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4: Y4 - Gynaecology [8] > [17] Causes of Infertility > Flashcards

[17] Causes of Infertility Flashcards

1
Q

What is infertility?

A

The inability to become pregnant after one year of intercourse without contraception involving a male and female partner

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2
Q

80% of couples will conceive in year if what criteria are met?

A
  • woman is under 40
  • Don’t use contraception
  • Have regular intercourse (every 2-3 days)
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3
Q

What is the cumulative pregnancy rate over 2 years with the same criteria?

A

90%

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4
Q

What happens with natural female fertility over time?

A

Declines with age

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5
Q

What are the 2 types of infertility?

A
  • Primary

- Secondary

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6
Q

What is primary infertility?

A

When someone who has never had a child has difficulty conceiving

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7
Q

What is secondary infertility?

A

When someone who has had 1 or more pregnancies has difficulty conceiving

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8
Q

What are the broad causes of infertility?

A
  • Ovulation disorders
  • Tubal disease
  • Uterine or cervical causes
  • Coital dysfunction
  • Male factor
  • Unexplained infertility
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9
Q

What % of infertility cases are due to ovarian disorders?

A

25%

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10
Q

How many groups of ovulation disorders are there?

A

4

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11
Q

What are the 4 groups of ovulation disorders?

A
  • Type I
  • Type II
  • Type III
  • Type IV
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12
Q

What are Type I ovulation disorders also known as?

A

Hypothalamic-pituitary failure

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13
Q

Where are LH and FSH produced?

A

Anterior pituitary gland

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14
Q

What are FSH and LH responsible for?

A

Stimulating ovulation each month

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15
Q

What happens to LH, FSH and oestradiol in type I ovulation disorders?

A

Lowered

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16
Q

What can cause type I ovulation disorders

A
  • Excess weight gain
  • Very high or very low body weight
  • Recent substantial weight gain
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17
Q

What can happen to menses as a result of type I ovulation disorders?

A

Absent or very infrequent

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18
Q

What is type II ovulation disorder also known as?

A

Hypothalamic-pituitary-ovarian dysfunction

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19
Q

What is the most common cause of type II ovulation disorders (and the majority of ovulation disorders)?

A

PCOS

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20
Q

What happens to levels of FSH in Type II ovulation disorders?

A

Normal

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21
Q

What happens to levels of LH in Type II ovulation disorders?

A

Normal or raised

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22
Q

What other hormones can be raised in Type II ovulation disorders?

A
  • Serum anti-mullerian hormone
  • Serum tesosterone
  • Free androgen index
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23
Q

What are Type III ovulation disorders also known as?

A

Premature ovarian failure

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24
Q

What is premature ovarian failure?

A

Cessation of ovulation due to depletion of the ovarian follicle pool before 40

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25
Q

What happens to serum gonadotrophin levels in premature ovarian failure?

A

Greatly raised

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26
Q

What happens to levels of AMH in premature ovarian failure?

A

Low/undetectable

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27
Q

What happens to levels of Oestradiol in premature ovarian failure?

A

Low

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28
Q

What can cause premature ovarian failure?

A
  • Autoimmune conditions
  • Genetics
  • Chemotherapy
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29
Q

What are Type IV ovarian disorders also known as?

A

Hyperprolactinaemia

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30
Q

What happens in Type IV ovarian disorders?

A

Pituitary gland produces too much prolactin leading to low oestrogen and may cause infertility

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31
Q

What is often the cause of hyperprolactinaemia?

A

Pituitary micoradenoma

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32
Q

What is an important cause of hyperprolactinaemia to rule out?

A

Space occupying macroadenoma

33
Q

What is an iatrogenic cause of hyperprolactinaemia?

A

Medications e.g. antipsychotic drugs

34
Q

What happens to prolactin levels in hyperprolactinaemia?

A

They go up obviously

35
Q

What happens to levels of LH and FSH in hyperprolactinaemia?

A

Low/normal

36
Q

What % of infertility cases are due to tubal disease?

A

20%

37
Q

How do tubal disorders lead to infertility?

A

Damage or blocked tubes can keep the sperm from getting to the egg or block passage of the fertilised egg into the uterus

38
Q

What are the potential causes of tubal disease?

A
  • PID
  • Previous surgery in abdomen or pelvis
  • Pelvic tuberculosis
39
Q

Give an example of previous pelvic or abdominal surgery that can cause infertility?

A

Surgery for ectopic pregnancy

40
Q

What % of cases of infertility are caused by uterine or cervical causes?

A

10%

41
Q

How can uterine and cervical disorders lead to infertility?

A
  • Interfere with implantation

- Increase risk of miscarriage

42
Q

What are some uterine disorders that can cause infertility?

A
  • Benign polyps or tumours
  • Endometriosis
  • Uterine abnormalities present from birth
43
Q

What congenital uterine abnormalities can cause infertility?

A
  • Septum

- Bicornuate uterus

44
Q

How do benign polyps or tumours of the uterus lead to infertility?

A

Can block fallopian tubes or interfere with implantation

45
Q

What are some possible cervical causes of infertility?

A
  • Cervical stenosis

- Sub-optimal mucus being produced

46
Q

What can cause cervical stenosis?

A
  • Inherited malformation

- Damage to the cervix

47
Q

What sort of mucus is normally produced by endocervical cells at ovulation?

A

Clear, watery mucus with a high water content and specialised glycoprotein molecules

48
Q

What does the mucus produced at ovulation normally facilitate?

A

Passage of sperm into the uterine cavity

49
Q

What happens to the mucus after ovulation?

A

It becomes hostile to sperm under the influence of progesterone

50
Q

What abnormalities of cervical mucus can lead to infertility?

A
  • Cervical infection leading to altered mucus

- Antisperm antibodies in mucus

51
Q

What problems with coitus can lead to infertility?

A
  • Erectile dysfunction
  • Premature ejaculation
  • Painful intercourse
  • Anatomical abnormalities e.g. hypospadias
  • Psychological or relationship problems
52
Q

What % of infertility cases are due to male factors?

A

30%

53
Q

What are some male factors that can lead to infertility?

A
  • Sperm/semen abnormalities
  • Varicocele
  • Infection
  • Ejaculation issues
  • Anti-sperm antibodies
  • Tumours
  • Chemo/radiotherapy
  • Undescended testes
  • Hormone imbalances
  • Defects in tubules
  • Genetic defects
  • Coeliac disease
  • Medications
  • Previous surgery
  • Environmental causes
  • Health and lifestyle
54
Q

What is a varicocele?

A

A swelling of the veins that drain the testicle

55
Q

How do varicoceles cause infertility?

A

Unknown - possibly related to temperature regulation

56
Q

What happens to sperm due to a varicocele?

A

Reduced quality

57
Q

How common is varicocele as a cause of infertility?

A

Most common reversible cause of male infertility

58
Q

What effects can infections have to lead to infertility?

A
  • Interfere with sperm production
  • Interfere with sperm health
  • Block passage of sperm
59
Q

What sorts of infections can lead to infertility?

A
  • Epididymitis
  • Orchitis
  • Some STI’s including gonorrhoea and HIV
60
Q

What ejaculation issues can lead to infertility?

A
  • Retrograde ejaculation

- Inability to ejaculate

61
Q

What is retrograde ejaculation?

A

When semen enters the bladder during orgasm instead of emerging through the penis

62
Q

What conditions can cause retrograde ejaculation?

A
  • Diabetes
  • Spinal injuries
  • Medications
  • Surgery of bladder, prostate or urethra
63
Q

What can cause inability to ejaculate?

A
  • Spinal cord injuries

- Certain diseases

64
Q

What genetic conditions can lead to male factor infertility?

A
  • Klinefelter’s syndrome
  • Cystic fibrosis
  • Kallmann’s syndrome
  • Kartagener’s syndrome
65
Q

What is the genetic defect in Klinefelter’s syndrome?

A

Male born with XXY karyotype

66
Q

What happens as a result of the XXY karyotype in Klinefelter’s?

A

Abnormal development of the male reproductive organs

67
Q

What medications can lead to male factor infertility?

A
  • Testosterone replacement
  • Long-term anabolic steroid use
  • Chemotherapy
  • Certain anti-fungal medications
  • Some ulcer drugs
68
Q

What previous surgeries can lead to male factor infertility?

A
  • Vasectomy
  • Inguinal hernia repair
  • Scrotal or testicular surgeries performed for testicular and rectal cancer
69
Q

How can the environment lead to male factor infertility?

A

Exposure to certain elements can lead to reduced sperm production/function

70
Q

What environmental factors can affect male fertility?

A
  • Industrial chemicals
  • Heavy metal exposure
  • Radiation or x-rays
  • Overheating the testicles
71
Q

What lifestyle factors can affect fertility in men?

A
  • Drug use
  • Alcohol use
  • Tobacco smoking
  • Emotional stress/depression
  • Obesity
72
Q

What recreational drugs can lead to male infertility?

A
  • Anabolic steroids
  • Cocaine
  • Marijuana
73
Q

What effect do anabolic steroids have on male fertility?

A

Can cause testicular shrinkage and sperm production to decrease

74
Q

How can cocaine or marijuana affect male fertility?

A

Temporarily reduce the number and quality of sperm

75
Q

How can alcohol use lead to male infertility?

A
  • Lower testosterone levels
  • Can cause ED
  • Decreased sperm production
  • Can cause liver disease which can cause further fertility issues
76
Q

What effect does tobacco smoking have on male fertility?

A

Lowers sperm count

77
Q

What % of cases of infertility have no explanation?

A

25%

78
Q

What is the likely reason for an unexplainable cause of infertility?

A

Combination of several minor factors in both partners

4: Y4 - Gynaecology [8] (52 decks)

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