Fertility Flashcards
give 5 causes of infertility
sperm problem (most common)
ovulation problem
tubal problems
uterine problems
unexplained
give 6 pieces of lifestyle advice for coupls getting pregnant
400mcg folic acid daily (woman)
healthy BMI
avoid smoking and excessive alcohol
reduce stress
aim for intercourse every 2-3
AVOID timed intercourse
what female hormone testing is done for fertility investigations
-serum LH (high may = PCOS) on day 2-5
-serum FSH (high may suggest poor ovarian reserve) on day 2-5
-progesterone on day 21 : rise = ovulation has occurred
-anti-mullerian hormone : marker of ovarian reserve. high = good ovarian reserve
what further Ix can be performed in secondary care to assess fertility
-USS pelvis for PCOS or uterine structural abnormalities
-Hysterosalpingogram to look at patency of fallopian tubes
-Laparoscopy and dye test for patency of fallopian tube, adhesions and endometriosis
what is a hysterosalpingogram
assess shape of uterus and patency of fallopian tubes
x-ray images are taken with a contrast medium
if dye doesn’t fill one of the tubes = obstruction
give 6 treatments options for anovulation
weight loss for PCOS
clomifene to stimulate ovulation
ovarian drilling in PCOS
metformin in insulin insensitivity & obesity
what is clomifene
-A selective oestrogen receptor modulator (anti-oestrogen)
Stops neg feedback of oestrogen on hypothalamus
Greater GnRH release and subsequently greater FSH and LH
how can sperm issues be managed
surgical sperm retrieval if there is a blockage
surgical correction of obstruction
intra-uterine insemination
intracytoplasmic sperim injection
donor insemination
give 3 pre testicular causes of male infertility
hypothalamus or pituitary pathology
suppression due to stress, chronic conditions or hyperprolactinaemia
kallman syndrome
can all cause hypogonadotrophic hypogonadism (low FSH, low LH = low testosterone)
Give 2 testicular causes of male infertility
- Testicular damage
- Genetic or congenital disorders
what are the post-testicular causes of male infertility
ejaculatory duct obstruction
rertrograde ejaculation
scarring from epididymitis
absence of vas deferens
give 5 Ix for male infertility
hormonal analysis : FSH, LH and testosterone
genetic testing
further imagining
vasography
testicular biopsy
what are the 6 steps of IVF
suppressing natural menstrual cycle
ovarian stimulation
oocyte collection
insemination
embryo culture
embryo transfer
how can the natural menstrual cycle be suppressed
-GnRH agonists (e.g. goserelin) : given in luteal phase. Itially stumulates pituitary to secrete large amounts of FSH and LH. There is then negative feedback suppressing natural GnRH, suppressing menstrual cycle.
-GnRH antagonist protocol (e.g. cetrorelix) : from 5-6 days of ovarian stimulation suppresses the body releasing LH and causing ovulation to occur
