2. Fertility Flashcards
What is meant by subfertility?
Think of subfertility as infertility
What is meant by infertility?
A disease of the reproductive system defined by the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sex
What is primary infertility?
When a woman is unable to ever bear a child i.e. she has never been able to get pregnant
This includes miscarriage, ectopics, abortions and stillborns
What is secondary infertility?
When a woman is unable to bear a child following either a previous pregnancy or a previous ability to carry a pregnancy to a live birth
Previously was able to have a baby
What are the different causes of subfertility?
Ovulatory disorders - 25% Tubal damage - 20% Uterine/peritoneal disorders - 10% Male factors - 30% Unexplained infertility - 25%
What lifestyle advice is given for conception?
No smoking Low alcohol consumption High folic acid consumption Keep weight down - male and female Low stress levels Low caffeine intake No drug abuse
What are the different ovulatory causes of infertility?
Type 1 - hypopituitary failure (most commonly by anorexia nervosa)
Type 2 - hypopituitary dysfunction e.g. polycystic ovarian syndrome
Type 3 - ovarian failure (or premature ovarian failure if under 40 years) e.g. due to a raised FSH level
Briefly describe polycystic ovarian syndrome
This is a type of ovulatory cause of infertility (type 2)
This is a set of symptoms that occur due to increased levels of androgens i.e. male hormones
Around 33% of women have this
This is a spectrum - can range from no clinical presentations to severe presentations such as irregular or no menstrual periods, heavy periods, excess body and facial hair, acne, pelvic pain, difficulty getting pregnant, and patches of thick, darker, velvety skin
What are the different types of tubal and uterine causes of infertility?
Pelvic inflammatory disease Previous tubal surgery e.g. for ectopic pregnancy Endometriosis - tubal and uterine Fibroids - uterine Cervical mucous defect
Briefly describe pelvic inflammatory disease
Infection of the upper part of the female reproductive system - uterus, fallopian tubes, ovaries and the inside of the pelvis
Main cause of this is chlamydia
Most often asymptomatic
Presents with pelvic pain, deep dyspareunia, malaise, fever, purulent vaginal discharge
Briefly describe endometriosis
Disease where tissue that normally grows within the uterus grows outside of it e.g. the fallopian tubes, the ovaries
Increased risk with age, increased FSH levels, frequent cycles
Presents with pain, dysmenorrhoea, meorrhagia, dyspareunia
Briefly describe uterine fibroids
Benign smooth muscle tumours of the uterus myometrium
These are very common, especially in afro-carribean populations
Women often complain of heavy, regular periods
Once one fibroid is present, the woman is likely to get another
Tends to resolve as you get older and oestrogen levels decrease - especially when you become post-menopausal
What are the main causes of male infertility?
Testicular causes e.g. cancer, surgery, congenital, undescended testes, trauma
Azoospermia with or without sperm antibodies
Reversal of vasectomy
Ejaculatory problems - retrograde and premature
Hypogonadism
What drugs are associated with increased rates of infertility?
Women: Long term usage of NSAIDs Chemotherapy Neuroleptics Spironolactone Depo-provera (the injection used for contraception - has a proven delay to come back to fertility) Men: Anabolic steroids Chemotherapy Chinese herbs for improving sperm count and mobility - some may actually have the opposite effect
Marijuana, cocaine, other illicit drugs for both male and female use
What is the first line of advice given to a couple who are finding it hard to conceive?
80% of couples become pregnant after 12 cycles and 50% of the remainder conceive within the second year
This is the general advice given within the first two years of trying to conceive if there are no other concerns regarding fertility
