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Reproductive Pathophysiology 2: Pregnancy and

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Reproductive Pathophysiology 2: Pregnancy and Female Infertility Nancy Long Sieber, Ph.D. E-162b Human Pathophysiology October 22, 2012 Polycystic Ovary Disease ... – PowerPoint PPT presentation

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Title: Reproductive Pathophysiology 2: Pregnancy and


1
Reproductive Pathophysiology 2 Pregnancy and
Female Infertility
Nancy Long Sieber, Ph.D. E-162b Human
Pathophysiology October 22, 2012
2
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3
http//www.well-net.com/womenshealth/contraception
/bbt-1.gif
Fertility
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Widmaier, E.P. Raff, H. and K.T. Strang. Vander,
Sherman and Lucianos Human Physiology 9/e.
McGraw-Hill. 2004
8
http//biology.unm.edu/ccouncil/Biology_124/Images
/fertilization.jpeg
9
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10
http//www.sgul.ac.uk/depts/immunology/dash/troph
/blastocyst.jpg
11
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12
Ectopic Pregnancy
13
Lithopedion (Stone child) Calcified remains of an
extrauterine pregnancy
Credit Dr Ahmed Haroun
http//www.radpod.org/2007/09/17/lithopedion/
14
A Molar Pregnancy
                                                
                      Hydatidiform mole.
http//www.waybuilder.net/sweethaven/MedTech/FraPk
r02.asp?iCode010305_010306
15
Genetics of Molar Pregnancies
Figure 1 Karyotype derivation of complete and
partial hydatidiform moles and rare biparental
repetitive complete hydatidiform mole
CHMcomplete hydatidiform mole. PHMpartial
hydatidiform mole. biCHMrare biparental complete
hydatidiform mole. P...
Gestational trophoblastic disease
Michael J Seckl , Neil J Sebire , Ross S
Berkowitz
The Lancet Volume 376, Issue 9742 2010 717 - 729
http//dx.doi.org/10.1016/S0140-6736(10)60280-2
16
Development of tissue layers in the embryo

http//www.hopkinsmedicine.org/craniofacial/LynmPr
oject/BSC/BSC2.HTMFIGURE1
17
Neural Tube Defects
http//www.cfsan.fda.gov/dms/sbifidap.gif
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20
Fig. 20.48
21
OK
22
Cephalic vs. Breech Presentation
http//www.breechbaby.info/images/fgwh2606.GIF
23
Breech Presentation
http//www.moondragon.org/obgyn/pregnancy/breech.h
tml
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26
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

27
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.

28
Lupus and Pregnancy
  • Disease flares and drugs may suppress fertility.
  • Problems with excessive blood clotting increase
    risk of miscarriage and premature birth.
  • Its unclear whether pregnancy makes lupus worse
    or better.

29
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

30
Common causes of Infertility in Women
  • Tubal Obstruction
  • Ovulatory disorders
  • Polycystic Ovary Disease
  • Endometriosis

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Obstruction of the Fallopian Tube
Normal Obstructed
http//www.healthsquare.com/fgwh/wh1c0603.jpg
33
Polycystic Ovary
http//medicineworld.org/images/blogs/2-2007/polyc
ystic-ovary-281680.jpg
34
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

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Endometriosis
http//www.whathealth.com/endometriosis/images/end
ometriosis.jpg
37
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.

38
                                  

http//www.aquinohotline.com/images/seps029.jpg
39
                                                
                                                  
                Source Management of the
Infertile Woman by Helen A. Carcio and The
Fertility Sourcebook by M. Sara Rosenthal
40
http//www.advancedfertility.com/age.htm
41
Use of Assisted Reproductive Technology
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
42
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