Duke PA Infertility
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| Infertility is defined as the failure to achieve a successful pregnancy after __ or more of regular unprotected intercourse | 12 months
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| When do you evaluate earlier for infertility | Age >35, irregular period suggesting anovulation, history of endometriosis or tubal disease, known male factor
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| What is evaluated to determine cause of infertility | Eggs (ovulation, ovarian reserve), tubes (HSG, laparoscopy), sperm (semen analysis, urology evaluation)
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| When is the placenta formed | 7-10 weeks
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| Progesterone coming from the corpus luteum accomplishes what | Keeps the endometrium in a receptive state (keeps it ready for implantation)
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| Problems with ovulation account for __% of female infertility factors | 40
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| WHO I classification of anovulation | No Estrogen, low/normal FSH, normal prolactin, no hypo-pituitary lesion (hypothalamic amenorrhea)
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| WHO II classification of anovulation | Estrogen, normal FSH, normal prolactin (PCOS)
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| WHO III classification of anovulation | Low estrogen, high FSH, normal prolactin (ovarian insufficiency)
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| High prolactin will shut down __ axis | Ovarian
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| If FSH is high it is __ failure | Ovarian
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| What is the most common reason a woman might not be ovulating | PCOS
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| Two out of three findings are needed for the diagnosis of PCOS. What are the three findings | Oligo- and or anovulation, hyperandrogenism, US with polycystic ovaries
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| How do oral medications such as Clomid and tamoxifen stimulate ovulation | They trick the brain into thinking there is no estrogen in the body so it stimulates the ovaries into producing more
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| What egg changes happen as a woman ages | Quantity, quality, recruitment
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| About how many follicles are present at birth | 1 million
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| About how many follicles are present at menarche | 400,000
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| About how many follicles are actually taken all the way to ovulation | 400
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| About how many follicles remain at menopause | 1000
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| As egg number decreases, there is less feedback from the ovaries, which causes a rise in __ | FSH
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| As FSH levels increase, likelihood of pregnancy __ | Decreases
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| What is an HSG | Hysterosalpingogram (tests for tubal patency)
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| Why would you do a laparoscopy for an infertile woman | Abnormalities on HSG, pelvic pain, high suspicion for endometriosis
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| What affect do most vaginal lubricants have on sperm motility | Decreased
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| Where does spermatogenesis take place | Seminiferous tubules
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| How many days prior to semen analysis does the man need to stay abstinent | 2-5 days
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| How soon should the semen sample make it to the lab for analysis | Within 1 hour
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| What does the WHO consider as a normal sperm count | >20 x 10(6)/ml
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| What does the WHO consider as a normal semen volume | >2ml
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| What is asthenospermia | Low motility
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| What is teratospermia | Low morphology
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| What is oligospermia | Low count
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| What is azoospermia | No sperm in ejaculate
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| Tubal/ peritoneal factors responsible for ____% of infertility problems | 35%
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| Infertility & Endometriosis: Possible mechanisms | Distorted pelvic anatomy; Altered peritoneal fn (peritoneal fluid tox to sperm, embryos); Altered hormonal & cell-mediated fn; Endocrine/ ovulatory abnormalities; impaired implantation
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| Testosterone is produced in: | Leydig cells
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| Sertoli cells: | ABP to concentrate T and DHT in seminiferous epithelium and epididymis
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| LH function | stimulates testosterone synthesis/secretion
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| FSH function | increases LH receptor numbers
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