Assessment of Infertility Flashcards
epidemiology of infertility (3)
15% couples
half of these couples will conceive either spontaneously or with relatively simple advice or treatment.
8% of the population remain subfertile and require more complex treatment such as assisted conception techniques.
chance of spontaneous pregnancy (3)
6 months: 75%
12 months: 90%
2 years: 95%
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
infertility
causes considerable psychological distress (health:‘a state of complete physical, mental and social well-being, not merely the absence of disease or infirmity’).
primary
(couple never conceived)
secondary
(couple previously conceived, although pregnancy may not have been successful e.g. miscarriage or ectopic pregnancy)
factors affecting infertility- increasing chance of conception (8)
-Woman aged under 30 years
-Previous pregnancy
-Less than three years trying to conceive
-Intercourse occurring around ovulation
-Woman’s (BMI) 18.5 – 30m/kg2
-Both partners non-smokers
-Caffeine intake less than two cups of coffee daily
-No use of recreational drugs
causes of secondary infertility (5)
-tubal disease
-fibroids
-endometriosis/adenomyosis
-weight related
-age related
Anovulatory Infertility- physiological (4)
-before puberty
-pregnancy
-lactation
-menopause
Anovulatory Infertility- gynae (hypothalmic) (2)
anorexia/bulimia
excessive exercise
Anovulatory Infertility- gynae (pituitary) (3)
hyperprolactinaemia
tumours
Sheehan syndrome
Anovulatory Infertility- gynae (ovarian) (2)
PCOS
premature ovarian failure
Anovulatory Infertility- other conditions (10)
Systematic disorder: e.g. chronic renal failure.
Endocrine disorder: e.g. testosterone secreting tumours, congenital adrenal hyperplasia, thyroid
Drugs: e.g. depo-provera, explanon, OCP
anorexia nervosa
1% population- females 85-95%
aetiology=social-cultural, family pathology, genetic
outcome= at 6 years: 1/3 cured, 1/3 ongoing, 1/3 worse (6-10% mortality)
anorexia nervosa- symptoms, signs + endo features (17)
weight loss, increase exercise, withdrawl friends, amenorrrhoea
low BMI (below 18.5), loss of hair, increased lanugo, low pulse and BP, anaemia, dehydration, reduced bone density, muscle loss and weakness
FSH, LH and oestradiol
polycystic ovary syndrome
commonest endocrine disorder in women (20-33%)
aetiology: inherited condition, weight gain exacerbates condition
polycystic ovary syndrome- symps + endo features (7)
S- obesity, hirsutism or acne, menstrual cycle abnormalities and infertility
E- high free androgens, high LH, impaired glucose tolerance
polycystic ovary syndrome- diagnosis (4)
score 2 out of three:
-chronic anovulation
-polycystic ovaries
-hyperandrogenism (clinical or biochemical)
premature ovarian failure (7)
1% before age 40 years
aetiology:
-idiopathic
-genetic (Turner’s syndrome- missing x chromosome)
(fragile X)
-chemotherapy, radiotherapy, oophorectomy
premature ovarian failure - symps + endo features (8)
S- hot flushes, night sweats, atrophic vaginitis, amenorrhoea, infertility
E- high FSH, high LH, low oestradiol
tubal disease- causes = infective (11)
-Pelvic inflammatory disease
(chlamydia, gonorrhoea, other: anaerobes, syphilis, TB)
-transperitoneal spread:
appendicitis, intra-abdominal abscess
-following procedure: IUCD insertion, hysteroscopy, HSG
tubal disease- causes = non infective (6)
-endometriosis
-surgical (sterilisation, ectopic pregnancies)
-fibroids
-polyps
-congenital
-salpingitis isthmica nodosa
hydrosalpinx due to pelvic inflam disease- features (6)
-abdominal/pelvic pain febrile
-vaginal discharge dyspareunia
-cervical excitation menorrhagia
-dysmenorrhoea
-infertility
-ectopic pregnancy
endometriosis (6)
presence of endometrial glands outside uterine cavity
approx. 20% (10% menstruating women, 30% women with infertility)
aetiology: retrograde menstruation is most likely cause, altered immune function, abnormal cellular adhesion molecules, genetic
