CC_Review_2 - Interpretation of Laboratory Tests: A...

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Interpretation of Laboratory Tests: A Case-Oriented Review of Clinical Laboratory Diagnosis (Part 2) Roger L. Bertholf, Ph.D. Associate Professor of Pathology University of Florida Health Science Center/Jacksonville Mark A. Bowman, MT(ASCP), Ph.D. Associate Professor of Clinical Pathology Clinical Laboratory Sciences Program Director University of Iowa College of Medicine
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Case 1: Failure to Conceive
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Case History A couple visits their family doctor, complaining that the wife had been unable to become pregnant. What questions should you ask?
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Infertility Definition: One year of unprotected intercourse without pregnancy 1°: No previous pregnancies 2°: Previous pregnancy (not necessarily live birth) Fecundability: Probability of achieving pregnancy within a menstrual cycle 20-25% for normally fertile couples 90% of couples should conceive within one year 10-15% of couples experience infertility
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Probabilities of failure to conceive 10 100 0 2 4 6 8 10 12 Months of unprotected intercourse Percent failed Nulliparous Parous 5 months 2.7 months 50
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Requirements for conception Male must produce adequate numbers of normal, motile spermatozoa Male must be capable of ejaculating the sperm through a patent ductal system The sperm must be able to traverse an unobstructed female reproductive tract The female must ovulate and release an ovum The sperm must be able to fertilize the ovum The fertilized ovum must be capable of developing and implanting in appropriately prepared endometrium
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Sperm Morphology % normal spermatozoa Head, acrosomal region Vacuoles Midpiece abnormalities Tail defects
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Comparison of Criteria WHO (1987) WHO (1992) Strict (1986) % Normal 50 30 14 Head length ( μ m) 3.0-5.0 4.0-5.5 5.0-6.0 Head width ( μ m) 2.0-3.0 2.5-3.5 2.5-3.5 W/L 1.5-2.0 1.5-1.75 1.0-1.67
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Evaluation of semen 2-3 days abstinence prior to collection Gelation/liquefaction (macroscopic) Color/volume/consistency/pH
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Sperm morphology
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Sperm motility
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The Endocrine System Hypothalamus/Pituitary/Pineal Thyroid/Parathyroid Thymus Adrenal Pancreas Kidney Testis Ovary
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Evaluation of male infertility Follow-up Semen analysis PCT Antisperm antibodies Sperm mucuous penetration Repeat LH, FSH, Testosterone N A N N A A
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Male Hypothalamic-Pituitary- Gonadal Axis GnRH LH, FSH Testosterone Inhibin FSH acts on Sertoli cells LH acts on Leydig cells
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Male reproductive endocrinology LH FSH Testosterone Diagnosis Hypothalamic or pituitary failure Gonadal failure N N Germinal compartment failure N N or Androgen resistence N N N Idiopathic
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Causes of female infertility Pelvic factors 50% Immunologic factors 5% Other 15% Ovulatory disorders 30%
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Female Hypothalamic-Pituitary- Gonadal Axis GnRH LH, FSH Estradiol Progesterone FSH stimulates follicular growth LH stimulates ovulation
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Cyclical changes in female reproductive hormones 1 4 8 12 16 20 24 28 Days since onset of menses FSH LH Estradiol Progesterone Ovulation
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This note was uploaded on 09/18/2011 for the course MED 6566 taught by Professor Staff during the Summer '11 term at University of Florida.

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CC_Review_2 - Interpretation of Laboratory Tests: A...

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