Female Factor Infertility Flashcards
What are the main causes of female factor infertility
Anovulatory Tubal Damage Uterine Abnormalities Endometriosis Miscellaneous e.g. Turners, medications, psychosexual
Describe the types of anovulatory infertility and give examples.
WHO group 1 - hypothalamic/pituitary failure e.g. IHH, Kallman’s, low body weight, stress, excessive exercise, intracranial tumour
WHO group 2 - hypothalamic/pituitary dysfunction e.g. PCOS
WHO group 3 - ovarian failure e.g. POF, turners can come into this category as it can cause POF
WHO group 3 - hyperprolactinaemia
what is PCOS
a condition which is present in 5 percent of reproductive aged women and is a common cause of oligo-amenorrhea
characterised by disrupted follicular genesis, excess of androgens and insulin resistance
what is the diagnostic criteria of PCOS
Rotterdam 2 of 3:
- polycystic ovaries on ultrasound - either more than or equal to 12 antral follicles in one ovary or an enlarged ovary more than or equal to 10ml
- evidence of hyperandrogenism
- oligo/anovvulation
what is premature ovarian failure
menopause before the age of 40
diagnosed by 2 FSH levels greater than 30mlU/ml one month apart.
what can cause hyperprolactinaemia
pituitary adenoma
antipsychotic medications
what can cause tubal damage
chlamydia
endometriosis
peritubal adhesiosn from surgery
history of previous ectopic suggest likely ongoing tubal damage
what uterine abnormalities exist
fibroids - submucosal, intramural, subserosal - submucosal more likely to affect fertility as they disrupt implantation
abnormal uterine shapes e.g. bicornate, double uterus/vagina
How are fibroids treated
hormonally dependent so may increase in size during IVF/pregnancy
can be removed if large and symptomatic >3cm is typical cut off
can be removed to improve fertility
what is endometriosis
presence and proliferation of endometrial tissue out with the uterine cavity
most likely due to retrograde menstruation with subsequent implantation and oestrogen derived growth of deposits
four grades; minimal, mild, moderate, severe
what is the name of a cyst of endometriosis of ovary
endometrioma
what is the reasons for reduced fertility with increasing maternal age
increase proportion of aneuploidy oocytes
this will be more likely to result in an aneuploidy embryo and thus miscarry
What test is done to assess ovulation in women with regular periods
mid luteal progesterone
should be done approx. 7 days before next mensturation
normal level is more than 16nmol/l -consistent with ovulation
what test is done to assess ovulation/anoulation in women with irregular periods
FSH, LH, testosterone, thyroid function, prolactin
FSH normal - PCSO
FSH high - POF
FSH low- IHH, over exercise, stress, low BMI
What are the methods of assessing tubal patency
HSG
Laparoscopy and dye
Hysterocontrasty-ultrasonography (HyCoSy)
What is HSG and who would get this investigation
this is first line for most women to assess tubal patency
should be done after menstruation and befpre ovulation incase there is pregnancy
involves injecting radiopaque dye into uterine cavity followed by taing a series of x ray images
how sensitive is HSG
80 percent sensitive to diagnosin tubal patency
why might a hsg show a wrong result
the dye can cause spasming of fallopian tubes and make them appear occluded when they are not
what are the risks of HSG
painful
false results
possibility of introducing infection into pelvis - screen for STIs prior to procedure or give antibiotics if unscreened
what is done if HSG is abnormal
laparoscopy
What is laparoscopy and dye
performed under general anaesthetic
inflate abdomen with CO2 inspect pelvis laparosccally with camera inserted through port in umbilicus
dye is injected into cervix via a catheter and the fallopian tubes are seen to fill with dye and spill some dye into the pelvis if patent
what are the advantages of laparoscopy and dye
you can visualise pelvis for endometriosis, adhesions, fibroids
opportunity to deal with some of these is they are present and not too severe
What patients would receive a laparoscopy rather than HSG
history of PID
history of ectopic pregnancy
endometriosis
What is hycosy
ultrasound opaque liquid injected into uterine cavity and ultrasound used to visualise
not done in ninewells
