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infertility
- inability to concieve within 12 months or regular coitus or 6 months if over 35 yrs.
- 40% female
- 40% male
- 20% unknown
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male infertility factors
- little amt of sperm
- decreased motility of sperm
- obstructed spermatic ducts/vas deferens
- scrotal varicolceles
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evaluating the cervix
- role of cervix is to provide nonhostile place for sperm to harbor
- secretes mucous and crypts to hold sperm
- US evaluates cervical legnth/incompetence
- hysperosalpingography- eval in/ex os
- <1mm may be cervical stenosis
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evaluating the uterus
- 1. structual anatomy
- shape/ecogenicity, fibroids?
- 2. acsess endometrium
- thickness, echogenicity, lesions
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Congenital uterine anomalies
- 1% women effected
- result of defecs in mullerian duct dev.
- septate uterus-infertility (implantation)
- t-shaped- DES cervical incompetencebicornuate- 2 uterine, 1 cervix (not infertile)
- didelphys- 2 uterine, 2 cervix (not infertile)
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evaluating the endometrium
- measured through menstral cycle for changes
- saline infused sonography (SIS)-submucosal fibroids, polups, adhesions, synechiae (scars) minimum 6mm endomet needed for preg.
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evaluating the fallopian tubes
- acess if blocked- fill with saline to cul-de-sac
- hysrosalpinx 50% reduction in preg rate
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hydrosalpingography
flouroscopic imaging of injecting contrast into uterine cavity
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evaluating the ovaries
- dominant follicle ruptures at 24-35 mm
- 4-8 follicles on ovary per cycle
- harvested at 20-22mm
- LH rises just before ovulation
- PCOS- inhibit release of lh and fsh no mature ova
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peritoneal factors
- adhesions (scar tissue at fallopian tube ends) and endometriosis (ectopic endo tissue)
- lapraoscopy- best way to evaluate both
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Ovarian Induction Therapy
- treatment by controlled ovarian stimulation
- administer Clomid (human menopausal gonadotropins) which enlarge multiple follicles.counted/measured/monitor in days 8-14. hcg given to sub for lh to trigger ovulation
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Monitoring the endometrium
- normal 2-14mm
- tv in a sagittal plane
- hyper to hyper
- at least 6mm for fertility
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In vitro fertilization (IVF)
- fertilize the oocyte outside the body and put back into uterus (embryo transfer)
- optimal placement w/in 2 cm apex of fundus
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intrauterine insemination
- used to treat male factor infertility
- catheter with sperm placed into fundus
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ZIFT
Zygote intrafallopian transfer
transfer of fertilized egg outside the body into fallopian tube laproscopically
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GIFT
gamete intrafallopian tube transfer
eggs and sperms are put into fallopian tube by laproscope, unfertilized
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Complications with assisted reproductive technology (ART)
ovarian hyperstimulation syndrome (OHSS)
- multiple gestations 30%
- 3 or more they reduce with potassium chloride to heart
- ectopic pregnancy/heterotropic preg
- ectopic and iup at same time (1:100)
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Ovarian hyperstimulation syndrome (OHSS)
enlarged ovaries 5-10 cm, multiple cysts, abd ascites, pleural effusion
ovulation induction- given fsh or gnrh then hcg
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