7. Infertility Flashcards
What can cause infertility?
Unidentifiable in 25% Male and female in 40% Male causes 30% Ovulatory causes in 25% Tubal factors in 20% Uterine and peritoneal disorders in 10%
What are the possible pre-testicular male causes of infertility?
Endocrine - hypogonadotropic hypogonadism, hyperprolactinaemia, hypothyroidism, diabetes
Coital problems - ejaculatory disorders, erectile dysfunction
General health/systemic illness
What are some testicular causes of infertility?
Klinefelter syndrome (XXY) Y chromosome depletion Immobile cilia syndrome Congential Infective - STIs Anti spermatogenic agents - heat, irradiation, drugs, chemotherapy Vascular - torsion, varicocele
What are the post-testicular causes of infertility?
Obstructive - congential, acquired (vasectomy, infective)
Coital problems - sexual dysfunction, hypospadias
What are the 3 groups of ovulatory disorders?
Hypothalamic-pituitary failure (10%) Hypothalamic-pituitary-ovarian dysfunction (85%) Ovarian failure (5%)
What are some physical reasons why implantation fails?
Uterine fibroids
Conditions causing scarring/adhesions - endometriosis, PID, previous surgery, asherman syndrome
Mullerian developmental anomalies
What can cause tubal damage?
Endometriosis
Ectopic pregnancy
Pelvic surgery
PID
What examinations should be done in males in infertility?
Not usually required
Examine penis for structural abnormalities
Scrotal exam
Secondary sexual characteristics
What examinations should be performed in female infertility?
BMI
Seindary sexual characteristics
Hirsutism, acne
Abdominal/pelvic/vaginal exam - masses, tenderness, infection, uterus size/position, vaginisimus
What advice should be given to patients with infertility?
Smoking cessation Reduce alcohol intake Lifestyle changes - stress Regular intercourse - 2-3 times a week Weight loss Reassurance
What investigations should be done in male infertility?
Semen analysis - sperm count, motility, liquification studies Bloods - LH, FSH, testosterone STI screen USS testes Karyotyping
What investigations should be done in female infertility?
Bloods - FSH/LH (day 2), mid-luteal phase progesterone (day 21), TFTs, prolactin levels, androgens
STI screen
Pelvic USS
When should you considering referring to secondary care?
Consider if history, exam and investigations normal in both partners and not conceived after 1 year
When should you consider early referral?
Women >36 (after 6 months)
Known cause/predisposing factors
What are the management options for infertility?
Medical treatment - ovulation induction
Surgical treatment - tubal occlusions
Assisted reproductive technology
