Causes And Treatments Of Subfertility Flashcards
Infertility
Failure to achieve pregnancy after one year of frequent unprotected sex
6 months of 2nd infertility and women over 36
Infertility affects how many couples?
1:6
Refer for early specialist consultation when?
- Women over 36
- Known cause of infertility or history of predisposing factors
- Investigations show no chance of pregnancy with expectant management
Female factors?
PCOS, premature ovarian insufficiency, hypopituitarism, radioChemo therapy
Tubual blockage, PID, endometriosis, ectopic pregnancy
Limited ovarian reserve, polyp, fibroid, synechiae (bonding of scar tissue)
Basic infertility checks?
History and examination
FSH,LH, oestrdiol, TFT, Day 2-3 of period
Mid luteal progesterone
Chlamydia swab and rubella
HSG- xray for inside of uterus and fallopian tubes
Pelvic ultrasound
Granulosa cells secrete?
Anti-mullerian hormone
With age, AMH?
Decreases
Most useful investigations in women?
Antral follicle count and pelvic ultrasound
FSH, LH, oestrogen and AMH
Ovulation meds?
Clomid, letrozole and FSH injection
Which scan with dye?
Hyscosy
Volume of semen?
2-6ml
In semen abnormal forms should be?
Less than 96%
Motility of sperm should be?
Over 40%
Count of sperm?
15 x 10 to the power of 6 per ml
For unexplained infertility?
- Do not offer IUI
- Do not offer oral ovulation stimulation
- Offer IVF for women who have not conceived after 2 years
How many cycle of IVF offered under age of 40?
3
Which drug helps with live birth?
Clomiphene
For IVF collection and prevent ovulation which 2 injections are given?
FSH and buserelin
For men with low sperm quality you would use?
Intra cytoplasmic sperm injection
When will further clinical assessment and investigation be conducted in a woman using artificial insemination?
If she hast conceived after 6 cycles
Offer once cycle of IVF to women aged 40-42 if??
- Hasn’t had IVF before
- No evidence of low reserve
- implications of pregnancy
