Fertile or not
33 important questions on Fertile or not
When is the conception risk highest?
What happens to the hormones when a woman is in menopause?
What is the surgical menopause called?
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When is a woman in temporary pharmacological menopause?
What are factors contributing to a faster age of onset for menopause?
- Genetics
- Employment status
- Divorcement status
- Smoking
What is the influence of smoking on the menstrual cycle and menopause?
What diseases is menopause associated with?
- Diabetes
- Osteoporesis
- Cardio vascular diseases
What is the optimal fertility window? And what is interesting about this?
What is the rhythm method?
What are types of contraception?
- Barrier contraceptive
- Intrauterine devices
- Pill use
- Beastfeeding
What is the advantage of a barrier contraceptive?
Barrier contraceptive has the advantage that it limits transmission of STDs.
What is the working of intrauterine devices?
Intrauterine devices (IUDs) do NOT prevent implantation, but rather sperm migration, ovum transport & fertilization – mechanism unclear.
Why is breast feeding a form of contraception?
Breast feeding uses no formula at all. It prevents ovulation. The GnRH pulse disrupted so there is not enough LH to ovulate.
What is the difference between the early pill and the present pill?
Early pill consisted of only estrogen release. It thereby had a
- Stimulation of uterine proliferation
- Inhibitory effect on proliferation of “the other follicles”
Present pill has progesterone-like agents added (or very little ‘estrogen’). Progesteron:
- Inhibits GnRH release, and hence stop of the normal hormonal production
- Inhibits follicle proliferation
What is typical for the male pill?
What is the influence of high [Ca2+] on spermatozoa?
What is the influence of low [Ca2+] on the penis?
How is male sterilization performed?
What are the two types of female sterilization? What happens during these procedures?
- Tubal ligation: uterine tubes are cut
- Ductal plugs: A plug-like device is inserted in the fallopian ducts by hysteroscopic techniques
What are three types of abortion?
- Spontaneous (miscarriage) without intentional intervention.
- Therapeutic abortions to maintain health of the mother
- Abortion as a means of birth control (legal until 24th week)
What are the three types of amenorrhea?
- Primary amenorrhea: failure of spontaneous menses to occur before 18 years of age (no menarch)
- Secondary amenorrhea: absence of menstruation for 6 months in a previously menstruating woman (for example: pregnant woman)
- Oligomenorrhea: cycles longer than 3 months
What is the role of stress in reproduction?
Most stress inhibits reproductive function
- Drought and Famine: (low body fat in women, malnutrition)
- Overcrowding
- Social stress (subordinates in Social Hierarchies)
- Over-training (sports)
What can cause that the ovary is not stimulated, resulting in primary amenorrhea?
- Hypogonadotropic amenorrhea
- Constitutional growth delay, weight loss (Anorexia), thyroid disorder
- Pituitary deficiency, cerebral tumour, congenital CNS defect
What can cause that the ovary cannot respond, resulting in primary amenorrhea?
- Hypergonadotropic amenorrhea
- Chromosomal insufficiency (45,X = Turner) (this can occur in mosaic, which does not always make it obvious)
- Ovarian failure
What can cause that the uterus does not respond to hormonal stimulation, resulting in primary amenorrhea?
- There is no uterus
•There is a uterus (normal chromosomes & secondary sexual characteristics), but:
•Genital tract obstruction
•Outflow obstruction e.g. imperforate hymen referred to as cryptomenorrhea
What can late discovery of cryptomenorrhea lead to?
How can primary amenorrhea be investigated?
- Physical examination
- Hormonal assessment: if normal, is there a uterus?
How is primary amenorrhea treated?
- Normalise body mass index
- Ovarian Failure – hormone replacement with cyclical estrogen and progestagens
- Pituitary-hypothamic cause – may need hormone replacement until fertility sought
- Outflow tract obstruction – surgery
What are the two types of secondary amenorrhea or oligomenorrhea?
- Physiological - pregnancy, lactation menopause
- Pathological – anovulation (no release of oocyte), Aschermann’s syndrome
What are the main causes of secondary amenorrhea?
- Pregnancy, Lactation, menopause
- Premature ovarian failure (<40)
- Hyperprolactinaemia, drug-induced or prolactinoma (production & spontaneous flow of breast milk due to disinhibition (dopamine) or excessive production from tumor)
- Tranquilizers, antipsychotics
- Weight/ exercise related amenorrhea (too much, too little)
- Polycystic ovarian syndrome
What is polycystic ovarian syndrome (PCOS)?
A syndrome with multiple small follicles on the ovarian epithelium.
What are investigations for secondary amenorrhea or oligomenorrhea?
- Pregnancy Test, FSH, LH, Prolactin, Thyroid Function Tests, Body Mass Index.
- Transvaginal scan in suspected PCOS cases
- Transvaginal scan or hysteroscopy in suspected Aschermann’s Syndrome (trauma to basal layer endometrium)
How is secondary amenorrhea or oligomenorrhea treated?
- Correct abnormalities of Body Mass Index
- If premature menopause – Hormone Replacement Thearpy (donor eggs if fertility sought)
- PCOS –correct weight, combined pill or cyclical progestagens, induction of ovulation
- Hyperprolactinaemia –Dopamine agonists
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