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