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Maternity Chapter 9


Infertility stats Infertility is a serious medical concern that affects quality of life and is a problem for 10% to 15% of reproductive-age couples (American Society for Reproductive Medicine [ASRM], 2010a;
Infertility vs Sterility Infertility means there is the possibility of conceiving through other means Sterility is the inability to conceive.
%chance of conception for normal couples 20% chance of conceiving
Primary infertility Woman has never been pregnant
Secondary infertility Woman has had a child before
How long before sperm is no longer viable? about 24hours, but the optimal time is a couple hours after intercourse.
amenorrhea r/t infertility after the discontinuation of oral contraceptives is seen more frequently in women with histories of menstrual dysfunction before initiation of contraceptive use.
integrity of the tubes The motility of the tube and its fimbriated end may be reduced or absent as a result of infections, adhesions, scarring, or tumors. Chlamydial infection impairs tubal function and impedes fertility.
Abnormalities of the uterus bicornuate or septate uterus
Asherman syndrome (uterine adhesions or scar tissue)
Male infertility can be caused by structural and hormonal disorders such as undescended testes, hypospadias, varicocele (varicose veins of the scrotum), low testosterone levels, vasectomy, Substance abuse use Amyl nitrate, butyl nitrate, ethyl chloride, and methaqualone
azoospermia no sperm produced
oligospermia few sperms produced
Hormone Analysis performed to assess endocrine function of the hypothalamic-pituitary-ovarian axis when menstrual cycles are absent or irregular, or to assess the woman's ovarian reserve.
clomiphene citrate challenge test (CCCT) performed to determine ovarian reserves: fewer eggs means less responsiveness to FSH.
Ultrasonography Abdominal or transvaginal ultrasound is used to assess pelvic structures
Hysterosalpingography cheduled 2 to 5 days after menstruation to avoid flushing a potential fertilized ovum out through a uterine tube into the peritoneal cavity. Liquid instilled in uterus and viewed with x-ray
Hysteroscopy Hysteroscopy uses a flexible scope threaded through the cervix to directly view the uterine cavity. This is the gold standard for evaluation of leiomyomas (fibroids) and adhesions that might impair implantation.
Laparoscopy Laparoscopy is useful to view the pelvic structures intraperitoneally, outside the uterus, which may reveal endometriosis, pelvic adhesions, tubal occlusion, leiomyomas (fibroids), or polycystic ovaries.
herbs to avoid for better fertility licorice root, yarrow, wormwood, ephedra, fennel, goldenseal, lavender, juniper, flaxseed, pennyroyal, passionflower, wild cherry, cascara, sage, thyme, and periwinkle
for sperm analysis: intruct patient to refrain from ejaculating for 2-5 days
Created by: ekm