5.3 Managment of Infertility Flashcards
What is infertility?
Actively trying for 12 months without falling pregnant
What are the causes of male infertility?
Sperm count (Azoospermia - no sperm, oligospermia - low sperm numbers) Sperm quality Anti sperm antibody Sexual dysfunction Lifestyle factors
What is azoospermia and what are the two kinds and give examples
No sperm
Production problem: Kleinfelters, anabolic steroids affecting the feedback
Obstructive problem: cystic fibrosis (no vas deferens)
What is oligospermia and what are the causes
Low sperm numbers
Testicular dystrophy (mumps as a child)
Undescended testis not corrected at an early age (cryptoorchaism)
What is the name for poor sperm motility?
Asthenospermia
What is the name for poor sperm morphology?
teratospermia
What can be done for male infertility problems?
Lifestyle changes - weight loss, reduce alcohol and stop smoking, alter medications, better management of medical conditions
Increased sperm turnover may reduce chromatin damage
Pharmacological treatment of erectile dysfunction
Causes of female infertility
Ovulation disorders (PCOS) Structural problems (fallopian tube occlusion) Endometriosis Sexual dysfunction Lifestyle factors
What is fecundability?
The monthly chance of getting pregnant
What effect does ageing have on fertility?
mitochondrial dysfunction
increase prevalence of aneuploidy in ageing oocytes
Increase incidence of spontaneous miscarriage
What investigations would you do on the female?
History Serology Pap smear Antenatal screen Pelvic ultrasound Hormones day 2 and 21 of cycle HyCosi for tubal patency
What investigations would you do on the male?
Semen analysis
trial wash
What would you look for in a semen analysis?
Volume, concentration, motility, morphology and anti-sperm antibody
what importance is anti-mullerian hormone?
Produced by the pre-antral follicles in the ovary and if there is no eggs there will be low AMH levels
tells about the reserve of eggs and predicts the response to IVF
When would you use karyotyping?
Men: severe oliogospermia
women: POF, poor ovarian reservem premature menopause
Couple: recurrent miscarriage and IVF failure
What are the fertility options?
Ovulation tracking Ovulation indication Artificial insemination (ICSI) IVF Egg donation Sperm donation Pre implantation diagnosis
What are the indications for IVF
Tubal obstruction Endometriosis Unexplained infertility Male factor infertility pre implantation genetic diagnosis
what is the IVF cycle
Interview and trial wash ovarian stimulation 10-14 days later egg collection embryo transfer endometrium support pregnancy test
when would you use intracytoplasmic sperm injection?
as treatment for male factor infertility obstruction oligospermia poor motility poor morphology sexual/erectile problems genetic disorder
What testing is done before implantation?
Single gene defects
translocations
screening for aneuploidy
HLA typing
what are the techniques for genetic diagnosis and when are they used?
CGH (comparative genomic hybridization)
- comprehensive chormosomal screening
PCR
- specific gene mutations
What is needed for pre implantation genetic diagnosis
ideally molecular diagnosis known in advance
