Endo - Infertility Flashcards
What is infertility?
Failure to achieve pregnancy after 12 months or more of unprotected sexual intercourse
What is primary infertility?
When have not had a live birth previously
What is secondary infertility?
When have had a live birth >12 months previously
What are the pre-testicular causes for infertility?
Congenital & acquired endocrinopathies;
Klinefelters 47XXY
Y chromosome deletion
What are the testicular causes for infertility?
- (Congenital)
- Cryptorchidism
- Infections
- Immunological
- Vascular
- Trauma/surgery
- Toxins
What are the post-testicular causes for infertility?
- Congenital
- Absence of vas deferens
- Obstructive azoospermia
- Erectile dysfunction
- Iatrogenic
- Vasectomy
What is cryptorchidism?
Testes do not pass through the inguinal canal and stay undescended
What can cause infertility in females?
Ovarian causes (40%):
- Anovulation(endo)
- Corpus luteum insufficiency
Tubal causes (30%):
- Infection
- Endometriosis
- Trauma
Uterine causes (10%):
- Chronic endometritis
- Fibroid
- Adhesions
- Congenital malformation
Cervical causes (5%):
- Chronic cervititis
- Immunological (Antisperm Ab)
Pelvic causes (5%):
- Endometriosis
- Adhesions
Unexplained (10%)What is endometriosis?
The presence of functioning endometrial tissue outside the uterus - responds to oestrogen!
What are the symptoms of endometriosis?
- Increased menstrual pain
- Menstrual irregularities
- Deep dyspareunia - pain on sexual intercourse
- Infertility
What treatment can be given for endometriosis?
- Hormonal
- Laprascopic ablation
- Hysterectomy
- Bilateral Salpingo-oophorectomy
What are fibroids?
Benign tumours of the myometrium - responds to oestrogen!
What are the symptoms of fibroids?
- Usually asymptomatic
- Increased menstrual pain
- Menstrual irregularities
- Deep dyspareunia - pain on sexual intercourse
- Infertility
What treatment can be given for fibroids?
- Hormonal
- Hysterectomy
What is the hypothalamic-pituitary-gonadal axis?
1) Kisspeptin neurons stimulate GnRH neurons
2) The GnRH neurons release GnRH and this causes the release of gonadotrophs in the anterior pituitary gland
3) LH & FSH are released into the systemic circulation
4) These gonadotrophs reach the gonads and stimulate the release of either testosterone oestrogen
5) These chemicals then have a negative feedback effect on the kisspeptin neurons
What would happen to LH, FSH and testosterone levels in hyperprolactinaemia?
LH - down
FSH - down
Testosterone - down
What would happen to LH, FSH and testosterone levels in primary testicular failure?
LH- up
FSH - up
Testosterone - down
What is Kallmann syndrome?
Failure of migration of GnRH neurons with olfactory fibers in a developing foetus - leads to: - Low GnRH - Low LH & FSH - Low testosterone (hypotgonadotrophic hypogonadism
What is the treatment for hyperprolactinaemia?
- Dopamine agonist (cabergoline)
- Surgery/DXT
What are the causes for hperprolactinaemia?
- Prolactinoma (micro/macro)
- Pituitary stalk compression
- Pregnancy and breastfeeding
- Medications (dopamine agonists)
What treatment can be given for male infertility?
General lifestyle:
- Optimise BMI
- Reduce alcohol intake
- Smokin cessation
Specific treatment:
- Dopamine agonist for hyper prolactinaemia
- Gonadotrophin treatment for fertility
- Testosterone
- Surgery
What is primary amenorrhoea?
When you start menstruating later than the age of 16
What is secondary amenorrhoea?
Periods start but then stop for at least 3-6 months
What is oligomenorrhoea?
Irregular or infrequent periods, >35 day cycles
OR
4-9 cycles per year
What would happen to the individual levels of LH, FSH and oestradiol in primary ovarian insufficiency?
LH: up
FSH: up
Oestradiol: down
What would happen to the individual levels of LH, FSH and oestradiol in anorexia nervosa-induced amenorrhoea?
LH: down
FSH: down
Oestradiol: down
How do you diagnose PCOS?
Rotterdam PCOS diagnostic criteria
How can you treat PCOS?
- Oral contraceptive pill - amenorrhoea
- Metformin - insulin resistance and amenorrhoea
- Anti-androgens - hirsutism
