Causes and Treatments of Subfertility Flashcards
What is the definition of subfertility?
- being unable to become pregnant despite unprotected sex for >1 year
Subfertility is being unable to become pregnant despite unprotected sex for >1 year. There is primary and secondary subfertility, what is primary subfertility?
- being subfertilebut have been pregnant before
Subfertility is being unable to become pregnant despite unprotected sex for >1 year. There is primary and secondary subfertility, what is secondary subfertility?
- subfertile and has never been pregnant
Subfertility is not being unable to become pregnant despite unprotected sex for >1 year. Is the cut off of >1 year the same for everyone?
- no
Subfertility is not being unable to become pregnant despite unprotected sex for >1 year. The cut off of >1 year is not the same for everyone. What are the 3 special circumstances where >1 year may not be used?
1 - adults >35 years may find it more difficult
2 - young couples may struggle
3 - significant pathology (fibroids, amenorrhea)
What is the incidence of subfertility?
- 1:7
- aprox 15%
What 3 basic things are required in order for a fertilised egg to implant and then develop into a baby?
1 - ovulation
2 - sperm
3 - functional fallopian tubes
Subfertility is not being unable to become pregnant despite unprotected sex for >1 year. What % of subfertility is male and female related?
- male = 20%
- female = 80%
Subfertility is not being unable to become pregnant despite unprotected sex for >1 year. The contribution of subfertility is different in male and females with 20 and 80% respectively. What are the main reason for female subfertility?
- ovarian (20%) (anything affecting ovulation)
- tubal (15%) (surgery, chlamydia)
- coital (5%) (ensure sex is occurring 2-3/week)
- others (5%) (fibroids, endometriosis)
- multifactorial (10%) (combination of lots of things)
- idiopathic (25%)
Subfertility is not being unable to become pregnant despite unprotected sex for >1 year. The contribution of subfertility is different in male and females with 20 and 80% respectively. What are the 4 main reason for male subfertility?
- poor sperm motility
- low sperm count
- good sperm morphology
- erectile dysfunction
When we perform a medical history relating to subfertility, what are the main things we would ask males?
- if they’ve had mumps (viral infection) can affect testes and fertility
- cancer treatments
- vasectomy
- lifestyle (drinking, smoking, BMI)
In a male who has cystic fibrosis (CF), why would they have subfertility?
- CF can block ducts
- 95% of male with CF will not have a vas deferens
When we perform a medical history relating to subfertility, what are the main things we would ask females?
- age
- obstetric history
- menstrual history
- fibroids
- endometriosis
- PCOS
- lifestyle (smoking, drinking, BMI)
When we perform a medical history relating to subfertility, there are a number of things we would ask females:
- age
- obstetric history
- menstrual history
- fibroids
- endometriosis
- PCOS
- lifestyle (smoking, drinking, BMI)
Which of these is most important?
- age
- as they age the number of eggs reduces
If a male attends the fertility clinic and he has problems with his sperm we would need to do an examination. When doing an examination, what 3 things would we be conscious about checking in the scrotum?
1 - testes (no sperm being made, so testes will be small)
2 - vas deferens (pipes for sperm are blocked)
3 - epididymis
In men what does azoospermia mean?
- medical term used when there are no sperm in the ejaculate
When a patient attends their GP for an appointment about fertility, they GP can do a hormonal profile. What hormones would be measured?
- leutenising hormone (beginning of cycle is best, 1st day of bleeding)
- follicular stimulating hormone (beginning of cycle is best, 1st day of bleeding)
- thyroid stimulating hormone (important in fertility)
- progesterone day 21 (peaks following ovulation)
- prolactin (can inhibit estrogen and ovulation)
When a patient attends their GP for an appointment about fertility, they GP test of chlamydia, why is this?
- STI
- can cause problems with fallopian tubes
When a patient attends their GP for an appointment about fertility, they GP get an ultrasound test. What are the 3 things the GP might be able to identify using an ultrasound?
1 - fibroids
2 - endometriosis
3 - PCOS
When a patient attends their GP for an appointment about fertility, they GP get a tubal patency test. What is this test?
- tests to check if fallopian tubes are blocked
When we want to assess a males fertility, we can investigate the sperm. Based on the WHO guidelines, what is the normal % for normal sperm morphology?
- 4%
- all that is required for fertilisation
When we want to assess a males fertility, we can investigate the sperm. Based on the WHO guidelines, what is the normal % for normal sperm count?
- > 39 million
When we want to assess a males fertility, we can investigate the sperm. Based on the WHO guidelines, what is the normal % for progressive sperm motility?
- > 32%
The image below is from a Hysterosalpingo-Contrast Sonography (HyCoSy) is an ultrasound procedure used to assess the patency. What does the image confirm?
- that left fallopian tube is blocked
The image below is from a hysterosalpingography, an X-ray procedure used to assess the patency. What does the image confirm?
- left tube may be blocked
Why is it important to address lifestyle in patients with subfertility?
- BMI, smoking and drinking all reduce fertility
In males with subfertility this may be due to varicocele. What is a varicocele?
- an enlargement of the veins within scrotum
- similar to a varicose vein
- common cause of low sperm production and decreased sperm quality
In males with subfertility this may be due to varicocele. A varicocele is an enlargement of the veins within scrotum, similar to a varicose vein. This is a common cause of low sperm production and decreased sperm quality. How can this be treated?
- unblock the veins
- remove the sperm directly from the testes (then use it in IVF)
In males with subfertility this may be because they have had a vasectomy. What is a vasectomy?
- vas deferens are cut and ligated
- sperm cannot reach the penis
- can be reversed in 42% of cases
What is hypogonadotropic hypogonadism?
- hypothalamus or pituitary are not functioning correctly
- gonads will not develop properly
Hypogonadotropic hypogonadism is when the hypothalamus or pituitary are not functioning correctly, causing the gonads not to develop properly. How can this be treated?
- provide exogenous hormones, but response will be slow
In females with subfertility this may be because they have ovulation problems. How can this be treated?
- induce ovulation
- ovarian drilling
- reverse ovarian sterilisation if this was performed
In a fertility clinic, what does ART stand for?
- assisted reproductive techniques
What is Intrauterine insemination (IUI)?
- sperm are washed and concentrated
- sperm are placed directly in the uterus at time of ovulation
What is in-vitro fertilisation?
- an egg is fertilised naturally by adding sperm onto a dish in vitro
- the fertilised egg is placed back into the uterus around ovulation
- woman must be primed though prior to implantation
What is intracytoplasmic sperm injection?
- super is cleaned and concentrated with good quality sperm
- sperm is then inserted into the egg as it cannot penetrate zona pellucida
- fertilised egg is then implanted into the uterus when ovulation should be occurring
If a young couple attend a reproductive clinic, with no known reproductive problems and they have been having sex for 1 year, what treatment or advice would you provide?
1 - IVF
2 - hormone therapy
3 - nothing and to keep trying to become pregnant naturally
4 - IUI
3 - nothing and to keep trying to become pregnant naturally
- more likely to become pregnant naturally
If a young couple attend a reproductive clinic, and the woman has PCOS, Oligomenorrhea (infrequent periods) and a high BMI, what treatment or advice would you provide?
1 - lifestyle management
2 - hormone therapy
3 - nothing and to keep trying to become pregnant naturally
4 - IUI
1 - lifestyle management
- if they lose weight we can do ovulation induction
If a young couple attend a reproductive clinic, and the man has azoospermia (no sperm being released) and oligozoosperia (low sperm count), what treatment or advice would you provide?
1 - lifestyle management
2 - hormone therapy
3 - intracytoplasmic sperm injection
4 - IVF
3 - intracytoplasmic sperm injection
If a young couple attend a reproductive clinic, and the woman vaginismus (contraction of vaginal muscle making sex very difficult), what treatment or advice would you provide?
1 - lifestyle management
2 - hormone therapy
3 - intracytoplasmic sperm injection (ICSI)
4 - intrauterine insemination (IUI)
4 - intrauterine insemination (IUI)
- sperm are injected in manually
If a young couple attend a reproductive clinic, and the woman has Kallmanns syndrome (dysfunction of gonadotropin-pituitary-gonadal axis and loss of smell), what treatment or advice would you provide?
1 - lifestyle management
2 - hormone therapy
3 - intracytoplasmic sperm injection (ICSI)
4 - intrauterine insemination (IUI)
2 - hormone therapy
- gonadotropin hormone therapy
If a young couple attend a reproductive clinic, and the woman has a hysterectomy, what treatment or advice would you provide?
1 - lifestyle management
2 - surrogate
3 - intracytoplasmic sperm injection (ICSI)
4 - intrauterine insemination (IUI)
2 - surrogate
