40 hours after fertilization, the lab-grown fertilized ova are inserted into a woman's uterus, where ideally one or more of them will implant and grow
IVF, in-vitro fertilization
The inability to conceive a child or sustain a pregnancy to birth.
Infertility
Various brands of commercial kits are available for assessing the upsurge of ___ that occurs just before ovulation
LH
Orthodox Jewish law in which the couple may not engage in sexual relations 7 days following menstruation
Nida period
Associated with metabolic syndrome
PCOS
Waist circumference of 35 or above FBS >100 Serum triglycerides >150 BP >135/85 HDL <50
PCOS
___ may be given to a woman if it is believed that she will not produce enough on her own to support implantation
Progesterone
__ reduces hypothalamic secretion of gonadotropin releasing hormone, when then __ the production of LH and FSH, which leads to ___
Stress; lowers; anovulation
The potential to conceive but they are just less able to so without additional help
Subfertility
Procedure that involves oocyte retrieval by transvaginal, US-guided aspiration, followed by culture and insemination of the oocytes in the lab; within 24hrs the fertilized eggs are transferred by laparoscopic technique into the end of a waiting fallopian tube
ZIFT (zygote intrafallopian transfer)
tubes are patent if the dye appears in the
abdominal cavity
infection of the vagina can cause the pH of the vaginal secretions to become ___, ____ the motility of spermatozoa
acidotic; limiting or destroying
Absence of ovulation
anovulation
More often results from a hormonal imbalance such as hypothyroidism, or perhaps ovarian tumors, or Turner's syndrome (hypogonadism)
anovulation
the most common cause on infertility in women
anovulation
Proof that the zygote has implanted can be demonstrated by a routine serum pregnancy test ___ after transfer
as early as 11 days
normal amount of sperm in seminal fluid
at least 50 million, up to 200 million
An ideal BMI index for women
between 20 and 24 BMI
An alternative lifestyle available to both fertile and subfertile couples
child-free living
Can be as fulfilling as having children, because it allows a couple more time to help other people and contribute to society through personal accomplishments, allows for having free time to pursue hobbies, continue education, travel, and pursue careers
child-free living
Many organisms can cause PID but generally __ and __ are among those that cause it the most
chlamydia and gonorrhea
Douglas's cul-de-sac, the ovaries, the uterine ligaments, and the outer surface of the uterus and bowel
common sites for endometriosis to occur
Undescended testes
cryptorchidism
__ may lead to lowered sperm production if surgical repair of this problem was not completed
cryptorchidism
Couples who engage in coitus daily, hoping to cause early impregnation actually have a more ___ time than those that have sex every other day.
difficultly
Women using oral, injectable, or implanted hormones for contraception may have ___
difficultly becoming pregnant for several months after discontinuing these meds
usually occurs because of scarring has developed in the fallopian tubes
difficulty with tubal transport
at the time of ovulation, the basal temp can be seen to ___ slightly; then ____ and remains at that level for 3 to 4 days before the next menstrual flow
dip slightly (0.5*F); then rises to a level no higher than normal body temp
If fallopian tubes have been ligated, ___ pregnancy may occur open trying to reopen them
ectopic
the implantation of uterine endometrium or nodules that have spread from the interior of the uterus to locations outside the uterus
endometriosis
inflammation of the epididymis
epididymitis
The Ferrell kits are
expensive
Cons about IVF
expensive and only done at specialized centers
___ may be a rare cause of subfertility if they block the entrance of the fallopian tubes into the uterus of limit the space available on the uterine wall for effective implantation
fibromas (leiomyomas)
For the procedure, iodine-based radiopaque material is introduced into the cervix under pressure, outlining the uterus and both tube, and can be painful because the medium is thick
hysterosalpingography
a radiologic exam of the fallopian tubes using a radiopaque medium and is schedule immediately after a menstrual flow to avoid reflux of menstrual debris up the tubes and unintentional irradiation of a growing zygote
hysterosalpingography
visual inspection of the uterus through the insertion of a thin hollow tube, through the vagina, cervix, and into the uterus
hysteroscopy
the union of sperm and ovum under laboratory conditions
in-vitro fertilization
The chance of subfertility ___ with age
increases
If multiples are determined to be carried by the pregnant female and she and her partner elect to terminate one or more of the implanted embryos, this is done by
intra-abdominal injection of potassium chloride into the gestational sacs chosen to be eliminated
Sperm is instilled into the cervix
intracervical insemination
___ is more commonly used today and more apt to result in a viable pregnancy for tubal ligation reversal
intrauterine insemination
sperm is instilled directly into the uterus
intrauterine insemination
Ovulation kits are advantageous for women with
irregular work or daily activity schedules
And advantage of cryopreserved sperm is that
it can be used even after years of storage
One disadvantage of using frozen sperm is that
it tends to have slower motility than unfrozen specimen
This is scheduled during the follicular phase of a menstrual period and is done under general anesthesia because of the pain caused by extensive maneuvering
laparoscopy
the introduction of a thin, hollow, lighted tube through a small incision in the abdomen, just under the umbilicus, to examine the position and state of the fallopian tubes and ovaries
laparoscopy
Too frequent coitus can ___ a man's sperm count
lower
Occurs during the ___ phase of the menstrual cycle
luteal phase
PCOS causes some women to only
ovulate a few times a year
Possible complications from endometrial biopsies are
pain, excessive bleeding, infection, and uterine perforation
A ___ may be performed to rule out ovarian, tubal, or uterine structural disorders
pelvic US
an infection of the pelvic organs: the uterus, fallopian tubes, ovaries, and their supporting structures
pelvic inflammatory disease (PID)
If the man has never been able to achieve erection and ejaculation
primary ED
there have been no previous conceptions
primary subfertility
Benign hypertrophy of the ____ occurs in most men beginning at about 50 years of age
prostate gland
To prepare for therapeutic insemination, a woman must
record her BBT, assess her cervical mucus, or use an ovulation predictor kit to predict her likely day of ovulation
the least costly way for a women to determine a woman's ovulation pattern is to ask her to ___ for at least ___
record her basal body temp (BBT); 4 months
Scarring of the fallopian tubes is usually caused by
salpingitis
if the man has been able to achieve ejaculation in the past but now has difficultly
secondary ED
has been a previous pregnancy but the couple is unable to conceive at present
secondary subfertility
The three basic fertility tests involve
semen analysis in men and ovulation monitoring and tubal patency in women
Couples report a feeling of ___ during the time of IVF and ___ from answering family's and friends' questions about the procedure
social isolation; weariness
Because of its minimally invasive technique, ___ can be done any time during the menstrual cycle
sonohysterography
an US technique designed for inspecting the uterus
sonohysterography
the number of sperm in a single ejaculation orin a mL of semen
sperm count
movement of sperm
sperm motility
production of sperm cells
spermatogenesis
the inability to conceive because of a known condition, such as the absence of a uterus
sterility
An assisted reproductive technique for a woman who does not ovulate, use of an oocyte that has been donated and fertilized in the lab and placed back in the woman's uterus by embryonic transfer
surrogate embryo transfer
A woman who agrees to carry a pregnancy to term for a subfertile couple
surrogate mother
mumps orchitis
testicular inflammation and scarring because of the mumps virus
An abnormally high level of FSH on the 3rd day of a woman's menstrual cycle indicate
that her ovaries are not responding well to ovulation
if the endometrium removed by biopsy resembles a corkscrew in the second half of a menstrual cycle, this suggests
that ovulation has occurred
PID invasion of the fallopian tubes is most apt to occur at ___ because
the end of a menstrual period; menstrual blood provides such an excellent growth medium
Is used if the man has an inadequate sperm count or a woman has a vaginal or cervical factor that interferes with sperm motility
therapeutic insemination
The instillation of sperm into the female reproductive tract to aid in conception
therapeutic insemination
deposition of sperm into a woman's cervix or uterus
therapeutic insemination
At the time of ovulation, the cervical mucous is ___ and can be easily penetrated by spermatozoa for ____
thin and watery; 12 to 72 hours
epispadias
urethral opening on the dorsal surface
hypospadias
urethral opening on the ventral surface of the penis
___ could increase temp within the testes and slow and disrupt spermatogenesis
varicocele
varicosity of the spermatic vein
varicocele
Most couple's assume that fertility is the ___ fault; and even when the ___ can demonstrate ___
woman's; man's; low self-esteem