Female Infertility Flashcards
What are the 3 main causes of female infertility?
Anovulation, tubal disease, uterine/peritoneal disease
Investigations for female infertility are used to assess what?
Ensure regular ovulation and patent tubes
What investigation is used to tell if a woman is ovulation?
Mid-luteal phase (day 21) progesterone level should be > 16pmol/l
What hormones are measured in an endocrine profile for a female?
Day 2-5 LH/FSH, oestrogen, testosterone, sex hormone binding globulin, prolactin and TFTs
What is an endocrine profile used for in the investigation of female infertility?
To establish a cause of irregular or infrequent menstrual cycles
High testosterone and a high LH: FSH ration is seen in which condition?
PCOS
High FSH and low anti-Mullerian hormone indicate what?
Low ovarian reserve
A urine sample is used to test for what in the investigation of female infertility and why?
Chlamydia, a common cause of tubal disease
What is the first line imaging investigation for female infertility?
US of ovaries, uterus and tubes
What must be confirmed before embarking on ovulation induction?
Tubal patency
How may tubal patency be confirmed in low risk women?
Hysterosalpingography
How may tubal patency be confirmed in high risk women?
Laparoscopy and dye
When is a hysteroscopy indicated in the investigation of female infertility?
If there are uterine abnormalities suspected/found on US
What is the WHO group 1 type of anovulatory disorders?
Hypogonadotrophic hypo-oestrogenic
How do type 1 anovulatory disorders usually present?
Amenorrhoea
What will be the relevant hormone levels in type 1 anovulatory disorders?
Low FSH/LH/oestrogen, high prolactin
What are some causes of type 1 anovulatory disorders?
Pituitary tumours, hypothalamic dysfunction
What is the treatment for type 1 anovulatory disorders?
Treat the underlying cause
What is the WHO group 2 type of anovulatory disorders?
Normogonadotrophic normo-oestrogenic
How do type 2 anovulatory disorders usually present?
Oligo/amenorrhoea and maybe also increased body weight, acne and hirsutism
What will be the relevant hormone levels in type 2 anovulatory disorders?
Normal LH, FSH levels but high LH: FSH ration, high testosterone and low sex hormone binding globulin
What condition is the most common cause of type 2 anovulatory disorders?
PCOS
What are some treatment options for type 2 anovulatory disorders?
Weight loss, ovulation induction, ovarian drilling
What is the WHO group 3 type of anovulatory disorders?
Hypergonadotrophic hypo-oestrogenic
What will be the relevant hormone levels in type 3 anovulatory disorders?
High LH/FSH, low oestrogen
What are some causes of type 3 anovulatory disorders?
Hypothyroidism, premature ovarian failure, Turner’s
What are some treatment options for type 3 anovulatory disorders?
HRT, donor oocytes
When can ovulation induction be used as a treatment for subfertility?
If semen analysis is normal, tubes are patent and the female partner has a BMI < 30
Before starting ovulation induction, if the woman is amenorrhoeic, what is given to induce a withdrawal bleed?
Progestogen for 7-10 days
What is the most commonly used agent for ovulation induction? What type of drug is this?
Clomifene citrate, an anti-oestrogen
How does clomifene citrate work?
It stops the production of oestrogen and hence stops oestrogen giving negative feedback to the pituitary gland so more FSH is produced
What are some medications that may be used in combination with clomifene citrate?
Metformin, letrozole, hMG, FSH
What type of drug is letrozole?
Aromatase inhibitor
How is ovarian induction monitored?
US scanning
When is tubal surgery offered to women?
If they have mild disease and are aged < 37
How are women with moderate-severe tubal disease treated?
Referred to ACT
