Assessment of infertility Flashcards
what is the definition of infertility?
failure to achieve a clinical pregnancy after 12 months of more of regular unprotected sexual intercourse (in absence of known reason) in a couple who have never had a child (WHO definition)
how long do you have to wait for IVF treatment in tayside?
2 years
which factors increase the chances of conception?
Woman aged under 30 years
Previous pregnancy
Less than three years trying to conceive
Intercourse occurring around ovulation
Woman’s body mass index (BMI) 18.5 – 30m/kg2
Both partners non-smokers
Caffeine intake less than two cups of coffee daily
No use of recreational drugs
what are common causes of secondary infertility?
tubal disease
fibroids
endometriosis/adenomyosis
weight related
age related
what are the physiological causes of infertility?
before puberty, pregnancy, lactation, menopause
what are gynaecological causes of infertility?
hypothalamic: anorexia/bulimia, excessive exercise
pituitary: hyperprolactinaemia, tumours, Sheehan syndrome
ovarian: PCOS, premature ovarian failure
what are the blood results in anorexia nervosa
low FHS, LH and oestradiol
what are the features of PCOS?
obesity, hirsutism or acne, menstrual cycle abnormalities and infertility
what is the criteria for a diagnosis of PCOS?
chronic anovulation
polycystic ovaries
hyperandrogenism (clinical or biochemical)
what can cause premature ovarian failure?
idiopathic, genetic (Turner’s syndrome, fragile X), chemotherapy, radiotherapy, oophorectomy
what are the clinical features of premature ovarian failure?
hot flushes, night sweats, atrophic vaginitis, amenorrhoea, infertility
what are the biochemical features in premature ovarian failure?
high FSH, high LH, low oestradiol
what are the inflammatory causes of tubal disease?
Pelvic inflammatory disease (chlamydia, gonorrhoea, other: anaerobes, syphilis, TB)
transperitoneal spread: appendicitis, intra-abdominal abscess
following procedure: IUCD insertion, hysteroscopy, HSG
what are the non infective causes of tubal disease?
endometriosis
surgical (sterilisation, ectopic pregnancies)
fibroids
polyps
congenital
salpingitis isthmica nodosa
what is the definition of endometriosis?
presence of endometrial glands outside uterine cavity
what is the cause of endometriosis?
Retrograde menstruation is most likely cause, altered immune function, abnormal cellular adhesion molecules, genetic
what are the clinical features of endometriosis?
dysmenorrhoea (classically before menstruation), dysparenuia, menorrhagia, painful defaecation, chronic pelvic pain, uterus may be fixed and retroverted, scan may show characteristic ‘chocolate’ cysts on ovary, infertility, asymptomatic
what are some examples of non obstructive male infertility?
47 XXY, chemotherapy, radiotherapy, undescended testes, idiopathic
what are the clinical features of non obstructive male infertility?
low testicular volume
reduced secondary sexual characteristics
vas deferens present
what are the biochemical features of non obstructive male infertility?
High LH, FSH and low testosterone
what are some examples of obstructive infertility?
congenital absence (cystic fibrosis), infection, vasectomy
what are the clinical features of obstructive male infertility?
normal testicular volume
normal secondary sexual characteristics
vas deferens may be absent
what are the biochemical features of obstructive male infertility?
Normal LH, FSH and testosterone
how is female infertility investigated?
BMI
General examination, assessing body hair distribution, galactorrhoea
Pelvic examination, assessing for uterine and ovarian abnormalities/tenderness/mobility
how is male infertility investigated?
BMI
General examination
Genital examination, assessing size/position testes, penile abnormalities, presence vas deferens, presence varicoceles
