1	Biomedical Science 107 Human Anatomy Pregnancy, Development, Birth And Infertility
2	The Penis Parts of the penis glans penis = head of the penis penile shaft = body of the penis corona glandis = rounded ridge at back end of the glans penis penile prepuce (foreskin) = not present in circumcised men; small glands under the foreskin secrete oil which when mixed with skin cells produces smegma
3	The Penis Retraction of the foreskin to remove smegma with soap and water is important to prevent bacterial infection. Penile shaft contains three cylindrical spongy tissue masses, two of which are the corpus cavernosa on the top of the shaft and the third is the corpus spongiosum on the bottom of the shaft (through which the urethra runs).
4	The Penis Length of non-erect (flaccid) penis is usually between 8.5 to 10.5 cm (3.3 to 4.1 inches) with an average of 9.5 cm (3.7 inches) The average length of an erect penis is 16 cm (6.3 inches) with a range of 12 cm to 23.5 cm (4.7 to 9.2 inches). Average circumference of an erect penis at its thickest point is 13.2 cm (5.2 inches) There is no correlation between skeletal system make-up and penis size. A smaller non-erect penis will enlarge more during erection than a larger non-erect penis.
5	The Clitoris The clitoris lies at the junction of the upper of the two labia minora above the urethral opening. The average length is about 2.5 cm (1 inch) with an average diameter of ½ inch. There is much individual variation with regard to size and shape.
6	The Clitoris The clitoral shaft (similar to the penile shaft) contains a pair of corpora cavernosa spongy tissue cylinders. There is no corpus spongiosum in the clitoris. This tissue is the labia minora in females (same embryological origin as the corpus spongiosum in the penis). The clitoral glans (head or tip) is covered by the clitoral prepuce (similar to the foreskin of the penis).
7	The Clitoris The clitoris is rich in deep pressure and temperature receptors with only few touch receptors. Plays an important role in sexual arousal. During the plateau phase the deep pressure receptors are important for detecting stimulation of the retracted clitoris through the clitoral hood and mons.
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10	SPERM In the 1990s the average number of sperm present in 2.75 ml of ejaculate was about 182 million. This is about half the number of sperm present per the same volume of semen from men during the 1940s. A man makes about one billion sperm for each ovum made by a woman Many of these sperm are structurally or biochemically abnormal (two heads, no head, twotails, etc.) or dead and these are resorbed by the female reproductive tract
11	SPERM For a male to be fertile at least 40% of the sperm must swim and 60% must be of normal shape and size A sperm is about 40 to 250 microns long and consists of a head, midpiece and flagella. The head of the sperm contains a haploid cell nucleus surrounded by an inner and outer acrosomal membrane. The acrosome is filled with enzymes that are necessary for fertilization. The head is covered by the sperm cell membrane.
12	SPERM The midpiece of the sperm contains many mitochondria which produce much ATP necessary to drive the movement of the flagella. The flagella moves back and forth to propel the sperm forward. During their travel from the vagina to the oviduct (about 15 cm = 6 inches) many millions of sperm are lost so that only about 100 to 1000 sperm reach the ampullary-isthmus junction where fertilization usually occurs. Only 20 to 200 sperm will actually reach the egg itself.
13	Vaginal Sperm Vaginal sperm = sperm initially coagulate in the vagina as fibrin (same as in a blood clot) forms to hold the sperm in the vagina, after about 20 minutes the sperm liquifies due to the presence of a fibrinolytic enzyme that breaks down fibrin. The semen raises the vaginal pH from about 4.2 (acidic) to a more neutral 7.2 to increase sperm motility. Female orgasm may increase pressure in the vagina to facilitate movement of the sperm into the uterus, but orgasm is not necessary for sperm travel.
14	Cervical Sperm Cervical sperm = Shortly before ovulation the cervical mucus is copious, watery and hospitable to sperm. Sperm travel through the cervix at about 2 mm per minute. There are cervical crypts in which some sperm may become lost and die or they may survive forming a reservoir of sperm that could later enter the uterus.
15	Uterine Sperm Uterine sperm = sperm swim at about 3 mm/minute through the watery uterine fluid. Oxytocin from the female pituitary and prostaglandins in the semen increase contractions of the uterine myometrium facilitating sperm travel to the oviduct. As sperm enter the uterus many white blood cells enter the uterus to remove dead sperm cells.
16	Sperm in the Fallopian Tubes Sperm enter the oviduct (Fallopian tube) at a slower rate as the tube is more narrow. About one half the sperm will enter the oviduct that does not contain an egg and thus cannot cause fertilization.
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36	Average Fate of 100 Conceived Eggs in the United States
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62	Fetal Circulation (to & from placenta) Umbilical Arteries = carry blood from fetus to placenta Umbilical Veins = carry blood from the placenta to the fetus Ductus Venosus = bypass developing, non-functional fetal liver Foramen Ovale = “hole” that allows blood to flow from the right atrium to the left atrium Ductus Arteriosus = shunts blood away from non-functional fetal lungs to fetal aorta (bypases left ventricle)
63	Changes in Fetal Circulation at Birth Foramen Ovale closes so blood no longer flows from right to left atrium = separates pulmonary and systemic circuits Ductus Arteriosis closes = so blood no longer bypasses the lungs Umbilical arteries & veins become connective tissue ligaments = no blood flowing to or from the placenta
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66	Rates of Twins per 100 Births
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72	Ultrasound Pictures at: http://www.obgyn.net/us/gallery/gallery.htm#Gynecology_Normal
73	Usual Timing of Early Events in Embryonic Development with Conception as Day 1
74	Developmental Landmarks
75	Teratogenesis (Birth Defects) Teratogen = a chemical that causes birth defects (eg. Thalidomide, alcohol, recreational drugs, rubella, etc.) The first two weeks of development the embryo is much less susceptible to teratogens Major morphological (shape) abnormalities can develop in many different developing organ systems if the embryo is exposed to teratogens during weeks 3 -10 of gestation. Exposure to teratogens during weeks 11 – 38 generally cause more physiological defects & minor morphological abnormalities.
76	Changes in the Mother During Pregnancy 1. Increased caloric intake 2. Extra protein intake to help build the structures of the embryo 3. Extra calcium intake to help build fetal bones 4. Extra folic acid (folate) to prevent neural tube defects such as spina bifida (failure of the neural tube to close in spinal cord region) or anencephaly (failure of the neural tube to close in the brain region = baby is born with only the most primitive portions of the brain and is not self-aware or conscious)
77	Changes in the Mother During Pregnancy 5. B vitamins for increased metabolism 6. The average woman should gain about 25-35 pounds during her pregnancy: about 11 pounds of fat 3 pounds increase size of breasts and uterus 2 pounds for placenta a pound of increased maternal blood volume about a pound of amnionic fluid, and an average 7 pound fetus.
78	Changes in the Mother During Pregnancy 7. Exercise is generally healthy and not harmful depending on the physical condition of the mother at the start of the pregnancy; moderate exercise can increase birth weight
79	Changes in the Mother During Pregnancy 8. Sexual intercourse during pregnancy rarely presents a danger to the mother or fetus, but it should be avoided if there is excessive uterine bleeding as the embryonic membranes may be ruptured. Air should not be blown into the vagina during oral sex as it could introduce air into the mother’s bloodstream (possible embolism). A sex counselor or doctor may recommend certain sexual positions which may be more comfortable or safer during pregnancy.
80	Changes in the Mother During Pregnancy 1. For the mother, there is about a 25% increase in respiratory function and 25% increase in erythropoiesis (red blood cell formation) during pregnancy to support the metabolic needs of the developing fetus.
81	Changes in the Mother During Pregnancy 2. Maternal fetal recognition = the rescue of the corpus luteum by the production of hCG starting within 48 hours of implantation. hCG replaces LH to maintain progesterone secretion during the first trimester. After this time, progesterone is produced by the maternal-fetal-placental unit. Progesterone is required to maintain the endometrium in a nutrient rich secretory state and progesterone prevents contractions of the myometrium to keep the fetus in the womb.
82	Changes in the Mother During Pregnancy 3. The estrogen produced during pregnancy from the placenta is primarily estriol. 4. A variety of steroids are produced by the fetal-placental unit. 5. Additional hormones produced by the placenta include: hCG, Prolactin, hPL (human placental lactogen) which causes an increase the maternal and fetal blood sugar and has been implicated in gestational diabetes and plays a role in lactation (milk production).
83	Changes in the Mother During Pregnancy 6. The corpus luteum and the placenta secrete relaxin. Relaxin levels rise near the end of pregnancy to relax the pubic symphysis (the connective tissue between the pubic bones of the pelvis) to increase the size of the pelvic outlet. Relaxin also helps to relax the cervix leading to dilation of the cervix during early labor.
84	SOME POSSIBLE MATERNALCOMPLICATIONS DURING PREGNANCY Minor ailments such as nausea, vomiting, breast tenderness, water retention, gas, bloating, belching, flatulence, minor cramping, headaches, enlarged veins (varicose veins), sleep disturbances, skin color alterations, hair changes, edema (swelling) in limbs, bleeding gums, mood changes, etc.
85	SOME POSSIBLE MATERNALCOMPLICATIONS DURING PREGNANCY Toxemia = about 7% of all pregnancies in last couple of months of pregnancy; can be caused by a high fat diet Symptoms = excessive weight gain, edema (swelling), high blood pressure (hypertension). Early toxemia is called preeclampsia, later more severe toxemia is eclampsia. Eclampsia can lead to convulsions, coma and possible death; there is some evidence that exposure to “familiar” semen may reduce a woman’s chance of developing eclampsia
86	SOME POSSIBLE MATERNALCOMPLICATIONS DURING PREGNANCY Diabetes Mellitus = maternal onset or gestational diabetes; about 1 in 350 pregnancies like Type II diabetes in which the cells of the mother do not respond to insulin leading to an increased blood sugar level causing excessive urine production. More dangerous to fetus than mother (in 30% of cases the fetus does not survive).
87	SOME POSSIBLE MATERNALCOMPLICATIONS DURING PREGNANCY Ectopic Pregnancy = implantation occurs outside of the uterus; ~96% of these are tubal pregnancies and 4% are abdominal pregnancies; causes pain and severe hemorrhage requiring surgical removal of the embryo; causes about 10% of all maternal deaths in the U.S.; in the abdomen, the fetus may accumulate calcium deposits to form a lithopedion or “stone baby” that are often not discovered until a later abdominal surgery is performed. Ectopic pregnancies are more common in older, multiparous white women, women that have had an abortion, endometriosis or pelvic infection
88	SOME POSSIBLE MATERNALCOMPLICATIONS DURING PREGNANCY Hydatiform Mole = occur in about 1 in 1000 pregnancies; triploid male embryos formed of swollen chorionic villi with no true embryo; secrete high amounts of hCG (looks like the women is pregnant); can be malignant; removed surgically.
89	SOME POSSIBLE MATERNALCOMPLICATIONS DURING PREGNANCY Septic Pregnancy = bacterial infection of the uterus that can be dangerous to the mother and the fetus. The cervical mucous plug helps to prevent bacterial infection.
90	SOME POSSIBLE MATERNALCOMPLICATIONS DURING PREGNANCY Placenta Previa Placenta previa is an obstetric complication that occurs in the second and third trimesters of pregnancy. It may cause serious morbidity and mortality to both fetus and mother. It is one of the leading causes of vaginal bleeding in the second and third trimesters. Placenta previa generally is defined as the implantation of the placenta over or near the internal os (opening) of the cervix.
91	Placenta Previa Total placenta previa occurs when the internal cervical os is completely covered by the placenta. Partial placenta previa occurs when the internal os is partially covered by the placenta. Low-lying placenta previa occurs when the placenta is implanted in the lower uterine segment. In this variation, the edge of the placenta is near the internal os but does not reach it.
92	Placenta Previa Frequency: In the US: Placenta previa complicates approximately 5 of 1,000 deliveries and has a mortality rate of 0.03%. Mortality/Morbidity: The maternal mortality rate secondary to placenta previa is approximately 0.03%. The great majority of deaths are related to uterine bleeding and the complication of disseminated intravascular coagulopathy.
93	Placenta Previa Pathophysiology: The exact etiology (cause) of placenta previa is unknown. The condition may be multifactorial and is postulated to be related to multiparity, multiple gestations, advanced maternal age, previous cesarean delivery, previous abortion, and, possibly, smoking. Unlike first-trimester bleeding, second- and third-trimester bleeding is usually secondary to abnormal placental implantation.
94	"Race:" Race: Recent reviews suggest an increased risk of placenta previa among African Americans and Asians. Age: Women older than 30 years are 3 times more likely to have placenta previa than women younger than 20 years.
95	Placenta Previa History: Vaginal bleeding It is apt to occur suddenly during the third trimester. Bleeding usually is bright red and painless. Initial bleeding usually is not profuse enough to cause death; it spontaneously ceases, only to recur later. The first bleed occurs (on average) at 27-32 weeks' gestation. Contractions may or may not occur simultaneously with the bleeding.
96	Placenta Previa Physical Symptoms & Examination: Profuse hemorrhage Hypotension Tachycardia Soft and nontender uterus Normal fetal heart tones (usually) Vaginal and rectal examinations
97	Placenta Previa True placenta previa at term is very serious. Complications for the baby include: Problems for the baby, secondary to acute blood loss Intrauterine growth retardation due to poor placental perfusion Increased incidence of congenital anomalies
98	Placenta Previa Risks for the mother include: Life-threatening hemorrhage Cesarean delivery Increased risk of postpartum hemorrhage Increased risk placenta accreta (Placenta accreta is where the placenta attaches directly to the uterine muscle.)
99	Placenta Previa Placenta previa, once diagnosed, will usually mean bed rest for the mother, frequently in the hospital. Depending on the gestational age steroid shots may be given to help mature the baby's lungs. If the bleeding cannot be controlled immediate cesarean delivery is usually done, regardless of the length of the pregnancy. Some marginal previas can be delivered without cesarean surgery, the other types of placenta previa preclude vaginal delivery.
100	SOME POSSIBLE MATERNALCOMPLICATIONS DURING PREGNANCY Incompetent Cervix The cervix is the part of the uterus that connects the uterus to the vagina. It is about 2 inches long. It keeps the uterus closed. It is usually very firm. At the end of pregnancy, contractions and other changes cause the cervix to soften and dilate so the baby can be delivered. An incompetent cervix is a cervix that dilates without contractions, usually in mid-pregnancy (18-22 weeks).
101	Incompetent Cervix Incompetent cervix may cause miscarriage at 18-24 weeks. Treatment is with cervical cerclage or prolonged strict bedrest. A stitch is placed high up around the cervix to keep it closed. A non-emergency cerclage is usually placed at 13-15 weeks. An ultrasound is done prior to placement of the cerclage to make sure the fetus looks healthy. The stitch is usually placed from the vagina.
102	Incompetent Cervix Symptoms: Some women complain of pelvic heaviness, or lots of discharge. Often when they see their provider they are found to have a very dilated cervix with the bag of waters coming out. Causes: The cervix may be weakened from previous child birth, surgery, and late pregnancy termination. Many times a cause cannot be found.
103	Incompetent Cervix Abdominal cerclage requires a cesarean section to delivery the baby. The stitch is usually left in place for future pregnancies. Cerclage is usually removed around 37 weeks. Surprisingly, labor may not start for weeks.
104	SOME POSSIBLE MATERNALCOMPLICATIONS DURING PREGNANCY Placenta Abruptio A separation of the placenta (the organ that nourishes the fetus) from the site of uterine implantation before delivery of the fetus.
105	Placenta Abruptio Causes, incidence, and risk factors It is frequently difficult to determine the exact causes of placenta abruptio. Definable, direct causes that result in placenta abruptio are quite rare (1 to 5%). They include mechanical factors such as abdominal trauma (for example, from an auto accident or fall), sudden loss in uterine volume as occurs with rapid loss of amniotic fluid or the delivery of a first twin, or an abnormally short umbilical cord (usually only a problem at the time of delivery).
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119	Stages of Birth First Stage of Labor Cervical Dilation Second Stage of Labor Delivery of the Baby Third Stage of Labor Delivery of the Placenta (Afterbirth)
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131	Day of Delivery, Measured from Day of Conception
132	Length of Pregnancy Medical Doctor/Obstetrician = about 40 weeks From last menstrual period (which can be more than two weeks before fertilization) to birth Scientists/Researchers = about 38 weeks From the time of fertilization (conception) to birth This is the actual time the embryo/fetus is developing before birth Lay Person/General Public = about 34-36 weeks From time of positive pregnancy test (often 10 days to two weeks after the last missed menstrual period) to birth
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134	Braxton-Hicks Contractions Toward the middle of pregnancy (or earlier), muscles of uterus tighten for anywhere from 30 to 60 seconds. Not all women feel these random, usually painless contractions, which get their quirky name from John Braxton Hicks, an English doctor who first described them in 1872.
135	Braxton-Hicks Contractions How can I tell the difference between Braxton Hicks and true labor contractions? Most women pregnant for the first time will ask their practitioner or friends this question often, and the answer is maddeningly vague: "You'll know real labor when it begins." Truth is, they're right. Labor contractions are noticeably longer as well as more regular, frequent, and painful than Braxton Hicks. Also, labor pains will increase in frequency, duration, and intensity as time goes on, while Braxton Hicks remain unpredictable and nonrhythmic.
136	Braxton-Hicks Contractions What if the Braxton Hicks contractions become painful? As your pregnancy progresses, these contractions may become more intense and even painful at times; when they start to become more intense and frequent, they're referred to as false labor. False labor may feel like the real thing, but the contractions will still be irregular in intensity, frequency, and duration and can taper off and then disappear altogether. In other words, if you ever notice that your contractions are easing up in any way, they are most likely Braxton Hicks.
137	Birth Presentations Basically, how the fetus “faces” the cervix/pelvis Breech Birth = one arm, both legs = both knees folded, one knee folded with one foot emerging first, kneeling, or butt first Transverse Presentation = backside first About 3 – 4 % of baby’s are breech May require turning the fetus, forceps, vacuum suction, or cesarean section.
138	Labor -- Stage 1 (effacement) Purpose: to soften and thin out cervix Intensity: variable; usually light and relatively easy to control Contraction Length: from 30 to 60 seconds Contraction Interval: from 5 to 20 minutes Duration: varies greatly with each individual
139	Labor -- Stage 1 (early dilation) Purpose: to open the cervix from 0 to approximately 7 centimeters Intensity: stronger and harder to manage, but controllable Contraction Length: about 60 seconds Contraction Interval: from 1 to 3 minutes Duration: first baby about 5 to 9 hours; other children about 2 to 5 hours
140	Labor – Stage 1 (transition) Purpose: continuing to open the cervix (from 7 to 10 centimeters), and pushing the baby down the birth canal Intensity: extremely strong and erratic; more difficult to manage Contraction Length: from 60 to 90 seconds Contraction Interval: from 1 minute; may be erratic Duration: very short
141	Labor – Stage 2 (expulsion of fetus) Purpose: to expel the baby from the uterus Intensity: less strong than during transition stage; somewhat controllable Contraction Length: about 60 seconds (varies) Contraction Interval: varies from 1 to 3 minutes Duration: Varies greatly; longer with first baby; perhaps 30 minutes to 2 hours
142	Labor – Stage 3 (expulsion of placenta = afterbirth) Purpose: to expel the placenta from the uterus Intensity & Duration: Variable Total Duration: about 20 minutes up to an hour
143	Clinical Aspects of Birth Forceps (only used in some situations) Sometimes used to help deliver the fetus; some marks may appear on the babies head, but these usually soon disappear after birth
144	Clinical Aspects of Birth -- Mom Episiotomy = incision to increase size of vagina to prevent tearing May shave and use antiseptics around vaginal area
145	Clinical Aspects of Birth -- Mom Tranquilizers (eg. Valium) Effects on mom = physical relaxation and reduced anxiety; takes the edge off pain but does not eliminate it entirely Effects on baby = minimal
146	Clinical Aspects of Birth -- Mom Barbituates (eg. Sodium Pentothal) Effects on mom = drowsiness and reduced anxiety; may slow progress of labor Effects on baby = can depress nervous system and breathing
147	Clinical Aspects of Birth -- Mom Narcotics (eg. Morphine) Effects on mom = reduce pain and elevate mood, but may inhibit contractions and cause nausea or vomiting Effects on baby = can depress nervous system and breathing
148	Clinical Aspects of Birth -- Mom Amnesics Effects on mom = do not reduce pain but cause the woman to forget her experience after it is over; may cause physical excitation and wildness Effects on baby = minimal, but possible danger of overdose when self-administered with adverse effects on the newborn
149	Clinical Aspects of Birth -- Mom Anesthetics = come in various forms to block pain (similar to novocaine) Paracervical = injection into cervix Effects on mom = block pain the uterus and cervix; short-lasting; ineffective lat ein labor; can lower mother’s blood pressure Effects on baby = causes slowing of fetal heartrate in about 20% of cases
150	Clinical Aspects of Birth -- Mom Anesthetics Pudendal = injections around vagina Effects on mom = blocks pain from perineum and vulva in about 50% of cases Effects on baby = minimal
151	Clinical Aspects of Birth -- Mom Anesthetics Regional = spinal, saddle block, epidural Injection of anesthetic into the fluid surrounding the spinal cord Effects on mom = blocks pain from uterus, cervix, and perineum; spinal and saddle block also block movement below point where administered; highly effective but can cause a serious drop in blood pressure or seizures in rare cases; can be used for cesarean deliveries Effects on baby = generally no effect (does not pass across placenta), but can require forceps for delivery more often than other methods
152	Clinical Aspects of Birth -- Mom Anesthetics General = woman unconscious Effects on mom = usually used only in the last few minutes of labor to eliminitate pain completely, but amy cause vomiting or other complications and is a leading cause of maternal death during delivery; can be used for cesearan delivery; rarely performed Effects on baby = can depress nervous system and breathing
153	Clinical Aspects of Birth - Baby Baby will automatically cry, not necessary to “spank” baby at birth to start breathing Clamp the umbilical cord about 2-3 inches from babies abdomen, another clamp beyond that toward mother and cut with scissor in between; there are no nerves in the umbilical cord = no pain for either mom or baby
154	Clinical Aspects of Birth - Baby Erythromycin, penicillin or silver nitrate drops are put into eyes to prevent gonorrhea infection (sometimes by state law)
155	Clinical Aspects of Birth - Baby About 10% of babies are premature Much more common in twins & multiples Premature baby = less than 5.5 lbs (2.49 kg) and greater than 2 lbs 3 ozs (0.99kg) Babies that are below this weight (0.99 kg) are usually stillborn Causes: unknown, adrenal hormones, uterine distention, maternal stress or maternal disorder/disease
156	Clinical Aspects of Birth - Baby Week of Birth for Premature Babies by % 38 weeks = 99 % 25 weeks = 59% 23 weeks = 18 % Before 22 weeks < 1%
157	Cesarean Delivery Removal of baby from incision through abdomen and uterus Rate of Cesarean in the U.S. = In 2000, of all births in the United States, 23% were cesarean, approximately 37% of which were repeat cesarean births (i.e., births to women who had a previous cesarean birth). Rate of Cesarean in Europe = The cesarean delivery rate for the past 20 years in the United States is consistently 50-75% higher than the rate in Europe. Although it is currently increasing in Europe.
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159	Infertility The remaining slides discuss the causes and treatments of male and female infertility
160	Female Infertility FEMALE INFERTILITY CAN BE CAUSED BY: 1. Failure to ovulate 2. Tubal blockage 3. Implantation does not occur 4. Reduced sperm transport 5. Antibodies made against partner’s sperm
161	Female Infertility 1. Failure to Ovulate (leading cause of female infertility) Can be caused by stress, low body fat (Athletic Menstrual Cycle Irregularity), depression or lack of hypothalamic (GnRH) hormone secretion or hyperprolactinemia
162	Treatment for Ovulation Failure clomiphene = anti-estrogen drug that blocks the negative feedback effects of estrogen on LH and FSH = more likely LH surge = more likely to ovulate;can increase the possibility of twins (about 5% versus the normal 1%) hMG = Pergonal, followed by hCG = mimics effects of LH surge bromocriptine = inhibits prolactin to block effects of hyperprolactinemia; allows LH surge to occur
163	Female Infertility 2. Tubal Blockage Blockage of oviducts (about 30-35% of infertile women); can be caused by kink in tube, scarring, ectopic pregnancy, endometriosis, or pelvic inflammatory disease (PID)/STI Treatment Introduce carbon dioxide gas or air to inflate and expand the tubes = transcervical balloon tuboplasty; sometimes fixed with surgery
164	Female Infertility 3. Implantation does not occur Can be due to inadequate priming of the uterus by estrogen and progesterone; fibroids, scars due to PID or abortion by dilation and curretage (D & C) Treatment Give supplemental estrogen and progesterone to thicken endometrium
165	Female Infertility 4. Reduced Sperm Transport or Antibodies Made Against Partner’s sperm Highly acidic vagina, hostile cervical mucous, cervical damage due to an abortion or as a result of STI infection Multiple exposure to the same semen sometimes causes the woman to make antibodies against her partner’s sperm which cause the immune system to destroy the sperm (like a sperm vaccination)
166	Treatment for Reduced Sperm Transport/Antibodies Surgery to correct cervical problems; when antibodies against the partner’s sperm are made donor artificial insemination is often the only effective treatment
167	Male Infertility 1. Oligospermia (Hypospermatogenesis)= low sperm count due to low spermatogenesis 2. Azoospermia = absence of sperm in the semen Azoospermia could be caused by a blockage in the male duct system = obstructive azoospermia or it could be caused by a significant lack of spermatogenesis in the seminiferous tubules
168	Male Infertility 3. Lacking sufficient numbers of gonadotropin receptors = no pituitary hormone stimulation 4. Structural damage to the testes due to mumps (fever), radiation, old age, or the presence of a varicocele. A varicocele is a varicose (twisted) vein in the testes that could lead to an increase in testes temperature and a decrease in spermatogenesis.
169	Male Infertility 5. In about 10% of infertile men, they make antibodies against their own spermas the sperm somehow escaped the reproductive tract 6. About 1 in 1000 men are lacking a portion of the Y chromosome necessary for normal spermatogenesis 7. Malfunction in the duct system caused by scarring or an STI
170	Male Infertility 8. Malfunction of one of the accessory glands (seminal vesicles, prostate) 9. Environmental causes such as smoking (decreases sperm motility, causes more abnormal sperm to form, & lower blood testosterone levels); marijuana; environmental pollutants or endocrine disrupters
171	Male Infertility - Treatments Supplemental hormone administration (GnRH, Pergonal, clomiphene or sometimes adrenal hormones); Surgery for some cases of varicocele or obstructive azoospermia
172	Male Infertility - Treatments Measuring the FSH level in a male can help determine if the cause is obstructive (blocked duct = no effect on spermatogenesis) or decrease in spermatogenesis (fewer sperm = lower inhibing level) Blockage in ducts = normal sperm production = normal inhibin = normal blood FSH level Decrease spermatogenesis = decrease sperm production = decrease inhibin = abnormally high blood FSH level