4: Assessment of infertility Flashcards
What infection can cause infertility?
Chlamydia
The ___ you are, the less fertile you are.
older
A BMI over __ significantly increases your risk of infertility and complications of pregnancy.
30 kg/m2
What is the WHO definition of infertility?
Failure to achieve pregnancy after 12 months of unprotected intercourse in a couple who have never had a child (without a known reason)
What is primary infertility?
Infertility in a couple who have never conceived
What is secondary infertility?
Infertility in a couple who have previously conceived
Under which age are you more likely to conceive?
30
At which point in the menstrual cycle is conception most likely?
Ovulation
Which lifestyle factors affect the chances of conception?
Weight
Smoking
Caffeine intake
Recreational drugs
What are the three general causes of infertility?
Male factors
Female factors (i.e problems with tubes, reduced egg reserves, endometrosis)
Mixture of the two
What is the name for failure to release an egg?
Anovulation
When is anovulation normal?
Before puberty
During pregnancy
After menopause
Which eating disorders can cause anovulation?
Why?
Anorexia nervosa
Bulimia nervosa
associated low BMI
What are some clinical features of anorexia nervosa?
BMI < 18.5
Hair loss
Bradycardia, hypotension
Anaemia
Which endocrine gland functions abnormally in anorexia nervosa?
Hypothalamus
Which hormonal changes are seen in anorexia nervosa?
Low GnRH…
FSH, LH…
… and oestradiol release
Which pituitary tumour can cause anovulation?
Prolactinoma
producing hyperprolactinaemia
Which syndrome causes infarction of the anterior pituitary gland post-partum?
Sheehan syndrome
What is the commonest endocrine disorder in woman and causes anovulation?
Polycystic ovary syndrome (PCOS)
What are the clinical features of polycystic ovary syndrome?
Oligo- or amenorrhoea
Hyperandrogenism symptoms - acne, hirsutism, obesity
What hormone changes are seen in polycystic ovary syndrome?
High free testosterone
High LH
(Remember that PCOS causes insulin resistance > hyperinsulinaemia. That causes the inhibition of sex hormone-binding globulin, which usually mops up testosterone, and increases the levels of LH for some reason.)
What three factors are diagnostic of PCOS?
2 of Rotterdam criteria:
- Oligo- or amenorrhoea
- Ultrasound evidence of polycystic ovaries
- Symptoms of hyperandrogenism - acne, hirsutism, obesity
What genetic syndrome causes premature ovarian failure and therefore infertility?
Turner’s syndrome
What is the karyotype of Turner’s syndrome?
45 XO
What are the clinical features of premature ovarian failure?
Amenorrhoea
Menopausal symptoms - hot flushes, night sweats, atrophic vaginitis (most commonly manifesting as dryness)
In premature ovarian failure, negative feedback of the HPO axis kicks in - what hormonal changes are seen?
High GnRH
High FSH and LH
in an attempt to compensate for ovarian failure
but low oestradiol
because the ovaries can’t produce any
Which other endocrine diseases cause menstrual symptoms and can lead to infertility?
Hyper and hypothyroidism
Tumours producing ___ can cause virilisation and infertility.
testosterone
Which drugs are designed to cause infertility?
Contraceptives
In females, problems with the ___ tubes themselves can cause infertility.
Fallopian tubes
What are some infective tubal diseases?
Pelvic inflammatory disease (chlamydia/gonorrhoea/syphilis/TB…)
Abdominal diseases e.g appendicitis
Iatrogenic
What is endometriosis?
Presence of endometrial tissue OUTSIDE uterus
What are the clinical features of endometriosis?
Painful, bloody menstruation (dysmenorrhoea)
Painful intercourse (dysparenuria)
Infertility
Which surgeries can cause tubal disease?
Sterilisation
Removal of ectopic pregnancies
Which type of disease, following infection by chlamydia, gonorrhoea etc, can cause ectopic pregnancy and infertility?
Pelvic inflammatory disease
What are some pre-testicular causes of male infertility?
Hypogonadism
Hypothyroidism
Hyperprolactinaemia
Diabetes (remember it’s a big cause of ED)
Erectile dysfunction
What is a genetic cause of male infertility?
What is the karyotype?
Klinefelter’s syndrome
47 XXY
What are some post-testicular causes of male infertility?
Obstruction of epididymis, vas deferens
Vasectomy
Which drugs can cause male infertility?
Steroids e.g testosterone, anabolic steroids
Spironolactone at high doses
What happens to the size of the testes in non-obstructive male infertility?
Reduced size
How palpable is the vas deferens in
a) obstructive
b) non-obstructive male infertility?
a) Non-palpable
b) Palpable
What happens to the level of FSH, LH and testosterone in
a) obstructive
b) non-obstructive male infertility?
Obstructive - all normal (not a hormonal problem)
Non-obstructive - high FSH & LH, low testosterone
A progesterone level of more than ___ nmol/L a week before period indicates that ovulation has occurred.
> 30 nmol/L
Which investigations are used to determine if the fallopian tubes are patent or not?
Hysterosalpingiogram
Laparoscopy
What investigation is done for suspected endometriosis in the uterus?
Hysteroscopy
remember hyster- means uterus
Which imaging can be used to investigate infertility?
Pelvic USS
Which hormones are measured in a patient who has anovulation?
Urine HCG
Prolactin
TSH
Testosterone
LH, FSH and oestradiol
What is a sort-of varicose vein which occurs in the testes and can cause male infertility?
Varicocele
What is analysed to determine the cause of male infertility?
Semen
Hormones (LH, FSH, testosterone, prolactin, TSH)
Again, which imaging can be used to examine the testes?
Testicular / scrotal USS
Name three classes of contraception which cause anovulation.
OCP
Contraceptive implant
Contraceptive injection
