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Reproduction, Conception, & Infertility

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Mensturation Cycle Length
1st day of one period to first day of next period (21-35 days)
Amount of menstural flow
25-60ml per period
Length of menses
2-8 days usually (this may vary)
menstruation controlled by feedback system of 3 cycles
endometrial hypothalmic-pituitary ovarian
endometrial cycle - 4 phases
menstural proliferative secretory ischemic
Hypothalamic-pituitary
Hypothalamic releases gonadotropin-releasing hormones (GnRH) due to low levels of estrogen and progesterone stimulating the pituitary to release Follicle stimulating hormones (FSH) starting the follicular phase (days 1-14), and then the lutenizing hormone is released starting the luteal phase (days 15-28)
follicular phase
days 1-14
luteal phase
days 15-28
Ovarian Cycle
the follicular phase matures the follicle and near ovulation there is an estrogen surge. This phase varies the most in length. Once ovulation has occurred the progesterone is increase in preparation of a pregnancy this is the luteal phase which maintains the corpus luteum
Estrogen
secreted in large amounts by the ovaries in non-pregnant women. Controls the development of the female secondary sex characteristics: breast, hips, and fatty deposits. Assist in maturation of ovarian follicles Cause uterus to increase in size and wt. Estrogen inhibits FSH production and stimulates LH production.
Progesterone
secreted by the corpus luteum and is found in greatest amounts during the secretory phase. Decreases uterine motility and contractility preparing uterus for implantation. Prepares breasts for lactation (Temp rise in ovulation due to progesterone)
Increases in ______ ______ is essential to ovulation
follicular maturation
primary amenorrhea
not established <16yrs of age or 4 yrs of breast development
secondary amenorrhea
may be caused by pregnancy, lactation, hormonal imbalances, poor nutrition, exercise, etc.
Dysmenorrhea
painful menstruation
Premenstrual syndrome
associated with luteal phase (2 wks prior to onset)
Endometriosis (med)
Danazol
Menorrhagia
Abnormal Uterine bleeding
Sexually Transmitted diseases
Chlamydia; Chlamydia- may cause infection in neonates Gonorrhea- may lead to PID or pelvic abscess leading to infertility; asymptomatic Pelvic Inflammatory disease Human papillomavirus (genital warts) - linked to ca of cervix, vagina, vulva, anus and penis. May impede vaginal delivery Herpes Simplex Virus Type 2 Infection- may recur throughout lifetime linked to cervical ca. Viral Hepatitis HIV- increasing in heterosexual population; perinatal transmission may occur. Vaginitis- Trichomonas, Gardnerella, and Candida albicans (thrush). Vaginal discharge, itching, burning Human papillomavirus (genital warts) - linked to ca of cervix, vagina, vulva, anus and penis. May impede vaginal delivery Herpes Simplex Virus Type 2 Infection- may recur throughout lifetime linked to cervical ca. Viral Hepatitis HIV- increasing in heterosexual population; perinatal transmission may occur. Vaginitis- Trichomonas, Gardnerella, and Candida albicans (thrush).
Vaginitis- Trichomonas, Gardnerella, and Candida albicans (thrush).
Vaginal discharge, itching, burning
Chlamydia
may cause infection in neonates
Causes of infertility
- delayed age for family - genetic and chromosomal abnormalities - environmental factors: radiation, drugs, smoking, etc.
PRIMARY infertility
inability to conceive
SECONDARY infertility
inability to conceive after one or more successful pregnancies
STERILITY
absolute inability to conceive
FEMALE factors associated with infertility
- infections: adhesions, scarring - endometriosis: presence of endometrial tissue outside uterine cavity - structural disorders: bicornate, septate uterus - ovulatory factor: anovulation - cervical factor: poor cervical mucus
MALE factors associated with infertility
Sperm production - decreased, may be due to infection, mechanical problems, environmental influences - sperm motility and transport
Assessment Dx for infertility
Physical exam, semen analysis, post coital test, sperm penetration assay Evaluation of ovulation Basal body temperature Endometrial biopsy Mittelschmerz, spinnbarkeit & fern test Evaluation of pelvis Hysterosalpingogram (HSG) Laparoscopy
Treatment of infertility (1)
Pelvic factor etiology Medical; Danazol (synthetic androgen) Surgical: Obliteration endometrial implants Ovulatory factor etiology Pharmacological- includes clomiphene citrate (Clomid), human menopausal gonadotropin (hMG, Pergonal), Palodel, Metrodin (FSH) Cervical factor etiology Estrogen- increases cervical mucus Male factor infertility Lifestyle/environmental changes Surgery (varicocele) Artificial insemination (for low sperm count)
Treatment of infertility (2)
Assisted reproductive technology In vitro fertilization- embryo transfer Ovum transfer- donor female Gamete intrafallopian transfer (GIFT) Zygote intrafallopian transfer (ZIFT) Psychologic & cultural aspects of infertility Emotions include: surprise, denial, anger, guilt, grief, isolation Infertility represents a major life crisis for families Religious and family beliefs National support groups such as RESOLVE, exist to assist couples in dealing with infertility Components of Sexual History General physical, developmental, lifestyle factors Psychosocial factors Past sexual activity Current sexuality related to childbearing Adoption Surrogate mothers
Rhythm method
identify the fertile phase
Cervical mucus method
assessment of cervical mucus changes. At ovulation, mucus is clearer, and stretchy (spinnbarkeit) and more permeable to sperm. Luteal phase, mucus is thicker trapping sperm.
Douching after intercourse
not recommended. May push sperm higher.
Emergency contraception
Previn & Plan B
First Trimester Abortion
Vacuum aspiration, Methotrexate & Misoprostal (RU 486) prevents implantation
Second Trimester Abortion
Dilate & Evacuate Hypertonic and uterotonic agents- Saline solutions
Ovum (oocyte) survives ___ hours
12-24
Sperm survive up to ___ hrs in the female reproductive tract
72
Ovum contains __ autosomal chromosomes plus one ___ sex chromosome.
22; X
Sperm contains __ autosomal chromosomes plus one ____ chromosome.
22; X or Y
Amnion
fluid filled sac surrounding embryo
Chorion
develops from chorionic villi; inner layer adheres to amnion; outer layer adheres to decidua
Germ Layers
all tissues and organs develop from the ectoderm, endoderm, and mesoderm
____ carries oxygenated blood from placenta to fetus
vein
____ carries deoxygentated blood from the fetus to the placenta
arteries
______ surrounds the blood vessels in the placenta
wharton\'s jelly
EMBRYONIC PERIOD
Development is cephalo-caudal pattern. Tubular heart begins beating by end of 4th week. Organogenesis: Marks the period from 4th-8th weeks- major organ formation occurs; embryo most vulnerable to toxic substances. Most congenital malformations occur at this period
FETAL PERIOD
End of the 8th week to birth. Characterized by maturation of tissues, organs and rapid body growth.
Weeks 9-12
human appearing face, sex determination apparent
Weeks 13-16
lanugo develops, increased fetal activity, urine formed by kidneys
Weeks 17-20
Quickening occurs, vernix caseosa and brown fat form
Weeks 21-24
Alveoli develop
Weeks 25-28
Survival possible
Weeks 29-32
increased subcutaneous fat
Weeks 33-36
Surfactant maturity
Weeks 37-40
Full term at 38 weeks
Dizygotic (fraternal)
70%; originate from 2 separate zygotes
Monozygotic (identical)
30%; result from fertilization of one ovum which splits to form 2 separate zygotes

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