When is it time to be born? Labor and Delivery Reproductive Pathophysiology 2: Pregnancy and Female Infertility Nancy Long Sieber, Ph.D. E-162b Human Pathophysiology October 18, 2010

Fertility

Widmaier, E.P. Raff, H. and K.T. Strang. Vander, Sherman and Luciano’s Human Physiology 9/e. McGraw-Hill. 2004

Ectopic Pregnancy

A Molar Pregnancy Hydatidiform mole.

Neural Tube Defects

Fig

Widmaier, E.P. Raff, H. and K.T. Strang. Vander, Sherman and Luciano’s Human Physiology 9/e. McGraw-Hill. 2004

Cephalic vs. Breech Presentation

Breech Presentation

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

Polycystic Ovary

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

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.

Source: Management of the Infertile Woman by Helen A. Carcio and The Fertility Sourcebook by M. Sara Rosenthal

Number of ART cycles reported in ,435* Number of live-birth deliveries resulting from ART cycles started in ,412 Number of infants born as a result of ART cycles carried out in ,569 Use of Assisted Reproductive Technology