assessment of infertility Flashcards
why might it be increasing
rise in chlamydia
older women
increase in obesity
male factor infertility
increasing awareness of identifications
T/F spontaneous pregnancy is likely
F
what is infertility
12 months of regular unprotected sex without conception
> but won’t get IVF on NHS until at least 2 years
what factors affect fertility
age - under 30yrs you are much more likely to conceive
having a previous pregnancy - more likely
intercourse occurring around ovulation
woman’s BMI - 18.5 - 30
both parents non-smokers
no use of recreational drugs
caffeine (less so)
common causes of infertility
tubal disease
fibroids
endometriosis / adenomyosis
weight related
age related
symptoms of infertility
lactation, menopause
gynaecological conditions:
hypothalamic > anorexia/bulimia , excessive exercise
pituitary > hyperprolactinaemia , tumours , Sheehan syndrome
ovarian > PCOS , premature ovarian failure
others:
systematic disorders > chronic renal failure
endocrine > testosterone secreting tumour, congenital hyperplasia , thyroid
drugs > depo-provera
polycystic ovarian syndrome
commonest endocrine disorder in women
inherited , weight gain makes it worse
obesity, hirsutism or acne, menstrual cycle abnormalities and infertility
high free androgens, high LH, impaired glucose tolerance
diagnosis = score 2/3 of:
chronic anovulation
polycystic ovaries
hyperandrogenism
premature ovarian failure
in older women
idiopathic, genetic , Turners, chemotherapy
hot flushes , night sweats, atrophic vaginitis
amenorrhea , infertility
endocrine features = high FSH, high LH, low oestradiol
tubal disease causes
infection ie pelvic inflammatory disease / appendicitis
non-infection ie endometriosis , fibroids , surgery
do i have pelvic inflammatory disease
endometriosis
presence of endometrial glands outside uterine cavity
retrograde menstruation is most likely to cause, altered immune function, abnormal cellular adhesion molecule, genetics
dysmenorrhea (before period), dyspareunia , menorrhagia , painful defaecation
male factors of infertility
idiopathic
smoking
excess alcohol
obesity
undescended testes
sexual factors
varicose veins
pre-testicular
testicular
post testicular
investigation of infertility
history: infertility history, gynaecology, andrology, sexual history, social history, PMH, PSH, POH
examination: BMI, general, pelvic
ivx for females = endocrine swab for chlamydia, cervical smear, blood got rubella immunity, midluteal progesterone level, test for tubal patency
others = hystseroscopy, US, chromosomes
