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