Assessment of Infertility Flashcards
define 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 can be broken into 2 - name them
primary or secondary
define:
(a) primary infertility
(b) secondary infertility
(a) primary infertility
couple who have nerve conceived
(b) secondary infertility
couple previously conceived, although pregnancy may not have been successful e.g. miscarriage or ectopic pregnancy
what increases the chance of fertility?
woman < 30 previous pregnancy intercourse around ovulation healthy BMI non-smokers low caffeine intake no recreational drugs
nae the condition that results in infertility that affects 1% of the population that is more common in females
anorexia nervosa
clinical features of anorexia nervosa?
low BMI loss of hair increased lanugo low pulse and BP anaemia
endocrine features of anorexia nervosa - low or high?
(a) FSH
(b) LH
(c) oestradiol
(a) FSH - LOW
(b) LH - LOW
(c) oestradiol - LOW
name the commonest endocrine disorder in women
polycystic ovarian syndrome
polycystic ovarian syndrome clinical features?
inherited obesity hirsutism acne cycle abnormalities infertility
endocrine features of PCOS - low or high?
(a) androgens
(b) LH
(c) glucose
endocrine features of PCOS - low or high?
(a) androgens - HIGH
(b) LH - HIGH
(c) glucose - IMPAIRED
diagnosis of PCOS is 2 out of the 3 what?
chronic anovulation
polycystic ovaries
hyperandrogenism
what can cause premature ovarian failure?
idiopathic
genetic - turners or fragile X
chemo or radiotherapy
oophorectomy
clinical features of premature ovarian failure?
hot flushes
night sweats
atrophic vaginitis
endocrine features of premature ovarian failure - low or high?
(a) FSH
(b) LH
(c) oestradiol
(a) FSH - HIGH
(b) LH - HIGH
(c) oestradiol - LOW
tubal disease can be either what 2 things?
infective or non-infective
what is a hydrosalpinx?
a condition that occurs when the fallopian tube is blocked and fills with serous or clear fluid near the ovary
the blocked tube may become substantially distended giving the tube a characteristic sausage-like shape
clinical features of hydrosalpinx due to pelvic inflammatory disease
abdominal pain
vaginal discharge
infertility
ectopic pregnancy
presence of endometrial glands outside uterine cavity defines what?
endometriosis
endometriosis clinical features?
dysmenorrhoea dysparenuia
menorrhagia
painful defaecation
chronic pelvic pain
uterus may be fixed and retroverted
scan may show characteristic ‘chocolate’ cysts on ovary
infertility or asymptomatic
clinical features of non obstructive disorders in male such as 47 XXY, chemo/radiotherapy?
low testicular volume
reduced secondary sexual characteristics
vas deferens present
endocrine features of non-obstructive disorders - low or high?
(a) FSH
(b) LH
(c) testosterone
(a) FSH - HIGH
(b) LH - HIGH
(c) testosterone - LOW
give examples of obstructive causes
cystic fibrosis, infection or vasectomy
clinical features of obstructive causes of infertility
normal vesicular volume
normal secondary sexual characteristics
vas deferens may be absent
endocrine features of non-obstructive disorders - low or high or normal?
(a) FSH
(b) LH
(c) testosterone
(a) FSH - NORMAL
(b) LH - NORMAL
(c) testosterone - NORMAL
what is examined in a female with infertility?
BMI
general - body hair and galactorrhea
pelvic examination - uterine and ovarian abnormalities/tenderness and mobility
what is examined in a male with infertility?
BMI general size/position of testes penile abnormalities presence of vas deferens presence of varicoceles
name the test of tube patency
hysterosalpingiogram or laparoscopy
in who is a hysterosalpingiogram performed?
those with previous pelvic surgery, Crohns or obesity
rest get laparoscopic
what is only performed in cases where suspected or known endometrial pathology?
hysteroscopy
name the non-invasive investigation to view the inner pelvis?
pelvic US
