Causes and Treatments of Subfertility Flashcards
Infertility Definition:
- period of time people have been trying to
conceive without success, after which
formal investigation is justified and
treatment - failure to achieve pregnancy after 12
months or more of regular unprotected
sexual intercourse
Primary inferitility:
in couples who have never concieved
Secondary infertility:
in couples who have conceived at least once before (with the same or different sexual partner)
Subfertility:
any form of reduced fertility that results in a prolonged duration of unwanted lack of conception
What % of the population are affected by subfertility?
15%
Chances of Pregnancy:
- 1 month
- 6 month
- 1 year
- 2 years
1 month 20%
6 months 60%
1 year 85%
2 years 95%
Role of expectant management
Prime Causes of Infertility:
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Causes of Subfertility:
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Hormonal Control of Ovulation:
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Anovulation: Causes: Categories:
- hypothalamic ( low GnRH, low FSH/LH, low
oestrogen) - pituitary failure (low FSH/LH, low
oestrogen) - PCOS
– Endocrine
Anovulation: Hypothalamic Causes:
- weight or exercise related amenorrhoea
- Kallman’s syndrome
- stress
- idiopathic
Anovulation: Pituitary Failure Causes:
- Sheehan’s syndrome
- craniopharyngioma
- hypophysectomy
- cerebral radiotherapy
Anovulation: Ovarian Causes:
- PCOS
Anovulation: Other Endocrine Causes:
- hyperprolactinaemia
- hypothyroidism
- congenital adrenal hyperplasia
Hormonal Control of Male Fertility:
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Male Infertility: Categories:
- hypothalamic failure
- testicular failure
Smoking effect on female fertility
Alcohol effect on male fertility
- reduced
- lowers sperm count
Assessment:
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Examination:
- female: fibriods
- azoospermia: testicular varicose veins, vas
deferens, epididymis
Subfertility: Initial Investigations:
- hormonal profile: FSH,LH, Progesterone
(day 21), prolactin, TSH - chlamydia/STI
- pelvic ultrasound
- rubella status
- cervical screen
- semen analysis
- refer for tubal patency test: (HyCoSy, HSG,
lap and dye)
Semen Analysis
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*normal values
* what do we look for?
Abnormal Semen Analysis
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Hysterosalpino-contrast Sonography(HyCoSy)
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HSG: Hysterosalpinogram:
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How many semen analysis samples are taken?
2
few weeks apart
Infertility: Female Treatment:
- lifestyle management
- ovulation induction
- ovarian drilling
- reversal of sterilisation
- ART: assisted reproductive techniques: IUI,
IVF, ICSI
Infertility: Male Treament:
- lifestyle management
- varicocele
- vasectomy
- hypogondaotrophic hypogonadism
ART
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IUI:
- intrauterine semination
IVF:
- in-vitro fertilisation
- used to treat failed ovulation induction,
tubal disease, endometriosis and
idiopathic infertility
Disadvantages: multiple pregnancies, ovarian hyperstimulation syndrome
32% success for women under 35
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ICSI:
- intracytoplasmic sperm injection
- treatment for low sperm count and
inability to penetrate egg - injection within laboratory and then re-
inserted into female
Case: young male and female, unable to conceive for the past 12 months:
- detailed history
- frequency of intercourse
- idiopathic primary infertility
- IVF treatment
Case: female, PCOS, infrequent periods
- lifestyle management
- hormonal problem
- treatment with ovulation induction,
ovarian drilling or resection to manage
cysts
Case: male with oligozoospermia/azoospermia:
- ICSI treatment
Case: Vaginismus:
- psychosexual counselling
- IUI/IVF
- surrogacy
Case: Kallmann’s Syndrome:
- low gondatrophic releasing hormone
- ovulation induction
Case: Premature Ovarian failure:
- lack of oovocytes
- treatment: egg donation, IVF
Case: Hysterctomy:
- surrogacy
Case: Coital Difficulty:
- psychosexual counselling
- IVF
