SEARCH RESULTS FOR: ectopic pregnancy

Pathogenesis-of-Female-Infertility

Pathogenesis of Female Infertility
Author: Simonne Horwitz Reviewers: Claire Lothian, Hannah Yaphe, Yan Yu*, Nicole Paterson* * MD at time of publication
     Extreme stress, eating disorder, excessive exercise, intracranial tumor, or hyperprolactinemia*
↓ Gonadotropin releasing hormone (GnRN) from hypothalamus
↓ release of Luteinizing hormone (LH) & Follicle stimulating hormone (FSH) by pituitary
↓ release of estrogen by ovaries
Anovulation (oocyte is not released)
Fewer follicles available to ovulate
      * Causes of Hyperprolactinemia include: prolactinoma (prolactin-producing tumor), hypothalamic infiltrate or mass, chest wall irritation, hypothyroidism, renal or liver disease (↓ prolactin clearance), dopamine antagonists that ↑ prolactin secretion (antipsychotics, anti- depressants, anti-emetics)
Polycystic ovary syndrome (see PCOS: Pathogenesis and Clinical findings)
↑ androgen production & ↑ estrogen earlier in the menstrual cycle
↓ FSHà↓ follicle growth
↑ rate of follicle depletion
Oocyte not available every month for fertilization
            Premature ovarian insufficiency due to unexplained causes, chemotherapy, radiation, autoimmune ovarian destruction, Turner’s & Fragile X Syndromes
    Damage in germ cells that accumulates over a woman’s lifetime
Age-related changes in quality of granulosa cells surrounding oocyte
Genetic damage accumulates, such as ↑ rates of meiotic nondisjunction (failure of chromosomes to separate during gamete cell division)
Tubal occlusion or ↓ transport of oocyte tubal cilia dysfunction through fallopian tube
↓ quality of oocytes
Normal transport of oocyte & sperm through fallopian tube is impaired
↓ facilitation of sperm transportation
Inhibits normal zygote implantation
        Chlamydial or gonorrhoeal pathogens
Previous tubal surgery or ectopic pregnancy surgery       tissue removal ↓ transport of oocyte through fallopian tube
Female Infertility
     Previous abdominal infection or surgery Endometriosis
Congenital malformations or trauma / surgery to cervix
Uterine leiomyomata (benign smooth muscle monoclonal tumor) or polyp
Intrauterine procedures
Pelvic adhesions (scar-like tissue that tether together abdominal organs) may distort the shape and normal anatomy of the fallopian tube
Ectopic endometrial cells implant & Local inflammatory response grow along pathway of egg/sperm further ↓ egg/sperm mobility
Inability of cervix to produce normal mucus, and/or sperm physically unable to enter the cervix
Submucosal or intracavitary component disrupts uterine lining
                    Trauma to basalis layer of endometrium
Intrauterine scarring or synechiae (adhesions)
↓ vascularization & endometrial regrowth
     Legend:
 Pathophysiology
 Mechanism
Sign/Symptom/Lab Finding
  Complications
Published October 25, 2020 on www.thecalgaryguide.com

Ectopic Pregnancy

Ectopic Pregnancy: Pathogenesis and Clinical Findings
In vitro fertilization
Tubal disorders leading to infertility and unknown procedural causes
      Previous ectopic pregnancy
Underlying tubal disorder leading to previous ectopic
Pelvic inflammatory disease (PID)
Endometriosis
Tubal surgery or disorders
Age >35
Risk factor accumulation over time
Smoking
Impairment in tubal motility; impaired immunity (risk factor for PID)
        Tubal scarring leading to adhesions, obstruction, and alteration of tubal function
   Ectopic Pregnancy:
Implantation of developing blastocyst outside the uterine cavity, most commonly in fallopian tube (other locations: interstitial > cornual > cervical > ovarian > abdominal)
Embryo releases human chorionic gonadotropin (β-hCG), which supports corpus luteum to continue producing progesterone
On transvaginal ultrasound: Extrauterine gestational sac with a yolk sac or embryo
Embryo & trophoblast deathàloss of hormone support for the decidua (modified endometrial lining)
Progesterone maintains the endometrial lining, preventing it from shedding
Missed period
       Penetration of ovum into muscular wall of fallopian tube
Tubal distention àTubal rupture
Intra-abdominal hemorrhage
Pregnancy cannot survive without the uterine endometrium
Maternal blood extrudes through fimbriae of fallopian tubes and into peritoneal cavity
Lower abdominal pain (including peritonitis in cases of hemoperitoneum)
Hemoperitoneum
(blood in the peritoneal cavity)
Sloughing of decidua out of the uterus through the vagina
Vaginal bleeding (usually in first trimester)
Cessation of human chorionic gonadotropin (β-hCG) release from embryo
β-hCG plateaus or decreases
Authors: Jemimah Raffé-Devine Tahsin Khan Yan Yu* Reviewers: Brianna Ghali Bishwas Paudel Mackenzie Grisdale Christina Schweitzer Ron Cusano* Jadine Paw* * MD at time of publication
                     Syncope
↓ Level of consciousness
Positive β-hCG, but rising <35% over 2 days
Discriminatory zone: β-hCG >2000 + absence of intrauterine pregnancy
 Hypotension
   Shock
 Legend:
 Pathophysiology
 Mechanism
Sign/Symptom/Lab Finding
 Complications
 Published Oct 1, 2017, updated Oct 19, 2021 on www.thecalgaryguide.com