Female Infertility Flashcards
2 groups of female infertility?
anovulatory
tubal factor
what is anovulatory infertility?
where no ovulation takes place
can be normal physiological (before puberty, after menopause, while breastfeeding)
can be pathological (gynae condition, systemic disorder, problem in hypothalamus/pituitary)
hypothalamic causes of anovulatory infertility?
anorexia, bulimia and excessive exercise
due to reduction in FSH, LH and oestradiol
pituitary causes of anovulatory infertility?
hyperprolactinaemia
high levels of prolactin prevent ovulation in the same way which it does during pregnancy and breastfeeding
symptoms include galactorrhoea, aligomenorrhoea/amenorrhoea
other pituitary causes of anovulatory infertility??
sheehans syndrome (post partum hypopituitarism) pituitary adenomas
ovarian causes of anovulatory infertility??
PCOS
premature ovarian failure
PCOS diagnosis?
2 or more of following features present
- anovulation
- polycystic ovaries
- hyperandrogenism (clinical or biochemical)
symptoms of PCOS?
oligomenorrhoea or amenorrhoea hirsutism (due to high androgens) weight gain acne hair loss infertility
how does PCOS cause anovulatory infertility?
dont release an ovum due to overproduction of oestrogen by ovaries
in long term, increased testosterone levels can impair ovum quality and mean that any ovum released is poor quality
endocrine features of PCOS?
high LH
high free androgens
impaired glucose tolerance
what is premature ovarian failure?
ovaries stop producing oestrogen and healthy ova before age of 40
symptoms of premature ovarian failure?
basically menopause symptoms (hot flushes, night sweats, atrophic vaginitis, amenorrhoea/oligomenorrhoea)
what can cause premature ovarian failure?
unknown
can be genetic (turners, fragile X)
exposure to chemo/radiotherapy
can be autoimmune
endocrine features of premature ovarian failure?
high FSH and LH
low oestrogen
what is tubal factor infertility?
blockage in one or both fallopian tubes
can be infective or non-infective
infective causes of tubal factor infertility?
PID
trans-peritoneal spread of other infection such as appendicitis
iatrogenic infection eg from IUD insertion
what is PID?
pelvic inflammatory disease
infection in upper female genital tract
can result in endometritis, salpingitis, oophoritis, parametrises, peritonitis and tubo-ovarian abscesses
what usually causes PID?
bacterial infection spreading from vagina or cervix into fallopian tubes
symptoms of PID?
abdo/pelvic pain dyspareunia dysmenorrhoea inter-menstrual bleeding unusual vaginal discharge severe cases can have severe abdo pain, fever, nausea and vomiting
how is PID managed?
metronidazole + oflaxacin
what complications can occur with PID?
scarring and narrowing of fallopian tubes (can cause infertility and increases risk of ectopics)
how can blocked/scarred fallopian tubes due to PID be managed?
laparoscopic removal of scarring and adhesions after acute inflammation has resolved
non-infective causes of tubal factor infertility?
endometriosis
salpingitis isthmica nodosa
uterine polyps
uterine fibroids
what is endometriosis?
endometrial tissue growing outside of uterus
can involve the ovaries, fallopian tubes and tissue lining pelvis
can sometimes spread beyond pelvis
what happens with the endometrial tissue in endometriosis?
the tissue builds up over menstrual cycles (as it does inside the uterus) then breaks down and “bleeds”
this can cause cysts known as “endometriomas” in the ovaries
other possible complications in emdometriosis?
organs affected can be irritated and over time form scar tissue and adhesions between other pelvic organs
can cause blockage or scarring of fallopian tubes which can result in fertility issues
how does endometriosis present?
severe abdo pain thats worse during menstruation dyspareunia menorrhagia intermenstrual bleeding subfertility
how can endometriosis be managed?
hormonal therapy can be good (COCP etc) but cant be used if trying to conceive
conservative surgery can be used if trying to conceive and symptoms are very severe which would remove the tissue, cysts and adhesions without damaging repro organs
what can be used to diagnose endometriosis and assist with removal of endometrial tissue?
laparoscopy
what is salpingitis isthmica nodosa?
nodular scarring of fallopian tube as a result of inflammation
has been referred to as diverticulosis of fallopian tube bc irregular benign extensions of tubal epithelium develop
results in narrowing of fallopian tube and increases risk of infertility and ectopics
what are uterine polyps?
where endometrial lining inside uterus overgrows and as a result a polyp forms
how can uterine polyps present?
abnormal uterine bleeding
infertility/subfertility
how can polyps be managed?
can be removed surgically via hysteroscopy if causing symptoms or diagnosed during infertility investigation
what are uterine fibroids?
benign tumours of myometrium within uterus
3 main types
- subserosal
- intramural
- submucosal
v common and dont always result in infertility
how can fibroids cause infertility?
can block opening of fallopian tubes
can change shape of uterus, blood flow to uterine cavity and shape of uterine lining resulting in difficult implantation of foetus
how can fibroids be managed if needed?
laparoscopic myomectomy
