31) Infertility

Question 1

What is the definition of “Infertility”?

Answer 1

• It’s failure to achieve pregnancy, AFTER 12 MONTHS of regular unprotected intercourse

TYPES

• PRIMARY = Never been pregnant
• SECONDARY = previously conceived, but now cannot

Question 2

What are the CAUSES of INFERTILITY, in Women?

Answer 2

1) OVULATION DISORDERS

2) TUBAL INSUFFICIENCIES

3) UTERINE ABNORMALITIES* - Uterine Fibroid

Question 3

What are Ovulation Disorders?

Answer 3

• Turner’s + Kalman’s Syndrome
• Anorexia
• Athletes
• Hyperprolactinemia - Due to Pituitary Adenoma
• PCOS - Due to excess androgens
• Hypothalamic Amenorrhoea - Due to Malnutrition + Weight Loss

Question 4

How can Ovulation Disorders be Diagnosed + Treated?

Answer 4

DIAGNOSIS

• Basal Body Temperature
• INCREASED Levels of LH - BEFORE Ovultation
• HIGH Progesterone Levels - MORE THAN 4mg / ml

TREATMENT

• Treat Endocrine Disorders
• Ovulation Induction - Oestrogen Antagonist, or Inject Gonadotropin

Question 5

What is the Complication of OVULATION INDUCTION?

Answer 5

Ovarian HYPERSTIMULATION - due to exogenous hCG

• Where multiple follicles develop into —> lutenised cysts which secrete oestrogen / progesterone
• Causes Cytokine + Inflammatory Mediator release

CFs = Pleural Effusions, Abdominal Distension, Abdo-Pain, Nausea + Vomiting

Question 6

What are Tubal Insufficiencies?

Answer 6

• They’re Diseases of Fallopian Tube, or Blockage of Tube
• Impairs Conceiving

DUE TO

• Pelvic Inflammatory Disease
• Endometriosis
• Chronic Chlamydia Infection

Question 7

How can Tubal Insufficiencies be Diagnosed + Treated?

Answer 7

DIAGNOSIS

• HYsterosalpingography = To visualise uterine cavity with radiopaque dye
• Laparoscopy

TREATMENT

• IVF
• Tubal Re-anastamosis

Question 8

How can Infertility be Managed?

Answer 8

• Review Coital Technique
• Smoking + Alcohol Cessation
• Folic Acid Supplementation - start 3 Months BEFORE
• Genetic Counselling

ASSISTED REPRO TECH (ART)

• IVF
• Intracytoplasmic Sperm Injection
• Intrauterine Insemination

Question 9

Explain how IVF works

Answer 9

1) Inject Gonadotropins - to stimulate ovaries

2) LH SURGE is suppressed by Gonadotropin-RH agonists suppressing PG

3) Ovulation is triggered by hCG

4) 36h LATER = Oocytes are retrieved via US Guidance

5) Oocytes are incubated w/ sperm in a petri dish

6) Embryos are inserted into uterus - around 3 - 5 Days after retrieval