Endocrine infertility Flashcards
Infertility
Inability to conceive after 1 year of regular unprotected sex (occurs in 1 out of 6 couples)
-caused by male abnormalities (30%), female abnormalities (45%) or unknown cause (25%)
Male hypogonadism (testosterone deficiency) clinical features
- Loss of libido
- Impotence
- Small testes
- Decreased muscle bulk
- Osteoporosis
Male hypogonadism causes
Hypothalamic-pituitary disease -Hypopituitarism -Kallmann syndrome (anosmia, low GnRH) -Illness/underweight Primary gonadal disease -Congenital->Klinefelter syndrome (XXY) -Acquired->testicular torsion, chemotherapy Hyperprolactinaemia Androgen receptor deficiency
Male hypogonadism investigations
-LH/FSH/Testosterone
if all low do pituitary MRI
-Prolactin
-Sperm count
azoospermia=absence of sperm in ejaculate
oligospermia=reduced numbers of sperm in ejaculate
-Chromosomal analysis
check if congenital defect such as Klinefelter Syndrome
Male hypogonadism treatment
-Replacement testosterone for all patients
For fertility:
-if hypothalamic-pituitary disease, use subcutaneous gonadotrophins (LH and FSH)
-if hyperprolactinaemia, use dopamine agonist
Endogenous sites of androgen production
- Interstitial Leydig cells of the testes (males only)
- Adrenal cortex (males and females)
- Ovaries and placenta (females only)
- Tumours
Testosterone actions
- Male genital tract development
- Maintains fertility in adulthood
- Control of secondary sexual characteristics
- Anabolic effects (muscle, bone)
Adult clinical uses of testosterone
- Increases lean body mass
- Increases muscle size and strength
- Increases bone formation and bone mass in young men
- Increases libido and potency
- DOES NOT RESTORE FERTILITY (requires gonadotrophin treatment to restore normal spermatogenesis)
Amenorrhoea
Absence of menstruation (menstrual periods)
- Primary=failure to begin spontaneous menstruation by 16 years old
- Secondary=absence of menstruation for 3 months in a women who has previously had menstrual cycles
Amenorrhoea causes
- Pregnancy
- Lactation
- Ovarian failure (premature ovarian failure, ovariectomy, chemotherapy, ovarian dysgenesis such as Turner Syndrome=45,XO)
- Gonadotrophin failure (hypothalamic/pituitary disease, Kallmann syndrome, low BMI, post pill amenorrhoea)
- Hyperprolactinaemia
- Androgen excess (gonadal tumour)
Amenorrhoea investigations
- Pregnancy test
- LH, FSH, Oestradiol
- Day 21 progesterone
- Prolactin, thyroid function tests
- Androgens (testosterone, androstenedione, DHEAS)
- Chromosomal analysis (check if congenital defect such as Turner Syndrome=45, XO)
- Ultrasound scan of ovaries/uterus
Amenorrhoea treatment
CAUSE
- Primary ovarian failure=infertile and requires HRT
- Hypothalamic/pituitary disease=HRT for oestrogen, Gonadotrophins for fertility as part of IVF
Oligomenorrhoea
Infrequent (irregular long) cycles
-less severe than Amenorrhoea
Polycystic Ovarian Syndrome (PCOS)
- hormonal imbalance
- incidence=1 in 12 women of reproductive age
- associated with increased cardiovascular risk and insulin resistance
PCOS diagnosis
2 of:
- Polycystic ovaries on ultrasound scan
- Oligoovulation/ anovulation
- Clinical/ biochemical androgen excess
