Assessment of infertility Flashcards
When will infertility rise?
Older women Chlamydia infections Obesity Male factor infertility Awareness of treatments Change in expectations
What are the chances of spontaneous pregnancy?
6 months - 75%
12 months - 90%
2 years - 95%
What is the definition of infertility?
Failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercouse in a couple who have never had a child
What is primary infertility?
Never been able to concieve a pregnancy
What is secondary infertility?
Couple previously conceived although pregnancy not sucessful - miscarriage or ectopic
What factors will increase the chance of conception?
Women under 30 Previous pregnancy Less than 3 years trying to concieve Intercourse occuring around ovulation BMI between 18.5 and 30 Both non smokers Caffeine intake less than 2 cups daily No use of recreational drugs
What are physioloical causes of anovulatory infertility?
Pre-pubertal
Pregnancy
Lactation
Menopause
What are hypothalamic causes of anovulatory infertility?
Anorexia/bulimia
Excessive exercise
What are pituitary causes of anovulatory infetility?
Hyperprolactinaemia
Tumours
Sheehan syndrome
What are ovarian causes of anovultatory infertility?
PCOS
Premature ovarian failure
What are other causes outside gynalogocial causes for anovulatory infertility?
Chronic renal failure Testosterone secreting tumours CAH Thyroid Drugs: depo-povera, explanon, OCP
What are the clinical features of anorexia nervosa?
Low BMI Loss of hair Increased languo Low pulse Low BP Anaemia
What are the endocrine features of anorexia nervosa?
Low FSH
Low LH
Los oestrogen
What is the aetiology of PCOS?
Inherited condition
Weight gain exacerbates condition
What are the clinical features of PCOS?
Obesity Hirsutism Acne Cycle abnormalities Infertility
What are the endocrine features of PCOS?
High free androgens
High LH
Impaired glucose tolerance
How is PCOS diagnosed?
2 out of 3:
Chronic anovulation
Polycystic ovaries
Hyperandrogenism (clinical or biochem)
What is the aetiology of premature ovarian failure?
Idiopathic Genetic (turners, fragile X) Chemo Radiotherapy Oophorectomy
What are the clinical features of premature ovarian failure?
Hot flushes
Night sweats
Atrophic vaginitis
What are the endocrine features of premature ovarian failure?
High FSH
High LH
Low oestrogen
What are the infective causes of tubal disease?
PID (chlamydia, gonnrhoea, anaerobes, syphylis, 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 are the clinical features of hydrosalpinx?
Abdo pain Vaginal discharge Cervical excitations menorrhagia Dysmenorrhoea Infertility Ectopic pregnancy
What is endometriosis?
Presence of endometrial glands outside uterine cavity
What is the aetiology of endometriosis?
Retrograde menstruation
Altered immune function
Abnormal cellular adhesions molecules
Genetic
What are the clinical features of endometriosis?
Dysmenorrhoea Dyspareunia Menorrhagia Painful defecation Chronic pelvic pain Retroverted and fixed uterus Chocolate cysts Infertility
What endocrine problems can cause male infertility?
Hypogonadotrophic hypogonadism
Hypothyroidism
Hyperprolactinaemia
Diabetes
What genetic ocnditions can cause male infertility?
Klienfelters syndrome
Primary cilliary dyskinesia
CF
What drugs can decrease sperm count?
Alcohol, tobacco, mariuana
Testosterone supplements
What drugs can cause hromonal imbalances in males?
Marjuinaa Testosterone supplements Anabolic steroids Opiates Spironolactone
What drugs can decrease sex drive?
Excessive alcohol SSRI antidepressants (prozac)
What drugs can decrease the ability of sperm to fertiize the egg?
CCB
Drugs for gout - colchine, allopurinol
What are the clincal features of non obstructive male infertility?
4 XXY, radiotherapy, undescended testes, idiopathic
Low testicular volume
Reduces secondary sexual characteristics
Vas deferens present
What are the endocrine features of non obstructive male infertility?
High LH
High FSH
Low testosteron
What are the causes of obstructive male infertility?
Congenital absence - CF
Infection
Vasecomty
What are the clinical features of obstructive male infertility?
Normal LH
Normal FSH
Normal testosterone
What should be examined in an infertile woman?
BMI
Body hair distribution
Galactorrhoea
Pelvic exam assessing for uterine and ovarina abnormalities
What should be examined in an infertile male?
BMI
General exam
Genital examination - assessment of size/position testes, penile abnormalities, presence of vas deferens, presence of varicoceles
When should progesterone be assessed?
Midluteal progesterone level (day 21 of aa 28 day cycle)
A progesterone over 30 suggests ovulation
How is tubal patency assessed?
Hysterosalpingiogram or laproscopy
When should a pelvic ultrasound be performed?
Abnormality on pelvic exam e.g. enlarged uterus or adnexal mass
Possible polyp
What investigations should be done in an anovulatory woman?
Urine HCG Prolacin TSH Testosterone and SHBG LH, FSH, oestradiol
What investigations should be performed in a women with hirutism?
Testoesteron and SHBG
What investigations should be perfomed in a woman with amenorrhoea?
Endocrine profile
Chromosome analysis
When should semen be analysed?
Twice over 6 weeks apart
Need to have abstained for 3 days prior
What are the normal semen parameters?
More than 1.5 ml pH 7.2-7.8 More than 15x10 to the power of 6 per ml More than 50% motile More than 4% of normal morphology Less than 1x10 to the power of 6 WBC per ml
What investigations should be done in an abnormal semen analysis?
LH and FSH Testosterone Prolactin Thyroid function Chromosome analysis CF Testicular biopsy
