3 - Fertility Flashcards
Subfertility
Failing to conceive in one year of regular, unprotected, sexual intercourse
Infertility
failure to become pregnant after 12 months and more of regular unprotected sexual intercourse
Primary Infertility
being unable to ever bear a child. Includes miscarriages, ectopics, abortions and stillborns.
Secondary Infertility
being unable to bear a child following either a previous pregnancy or a previous ability to carry a pregnancy to a live birth
Hypopituitary Failure
Anorexia Nervosa
Hypopituitary Dysfunction
PCOS
Hyperprolactinaemia
Ovarian failure
If under 40 y/o - premature
Women in UK with PCOS
33% with polycystic ovaries
33% of that 33% with PCOS
Symptoms of PCOS
menstrual disturbance
Acne
Male pattern hair loss
Central obesity
PCOS LH, FSH and Testosterone levels
Raised LH
Normal FSH
Raised testosterone
Rotterdam Criteria for PCOS
2 of 3
Clinical hyperandrogenaemia
Oligomenorrhoea (6 to 9 in a year)
Polycystic Ovaries on Ultrasound
Pelvic inflammatory disease symptoms
May be asymptomatic
o Acute: pelvic pain, deep dyspareunia, malaise, fever
Endometriosis symptoms
Pain, dysmenorrhoea, menorrhagia, dyspareunia
Treatment of endrometriosis
NSAIDs for pain
Surgery
Fibroids
o Benign tumours of the smooth muscle of the myometrium
Fibroids symptoms
heavy, regular periods
Male causes of infertility
Testicular
Ejaculatory
Hypogonadism
Drugs linked to infertility - women
long terms NSAID use, chemotherapy, neuroleptics, spironolactone, depo-provera.
Drugs linked to infertility - male
sulfasalazine, anabolic steroids, chemotherapy, Chinese herbs for improving sperm count and motility.
Management of Hypopituitary failure
increase weight, decrease exercise.
Consider pulsatile GnRH or Gn with LH activity to induce ovulation.
Management of PCOS
weight loss
Clomiphene or metformin
Surgery - laparoscopic ovarian drilling
Management of Hyperprolacinaemia
Bromocriptine
When to offer IVF in unexplained infertility
2 years
What is Intrauterine Insemination
Sperm is separated in lab, removal of slower speed sperm, before partner is inseminated
Who do you offer IUI to
People who are unable to have vaginal intercourse (disability).
Requiring specific consideration (eg sperm wash in HIV pos men)
Same-sex relationships
How many cycles of IUI before offer IVF?
12
What is in vitro fertilisation?
Fertilisation of an egg (or eggs) outside the body
Who do you offer IVF to
o Women under 40 who have not conceived after 2 years of unprotected intercourse or 12 cycles of artificial insemination (6 IUI).
o Offer 3 full cycles (cycle being 1 ovarian stimulation and transfer of resultant fresh/frozen embryos).
Ovarian hyperstimulation syndrome
Consequence of drugs used to stimulate ovarian function e.g gonadotrophin or clomifene
What is Intracytoplasmic Sperm Injection
Embryologist selects a single sperm to be injected directly into an egg, instead of fertilisation taking place in a dish where many sperm are placed near an egg.
When is ICSI indicated
o Severe deficits in semen quality
o Obstructive azoospermia
o Non-obstructive azoospermia
o Couple in whom previous IVF treatment cycle has resulted in failed or very poor fertilisation
