Assessment of infertility Flashcards by Joanna Mitchell

When will infertility rise?

Older women
Chlamydia infections
Obesity
Male factor infertility
Awareness of treatments
Change in expectations

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What are the chances of spontaneous pregnancy?

6 months - 75%
12 months - 90%
2 years - 95%

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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

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What is primary infertility?

Never been able to concieve a pregnancy

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What is secondary infertility?

Couple previously conceived although pregnancy not sucessful - miscarriage or ectopic

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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

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What are physioloical causes of anovulatory infertility?

Pre-pubertal
Pregnancy
Lactation
Menopause

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What are hypothalamic causes of anovulatory infertility?

Anorexia/bulimia

Excessive exercise

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What are pituitary causes of anovulatory infetility?

Hyperprolactinaemia
Tumours
Sheehan syndrome

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What are ovarian causes of anovultatory infertility?

PCOS

Premature ovarian failure

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What are other causes outside gynalogocial causes for anovulatory infertility?

Chronic renal failure
Testosterone secreting tumours
CAH 
Thyroid 
Drugs: depo-povera, explanon, OCP

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What are the clinical features of anorexia nervosa?

Low BMI
Loss of hair
Increased languo
Low pulse
Low BP 
Anaemia

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What are the endocrine features of anorexia nervosa?

Low FSH
Low LH
Los oestrogen

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What is the aetiology of PCOS?

Inherited condition

Weight gain exacerbates condition

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What are the clinical features of PCOS?

Obesity
Hirsutism
Acne
Cycle abnormalities
Infertility

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What are the endocrine features of PCOS?

High free androgens
High LH
Impaired glucose tolerance

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How is PCOS diagnosed?

2 out of 3:
Chronic anovulation
Polycystic ovaries
Hyperandrogenism (clinical or biochem)

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What is the aetiology of premature ovarian failure?

Idiopathic
Genetic (turners, fragile X) 
Chemo
Radiotherapy
Oophorectomy

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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 ```