reproductive pathophysiology 2: pregnancy and female infertility
DESCRIPTION
Reproductive Pathophysiology 2: Pregnancy and Female Infertility. Nancy Long Sieber, Ph.D. E-162b Human Pathophysiology October 22, 2012. http://www.well-net.com/womenshealth/contraception/bbt-1.gif. Fertility. Widmaier, E.P. Raff, H. and K.T. Strang. Vander, Sherman and Luciano’s - PowerPoint PPT PresentationTRANSCRIPT
Reproductive Pathophysiology 2:Pregnancy and Female Infertility
Nancy Long Sieber, Ph.D.E-162b Human Pathophysiology
October 22, 2012
http://www.well-net.com/womenshealth/contraception/bbt-1.gif
Fertility
Widmaier, E.P. Raff, H. and K.T. Strang. Vander, Sherman and Luciano’s Human Physiology 9/e. McGraw-Hill. 2004
http://biology.unm.edu/ccouncil/Biology_124/Images/fertilization.jpeg
http://www.sgul.ac.uk/depts/immunology/~dash/troph/blastocyst.jpg
Ectopic Pregnancy
Lithopedion (Stone child)Calcified remains of an extrauterine pregnancy
Credit: Dr Ahmed Harounhttp://www.radpod.org/2007/09/17/lithopedion/
A Molar Pregnancy
Hydatidiform mole.
http://www.waybuilder.net/sweethaven/MedTech/FraPkr02.asp?iCode=010305_010306
Figure 1 Karyotype derivation of complete and partial hydatidiform moles and rare biparental repetitive complete hydatidiform mole CHM=complete hydatidiform mole. PHM=partial hydatidiform mole. biCHM=rare biparental complete hydatidiform mole. P...
Michael J Seckl , Neil J Sebire , Ross S BerkowitzGestational trophoblastic disease
The Lancet Volume 376, Issue 9742 2010 717 - 729 http://dx.doi.org/10.1016/S0140-6736(10)60280-2
Genetics of Molar Pregnancies
http://www.hopkinsmedicine.org/craniofacial/LynmProject/BSC/BSC2.HTM#FIGURE1
Development of tissue layers in the embryo
Neural Tube Defects
http://www.cfsan.fda.gov/~dms/sbifidap.gif
Fig. 20.48
OK
Cephalic vs. Breech Presentation
http://www.breechbaby.info/images/fgwh2606.GIF
Breech Presentation
http://www.moondragon.org/obgyn/pregnancy/breech.html
C-Sections
• Optimal rate: 10 – 15%• Rate in US: 25.2%• Both are safe in a normal pregnancy• Overall safety difficult to compare (since C-
sections are most often done when there are complications
Some Lingering Consequences of C-sections
• More post-delivery pain than a vaginal birth• Delayed nursing and bonding• Risk of respiratory problems, even if baby is
not premature• Increased risk of adverse outcomes in
subsequent pregnancies: placental problems, uterine rupture.
Lupus and Pregnancy
• Disease flares and drugs may suppress fertility.
• Problems with excessive blood clotting increase risk of miscarriage and premature birth.
• It’s unclear whether pregnancy makes lupus worse or better.
Spinal Cord Injury and Sexuality and Pregnancy
• Most women with spinal cord injury continue to be sexually active.
• Women with spinal cord injuries can have healthy babies, and about half deliver vaginally.
• Concerns during pregnancy include: autonomic dysreflexia, urinary tract infections, premature labor, abnormal presentation (i.e. breech), failure of labor to progress, and effects of drugs on the fetus
Common causes of Infertility in Women
• Tubal Obstruction • Ovulatory disorders• Polycystic Ovary Disease• Endometriosis
Obstruction of the Fallopian Tube
Normal Obstructed
http://www.healthsquare.com/fgwh/wh1c0603.jpg
Polycystic Ovary
http://medicineworld.org/images/blogs/2-2007/polycystic-ovary-281680.jpg
Polycystic Ovary Disease• Characterized by irregular menstrual periods, and failure to
ovulate.
• Appears to be due high constant levels of LH
• No LH surge, which is needed for ovulation, so the ova and follicles remain in the ovary.
• High LH stimulates high levels of testosterone, leading to hirsutism.
• Also characterized by obesity and insulin resistance
Endometriosis
http://www.whathealth.com/endometriosis/images/endometriosis.jpg
Endometriosis• Characterized by appearance of endometrial tissue outside
the uterus.
• The misplaced endometrial tissue responds to reproductive hormones the same way the uterine lining does, and therefore there is thickening of tissues during the follicular phase, and bleeding during menstruation.
• Women with endometriosis have fertility rates that are about 1/2 those without the disease. However, the mechanism by which this disorder causes infertility is unclear.
http://www.aquinohotline.com/images/seps029.jpg
Source: Management of the Infertile Woman by Helen A. Carcio and The Fertility Sourcebook by M. Sara Rosenthal
http://www.advancedfertility.com/age.htm
Number of ART cycles reported in 2007 142,435*
Number of live-birth deliveries resulting from ART cycles started in 2007
43,412
Number of infants born as a result of ART cycles carried out in 2007
57,569
http://www.cdc.gov/ART/ART2007/section1.htm
Use of Assisted Reproductive Technology