MFAC1521 Lecture Notes - Lecture 54: Ectopic Pregnancy, Laparoscopy, Trophoblast
29 Jun 2018
School
Department
Course
Professor
An infertile couple
By Gavin Sacks
Anovulation
Group 1: Hypothalamic-
pituitary failure
Group 2: Hypothalamic-
pituitary-ovarian dysfunction
(Polycystic ovarian
syndrome; PCOS)
Group III: Ovarian failure
Hormones
Hypogonadotropic;
Low FSH, LH, E2
(oestradiol)
Normogonadotropic;
High FSH, LH, E2
Hypergonadotropic;
High FSH, LH,
Low E2
Indicators
Weight loss
Stress
High levels of exercise
Anorexia
Drug-induced
Amenorrhea (misses at
least 3 periods in a row)
Weight gain
Acne
Obesity
Hirsutism
Amenorrhea
Oligomenorrhea (>35 days
without menses)
Irregular/absent periods
Short menstrual cycles
Hot flushes
Idiopathic factors
(unknown cause):
premature menopause
Genetic factors: Fragile X,
Turner’s syndrome
Iatrogenic factors
(medical): Surgery,
radiotherapy,
chemotherapy
Chances of
women
conceiving
Nearly all
Most
Remote chance without
donor eggs
Risks
Osteoporosis (E2 * for
bone density)
-
Infertility
Management
Gain weight
Reduce exercise
Change medications
FSH injections (to
stimulate follicle
development)
Lose weight
FSH injections
PCOS medications (anti-E2;
low E2 is detected by the
hypothalamus, stimulates
more FSH and LH)
Ovarian drilling (burning holes
into ovaries stimulates
periods)
Hormonal replacement
therapy
Egg donors
Treatments for
infertility
-
-
Ovarian
induction
FSH
injections
-
Intrauterine
insemination
Injecting
sperm
directly into
the uterus to
increase
chance of
pregnancy
Success rate
per cycle: 15-
20%
In vitro
fertilisation
(IVF)
IVF safety:
No fetal
abnormalities
No
premature
menopause
No long-term
cancer risk
Figure 1. IVF process
Figure 2. Embryoscope technology (embryos are photographed every 20
minutes to see cleavage after fertilisation); used to select the best embryos
for transfer
Document Summary
Group iii: ovarian failure pituitary failure pituitary-ovarian dysfunction (polycystic ovarian syndrome; pcos) Oligomenorrhea (>35 days premature menopause least 3 periods in a row) without menses) Fsh injections (to stimulate follicle development) low e2 is detected by the hypothalamus, stimulates more fsh and lh) Ovarian drilling (burning holes into ovaries stimulates periods) Injecting insemination sperm directly into the uterus to increase chance of pregnancy. Embryoscope technology (embryos are photographed every 20 minutes to see cleavage after fertilisation); used to select the best embryos for transfer. Embryo biopsy: multipotent cells (can give rise to >1 cell type) from trophoblast layer is collected for pre-implantation genetic diagnosis (pgd) to screen for chromosomal abnormalities/aneuploidy. Injecting sperm injection sperm (icsi) directly into an egg. Present in 20-25% of infertility: causes: pid, endometriosis, surgery, history of ectopic pregnancy. Ultrasound scan contrast sonography of the pelvis; (hycosy) blue dye injected to look for blocked tubes, uterine abnormalities.
