Assessment of Infertility Flashcards
How common is infertility?
Affects 1:6 couples (15%) = about half of these couples will conceive either spontaneously or with relatively simple advice/treatment
How much of the population require more complex treatment for infertility?
8% remain subfertile and require more in-depth treatment
What are some factors linked with the rise on infertility?
Older women, rise in chlamydia, increase in obesity, increasing male factor infertility, increasing awareness of treatment, change in expectations
What are the cumulative conception rates for spontaneous pregnancy?
75% at 6 months, 90% at 12 months, 95% at two years
What is infertility defined as?
Failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sex (in absence of known reason) in a couple who have never had a child
What are the types of infertility?
Primary = couple have never conceived Secondary = couple conceived, although pregnancy may not have been successful (e.g miscarriage)
Why is infertility classed as a disease?
It causes considerable psychological distress
What are some factors that increase the likelihood of successful spontaneous pregnancy?
Women aged <30, previous pregnancy, <3 years trying to conceive, intercourse occurring around ovulation, woman/s BMI 18.5-30, both partners non-smokers, caffeine intake <2 cups of coffee a day, no use of recreational drugs
What are physiological causes of anovulatory infertility?
Before puberty, pregnancy, lactation, menopause
What are some gynaecological conditions that cause anovulatory infertility?
Hypothalamic = anorexia/bulimia, excessive exercise Pituitary = hyperprolactinaemia, tumours, Sheehan's Ovarian = PCOS, premature ovarian failure
What are some general causes of anovulatory infertility?
Chronic renal failure, testosterone-secreting tumours, congenital adrenal hyperplasia, thyroid, drugs (Depo-Provera, explanon, OCP)
How common is anorexia nervosa?
Affects 1% of population = more common in women, unknown aetiology
What are some features of anorexia nervosa?
Low BMI (<18.5), loss of hair, increased lanugo, low pulse and BP, anaemia Endocrine features = low FSH, LH and oestradiol
How common is polycystic ovary syndrome (PCOS)?
Most common endocrine disorder in women (20-33%) = usually inherited, exacerbated by weight gain
What are some features of polycystic ovary syndrome?
Obesity, hirsutism or acne, cycle abnormalities, infertility
Endocrine features = high free androgens, high LH, impaired glucose tolerance
How is polycystic ovary syndrome diagnosed?
Score of 2 out of three of the following = chronic anovulation, polycystic ovaries, hyperandrogenism
What are some causes of premature ovarian failure?
Idiopathic, chemo/radiotherapy, oophorectomy
Genetic = missing X chromosome in Turner’s syndrome, fragile X
What are the features of premature ovarian failure?
Hot flushes, night sweats, atrophic vaginitis
Endocrine features = high FSH, high LH, low oestradiol
What are some infective causes of tubal disease?
Chlamydia, gonorrhoea, anaerobes, syphilis, TB
Spread from appendicitis/intra-abdominal abscess
Following IUCD insertion, hysteroscopy or HSG
What are some non-infective causes of tubular disease?
Endometriosis, surgical (sterilisation, ectopic pregnancy), fibroids, polyps, congenital, salpingitis isthmica nodosa
What are some symptoms of a hydrosalpinx due to pelvic inflammatory disease?
Abdominal/pelvic pain, vaginal discharge, dyspareunia, cervical excitation, dysmenorrhoea, infertility, ectopic pregnancy
How common is endometriosis?
Affects about 20% = 10% of menstruating women, 30% of women with infertility
What is endometriosis?
Presence of endometrial glands outside uterine cavity
What causes endometriosis?
Most likely due to retrograde menstruation
May be genetic, or due to altered immune function or abnormal cellular adhesion
