2: Fertility and Sub-Fertility: Causes, IVF Flashcards
Define sub fertility
Failure to conceive despite one-year of unprotected sex, in absence of known cause infertility.
What is infertility
No possibility of conceiving
What is primary sub-fertility
When women has not conceived previously
What is secondary sub-fertility
Women has conceived previously
What % of couples can conceive in one-year
80
What is mnemonic to remember causes of infertility
UMATE
What are the causes of infertility
Unexplained (28%) Male (25%) Anovulation (21%) Tubal (20%) Endometriosis (8%)
In males, how can causes of infertility be divided
- Sperm
- Azoospermia
- Inflammation
- Coitus
What is the most-common cause of infertility in males
Semen abnormality
What proportion of infertility is due to semen abnormality
85%
What is oligospermia
Decrease number of sperm in ejaculate
What are 4 causes of oligospermia
- Testicular cancer
- Varicocele
- Alcohol
- Idiopathic
- Rec drugs
What proportion of male infertility is due to azoospermia
5%
Define azoospermia
Complete absence of sperm in ejaculate
How can causes of azoospermia be classified
Pre-testicular, Obstructive, Non-Obstructive
What are 3 pre-testicular causes of azoospermia
- Hypogonadotorphic hypogonadism
- Kallman’s
- Anabolic steroids
What are 4 causes of obstructive azoospermia
- Congenital absence vas deferens (CF)
- Vasectomy
- Gonorrhoea
- Chlamydia
What can cause a congenital absence of the vas deferens
Cystic fibrosis
What are 3 non-obstructive causes of azoospermia
Klinfelter’s (XXY)
Chemotherapy
Cryptochidism
Orchitis
What are 3 inflammatory causes of male infertility
- Antibodies = reversal vasectomy
- Infective
- idiopathic
What are coitus causes of male infertility
Erectile dysfunction
What two medications can cause erectile dysfunction
B-blockers
SSRIs
What are the 3 cause of female infertility
- Anovulation
- Tubal
- Endometriosis
What are two types of anovulation
Primary and Secondary
What is primary anovulation
Anovulation due to pathology in the ovary
What are 4 causes or primary anovulation
- PCOS
- Tuners (45XO)
- Premature ovarian failure
- Iatrogenic: chemoradiotherapy
what is secondary anovulation
Anovulation due to problems with pituitary or hypothalamus
what are 5 causes of secondary anovulation
Kalmann’s
PCOS
Anorexia
Hyperprolactinaemia
What are 2 -tubal causes of female infertility
- PID
2. Previous surgery
Explain endometriosis as cause of infertility
Endometriosis causes inflammation, which can lead to scarring which can cause tubal occlusion.
In male ‘work-up’ for infertility what two things need to be established in history
- Alcohol and Smoking = both can cause subferility
- Medications = some can lead to ED
On examination, what 3 aspects may be focused on
- Secondary sexual characteristics (absence of)
- BMI
- Testicular volume
What can obesity cause
Subfertility
What can absence of secondary sexual characteristics be caused by
Klinfelter’s
After history and examination, what should be tested in male infertility
Semen analysis
In semen analysis what do WHO define as normal progressive motility
32%
In semen analysis what do WHO define as normal total motility
40%
In semen analysis what do WHO define as normal morphology
> 4%
Why may FSH be tested for male infertility
Will be raised in testicular failure
Why may LH be tested in male infertility
Low in androgen deficiency
What karyotyping may be ordered for male infertility
- Klinefelters (XXY)
- Cystic fibrosis - congenital absence VD
In history for female infertility what should be focused on
Alcohol and Smoking - Decrease fertility
Previous STI or pelvic surgery - tubal occlusion
What should be looked for on examination in female infertility
BMI Hirsuitism - PCOS Absence secondary characteristics Visual field defect - prolactinoma Pelvic mass
What test is ordered to determine ovarian reserve
FSH
When should FSH be measured
Day 2-4 of cycle
What is normal for FSH
> 10
What is used to determine if individual is ovulating
Mid-luteal progesterone
When should progesterone be performed
7d prior to first-day menses
In a 28-day cycle, when should mid-luteal progesterone be performed
day 21
What level of mid-luteal progesterone indicates a women is ovulating
> 30