Female Infertility Flashcards
What is infertility?
Failure to conceive after 2 years of regular unprotected sexual intercourse (UPSI)
What is primary subfertility?
Never managed to conceive
What is secondary subfertility?
Managed to conceive in the past but difficulty conceiving again
What are the risk factors?
Smoking
Obesity
Occupational risks
Excessive alcohol consumption
Drug use
What are the different causes?
Ovarian/ovulatory
Tubal
Pelvic uterine
Male infertility
No identifiable cause
What is the most common type of ovarian cause?
Anovulation
What is anovulation?
Failure of ovary to release over a period of least 45 days
What is the WHO classification of ovarian problems?
Group I
Group II
Group III
What is Group I?
Hypogonatrophic hypogonadism
= impaired secretions of gonadotropins
What is seen in Group I?
Low levels of FSH + LH = low oestradiol levels
What are the causes of Group I?
Prolactinomas (pituitary tumours)
Hypothyroidism
Drugs - antipsychotics, antidepressants, opioids + anti-hypertensives
What is Group II?
Hypothalamic-pituitary-ovarian dysfunction
What is seen in Group II?
Raised FSH/LH ratio
What is the main problem seen in Group II?
Polycystic ovary syndrome (PCOS)
What are the symptoms of PCOS?
Fewer or no periods
Hirsutism
Obesity
Acne
Infertility
What is Group III?
Hypergonadotrophic hypogonadism
= impaired response to gonadotrophins
What is seen in Group III?
High levels of FSH + LH
What are the causes of Group III?
Chromosomal abnormalities
Premature ovarian failure
Surgery/trauma
Defects in hormone synthesis
What are the causes of tubal problems?
Damage/blockage to fallopian tubes
= prevent sperm reaching ovum
Pelvic inflammatory disease (PID)
What are the causes of pelvic problems?
Pelvic adhesions + endometriosis
Pelvic damage from chlamydia
What are the causes of uterine problems?
Abnormalities = fibroids, polyps + adhesions
= affect sperm migration + embryo implantation
What is the treatment for Group I disorders?
Gonadotropin releasing hormones
Or gonadotropins with LH activity
What do GnRH analogues do?
Group I treatment
Activate GnRH receptor on pituitary gland = increased secretion of FSH + LH
What are examples of GnRH analogues?
Group I treatment
Buserelin
Goserelin
Nafarelin
What can also be done in the treatment of Group I disorders?
Hyperprolactinemia treatment with dopamine agonists
eg. Cabergoline
What are the drugs for Group II?
Clomifene citrate
Metformin
BOTH
How is Clomifene citrate used?
Group II treatment
Given for 5 days started on cycle day 2-5
Should NOT be used for more than 6 cycles
Why use Metformin?
Group II treatment
Women with PCOS frequently experience insulin resistance
What are the assisted reproductive technology?
Intrauterine insemination (IUI)
In vivo fertilisation
Intracytoplasmic sperm injection
What is IUI?
Fast moving sperm placed into woman’s womb close to time of ovulation
When is IVF considered?
If unsuccessful after 6 cycles of IUI despite evidence of normal ovulation a further 6 cycles then IVF considered
When is IUI considered?
Difficulty having sex due to disability or psychosexual problem
Pain during intercourse
Male impotence
One partner has HIV
Sperm donation used
What is IVF?
Woman’s eggs collected + fertilised manually with sperm
If successful embryo developed for 2-6 days then transferred to womb
Who is IVF for?
Woman with unexplained infertility
Blocked fallopian tubes
Male infertility
Unsuccessful treatment with IUI
What is the criteria for IVF?
Woman 21-39
BMI 19-30
Both non-smokers
No living children from past or present relationships
Both live at same address
Stable relationship
Neither sterilisation procedures
What are the risks of IVF?
Ovarian hyperstimulation syndrome (OHSS)
Ectopic pregnancy
What is lifestyle advice?
Women with BMI less than 19 = irregular periods
Both BMI over 30 = longer to conceive
Smoking + drugs = affect egg + sperm quality
Chlamydia + STIs
