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Year 2 RE > Causes and Treatments of Subfertility > Flashcards

Causes and Treatments of Subfertility Flashcards

1
Q

What is the definition of subfertility?

A
  • being unable to become pregnant despite unprotected sex for >1 year
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2
Q

Subfertility is being unable to become pregnant despite unprotected sex for >1 year. There is primary and secondary subfertility, what is primary subfertility?

A
  • being subfertilebut have been pregnant before
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3
Q

Subfertility is being unable to become pregnant despite unprotected sex for >1 year. There is primary and secondary subfertility, what is secondary subfertility?

A
  • subfertile and has never been pregnant
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4
Q

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?

A
  • no
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5
Q

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?

A

1 - adults >35 years may find it more difficult
2 - young couples may struggle
3 - significant pathology (fibroids, amenorrhea)

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6
Q

What is the incidence of subfertility?

A
  • 1:7

- aprox 15%

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7
Q

What 3 basic things are required in order for a fertilised egg to implant and then develop into a baby?

A

1 - ovulation
2 - sperm
3 - functional fallopian tubes

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8
Q

Subfertility is not being unable to become pregnant despite unprotected sex for >1 year. What % of subfertility is male and female related?

A
  • male = 20%

- female = 80%

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9
Q

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?

A
  • 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%)
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10
Q

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?

A
  • poor sperm motility
  • low sperm count
  • good sperm morphology
  • erectile dysfunction
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11
Q

When we perform a medical history relating to subfertility, what are the main things we would ask males?

A
  • if they’ve had mumps (viral infection) can affect testes and fertility
  • cancer treatments
  • vasectomy
  • lifestyle (drinking, smoking, BMI)
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12
Q

In a male who has cystic fibrosis (CF), why would they have subfertility?

A
  • CF can block ducts

- 95% of male with CF will not have a vas deferens

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13
Q

When we perform a medical history relating to subfertility, what are the main things we would ask females?

A
  • age
  • obstetric history
  • menstrual history
  • fibroids
  • endometriosis
  • PCOS
  • lifestyle (smoking, drinking, BMI)
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14
Q

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?

A
  • age

- as they age the number of eggs reduces

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15
Q

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?

A

1 - testes (no sperm being made, so testes will be small)
2 - vas deferens (pipes for sperm are blocked)
3 - epididymis

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16
Q

In men what does azoospermia mean?

A
  • medical term used when there are no sperm in the ejaculate
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17
Q

When a patient attends their GP for an appointment about fertility, they GP can do a hormonal profile. What hormones would be measured?

A
  • 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)
18
Q

When a patient attends their GP for an appointment about fertility, they GP test of chlamydia, why is this?

A
  • STI

- can cause problems with fallopian tubes

19
Q

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?

A

1 - fibroids
2 - endometriosis
3 - PCOS

20
Q

When a patient attends their GP for an appointment about fertility, they GP get a tubal patency test. What is this test?

A
  • tests to check if fallopian tubes are blocked
21
Q

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?

A
  • 4%

- all that is required for fertilisation

22
Q

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?

A
  • > 39 million
23
Q

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?

A
  • > 32%
24
Q

The image below is from a Hysterosalpingo-Contrast Sonography (HyCoSy) is an ultrasound procedure used to assess the patency. What does the image confirm?

A
  • that left fallopian tube is blocked
25
Q

The image below is from a hysterosalpingography, an X-ray procedure used to assess the patency. What does the image confirm?

A
  • left tube may be blocked
26
Q

Why is it important to address lifestyle in patients with subfertility?

A
  • BMI, smoking and drinking all reduce fertility
27
Q

In males with subfertility this may be due to varicocele. What is a varicocele?

A
  • an enlargement of the veins within scrotum
  • similar to a varicose vein
  • common cause of low sperm production and decreased sperm quality
28
Q

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?

A
  • unblock the veins

- remove the sperm directly from the testes (then use it in IVF)

29
Q

In males with subfertility this may be because they have had a vasectomy. What is a vasectomy?

A
  • vas deferens are cut and ligated
  • sperm cannot reach the penis
  • can be reversed in 42% of cases
30
Q

What is hypogonadotropic hypogonadism?

A
  • hypothalamus or pituitary are not functioning correctly

- gonads will not develop properly

31
Q

Hypogonadotropic hypogonadism is when the hypothalamus or pituitary are not functioning correctly, causing the gonads not to develop properly. How can this be treated?

A
  • provide exogenous hormones, but response will be slow
32
Q

In females with subfertility this may be because they have ovulation problems. How can this be treated?

A
  • induce ovulation
  • ovarian drilling
  • reverse ovarian sterilisation if this was performed
33
Q

In a fertility clinic, what does ART stand for?

A
  • assisted reproductive techniques
34
Q

What is Intrauterine insemination (IUI)?

A
  • sperm are washed and concentrated

- sperm are placed directly in the uterus at time of ovulation

35
Q

What is in-vitro fertilisation?

A
  • 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
36
Q

What is intracytoplasmic sperm injection?

A
  • 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
37
Q

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

A

3 - nothing and to keep trying to become pregnant naturally

- more likely to become pregnant naturally

38
Q

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

A

1 - lifestyle management

- if they lose weight we can do ovulation induction

39
Q

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

A

3 - intracytoplasmic sperm injection

40
Q

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)

A

4 - intrauterine insemination (IUI)

- sperm are injected in manually

41
Q

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)

A

2 - hormone therapy

- gonadotropin hormone therapy

42
Q

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)

A

2 - surrogate

Year 2 RE (53 decks)

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