Professional Documents
Culture Documents
Female Infertility
Course 2
Infertility
15% of couples
Pregnancy absence after a year of unprotected
sexual intercourse (6 months if f>35 years old)
Primary (no previous pregnancies)
Secondary (the couple already had a pregnancy/child)
2015-2016
2015-2016
Ovogeneza si varsta
2015-2016
Ovogenese
Long period (L3 IU 12-14 50 years)
in which the oocyte can be found in the
prophase of the reduction meiosis
(suspended prophase) this can lead to
chromosomal anomalies in elderly
mothers
High possibility of Down Syndrome when
it comes to mothers >35 years old
What is the age of your oocytes?????
2015-2016
2015-2016
Ovulation
Releasing the secondary oocyte from
the ovary under LH action
Signs:
Cervical mucus volume increase,
white egg-like, alkaline, elastic
Ovulation tests
Mittelschmerz
Basal body temperature (+0.4-0.8 C)
AFTER ovulation
2015-2016
2015-2016
Ovarian cycle
Follicular phase
Ovulation
Lutheal phase
Body temperature
Gonadotropin
hormons (LH, FSH)
HH. Sexual (E2,
Progesteron)
Uterine cycle
2015-2016
Menstruatin
Proliferative
Secretory
Couple Infertility
2015-2016
births/1,000
15-19
41.6
20-24
102.6
25-29
115.6
30-34
95.1
35-39
43.8
40-44
8.7
45-54
0.5
2015-2016
2015-2016
Tubal
Ovulatory
Cervical
Others (Obesity BMI>30 or <19; smoking,
alcohol, recreational drugs)
2015-2016
Tubal factors
2015-2016
2015-2016
Paraclinically History
AGE
History (menarche, MC, sexual history: sexual intercourse
frequency, pelvic pain, endometriosis (BIRTHS); drugs;
surgery; genetic illnesses; vaccinations;
Associated pathologies (thyroid, hirsutism, acne, breast
discharge- galactorrhoea);
Paraclinically:
AMH, PRL, TSH, FT4, FSH, LH, E2, Testosterone bio available,
Ab anti rubella, Ab anti toxoplasma
Chlamydia, Mycoplasma (Pelvi Inflamatory Disease major
cause of tube infertility and cervicitis)
Ab anti sperm cells (interferes with fertilization)
Hepatitis B, C , HIV, syphilis
Endometrial biopsy (premenstrual phase)
2015-2016
2015-2016
Hysterosalpingography
Radiological procedure ( involving X -rays ) used for visualization
of the uterine cavity and fallopian tubes . The most commonly
indicated suspicion of blocked tubes. Also visualizes the size
and shape of the uterus ( uterine cavity ) in infertility problems.
To check the success of the tubal ligation procedure
Contraindication:
Pregnancy and pelvic infections (advised to take prophylactic antibiotic
before any other procedure)
2015-2016
Laparoscopy
Allows diagnostic and treatment
through a 1cm incision (with
pneumoperitoneum) at the umbilical
level
2015-2016
2015-2016
Ring sterilization
2015-2016
Hysteroscopy
Hysteroscope is transcervical introduced
Indications
Uterine bleeding (myomas, endometrial
polyps, endometrial atrophy)
Infertility (intrauterine synechiae,
submucosal fibroids)
Uterine malformations
2015-2016
Uterine polyp
Double Uterus
2015-2016
Intrauterine Synechiae
Ashermans syndrome
2015-2016
Endometrial Ca.
2015-2016
2015-2016
AR (needs 2 alleles)
High HbS %
Under hypoxia, it creates
chains of hemoglobin and
they polymerize and
creates bridges that
deform the hematite
T- transplant
medular/hidroxyurea
2015-2016
Tay Sach
AR Death of nervous
system
Absence of
Hexosamindase A (Hex-A)
accumulation of fat
acids in nervous cell
Hearing loss, blindness,
lowering muscle tone,
dementia, paralysis,
convulsions, red sports on
retina,
IT CANNOT BE TREATED,
IT CANNOT BE SLOWED
DOWN
2015-2016
Cystic fibrosis
AR, Affects 1/2500 nb (Caucasians) and
1/10.000 (Asians); Life expectancy 30/40
years (1960- they lived approx. 6 months)
Lung, pancreas, reproductive organs
loading with thick mucus low in chlorine
CFTR mutation (cystic fibrosis
transmembrane conductance
regulator) gene
2015-2016
2015-2016
2015-2016
SOPC
usully LH/FSH
>3
2015-2016
Testosterone
Free (2-3%)(BD)
Poorly connected to albumin (BD)
Strongly connected to SHBG
2015-2016
2015-2016
2015-2016
Endometriosis
Presence of functional endometrial tissue
outside the uterine cavity (ANYWHERElungs, intestines, peritoneal cavity, brain)
6-10% of women
Aneuploidies cells 11, 16, 17
Asymptomatic infertility, chronic pelvic
pain, dysmenorrhea (especially following a
pain-free period)
2015-2016
2015-2016
2015-2016
2015-2016
2015-2016
2015-2016
???????????
Patient 27 years, without significant
PPA
Regular MC 35 Days
Maximum fertile period?
How do we document ovulation?
(post?)
2015-2016
?????????
Patient 35 years - high body
temperature for mostly 20 days
Dg??? posible
2015-2016
2015-2016
2. .
2015-2016
3.
2015-2016
4. .
2015-2016
Questions..zzzz??
2015-2016
2015-2016
2015-2016
Female sex
At birth 1-2 mil primary foliculles (contain primary
oocytes);
Puberty: 400.000 primary foliculles;
Adult 400 develop into mature follicules (contain
secondary oocytes)
Ovogenesis oocytes I oocytes II needs both X
chromosomes in the absence of one follicular atresia
(Turner syndrome- associated with foliculle-genesis)
2015-2016
Intersexuality
Sexualisation disorder characterized by a
mismatch of sexual characters belonging
to some females , like males
TRUE hermaphroditism
MALE/FEMALE
PSEUDOHERMAPHRODITISM
2015-2016
TRUE hermaphroditism
The simultaneous presence in the same gonads
or different GONADS, testicular and ovarian
tissue ( ovary , testis, ovotestis )
Variable karyotype: 46,XX or mosaicism or 46,XY
Differentiation OGI, OGE variable
OGE masculine, feminine, ambigue
OGI feminine/proper gonad of the same side
The sexualization of puberty - usually female
type
2015-2016
TRUE hermaphroditism
Hormonal values are variable
Karyotype - variable
DG +: OGE ambiguous , highlighting
the gonads of both types;
Treatment:
- Extraction of gonads(d.o after
puberty)
- OGE correction
Hormone replacement therapy
2015-2016
FEMALE
PSEUDOHERMAPHRODITISM
LOOKS like male, but XX
Congenital Adrenal
Hyperplasia
Deficit 21-hidroxilaza (CYP21Achromosomal
6p21.3; REN cortex SR) deficit of cortisol and
aldosteron with secretion increase of DHEA,
androstendion and testosterone
OTHER ENZYMES:
2015-2016
11-betahidroxilaza
(8q21)
OR
3-betahidroxisteroid
dehYdrogenase
(1p13)
or
Aromatase
2015-2016
2015-2016
2015-2016
MALE
PSEUDOHERMAFRODITISM
looks like woman, but XY
The presence of male gonad ( testicle ) as one gonad
, genital tract and female secondary sexual
characteristics are ambiguous ( intersex )
Intersexuality is clinically varied:
predominantly male look = micropenis with hypospadias
Completely ambiguous look = fused labia, partially clitoris,
but with micropenis, urinary meatus based phallus
Predominantly female look = vulva with enlarged clitoris
Phenotype may be normal girl
2015-2016
Causes of PHM
PSM apears through :
gonad embryo destruction before masculinity ( before
seven . 6-12 v.i.u)
defective biosynthesis of testosterone(deficit 17hydroxylase/17,20-lyase or 17--Hydroxysteroid
dehydrogenase)
2015-2016
MALE
PSEUDOHERMAPHRODITISM
Feminizing testicle syndrome ( Morris ) - fully resistant
to androgen ( receptor defects ) ;
Karyotype 46, XY
Joan of Arc
2015-2016
Queen Elizabeth I
2015-2016
2015-2016