Fertility Flashcards
What are the causes of male infertility?
Pre-testicular (LOW FSH)
Testicular (HIGH FSH)
Post- testicular (NORMAL FSH)
Pre:
Hypothalamic disease
Kallmans
Prader-Willi
CHARGE
Pituitary pathology
Tumours
Brain injury inc iatragenic
Testicular: Genetic. Kleinfelters. Noonan’s
Cryptorchidism
Acquired: injury, varicocele, tumours. chemo/xrt, idiopathic
Post: Congenital
Congenital absence of the vas deferens
CF
Youngs
Acquired: Infection, Vasectomy
Sperm dysmotility
Immotile cilia syndrome
Maturation defects
Immunological infertility
Globozoospermia
Sexual dysfunction
What are the WHO classification of sub fertility disorders?
Type 1 - hypothalamic pituitary failure (stress/anorexia/exercise)
Type 2 - hypothalamic pituitary dysfunction (PCOS)
Type 3 - Ovarian Failure
Also - Hyperprolactinaemic amenorrhoea
What is treatment of sub fertility, according to type?
Management Group I
Increase BMI if <19 kg/m2
Reduce exercise if high levels
Pulsatile GnRH or Gonadotrophins with LH activity to induce ovulation
Management Group II
Weight reduction if BMI >30
Clomifene/Clomiphene (1st line)
Meformin (1st line)
Clomiphene & Metformin (1st/2nd line)
**Do not use Clomiphene for more than 6 months total **
Laparoscopic drilling (2nd line)
Gonadotrophins (2nd line)
Management Group III
Consider IVF with donor eggs
Management Hyperprolactinaemia
Investigate cause e.g. MRI head (?pituitary adenoma) medication review (some antipsychotic medications for example can cause prolactin rise)
Dopamine agonist (Bromocriptine advised by NICE as 1st line)
What are risk factors for OHSS?
PCOS
High AMH
Increased antral follicle count
Previous OHSS
NOT high oestrogen
What investigations are used for sub fertility?
If any history of PID/Endometriosis - lap & dye so can physically assess for other pathology at the same time
If low sperm count - repeat in first instance, 3 months apart
What is the impact of uterine artery embolisation on pregnancy outcomes?
Higher rates of caesarean section +PPH
Suggestion by studies of higher rates 1st trimester miscarriage
Unchanged rates of miscarriage (after 1st trimester), SGA, malpresentation or preterm delivery
What are the indications for and complications of Uterine artery embolisation
Indications: management of fibroids
Effective as surgery up to 5 years
40-70% reduction in fibroid volume
1 in 3 go on to need further treatment
Ongoing hysterectomy risk is 2.9% (from complications)
Contraindications:
PID
Pregnancy
Complications:
Typically present late…
vaginal discharge 16%
expulsion of fibroid material 10%
Endometritis (rare)
Amenorrhoea
Change in sexual function
What are normal parameters for semen analysis?
Semen volume: Greater than or equal to 1.5 ml
pH: Greater than or equal to 7.2
Sperm concentration: Greater than or equal to 15 million spermatozoa per ml
Total sperm number: 39 million spermatozoa per ejaculate or more
total motility (% of progressive motility and nonprogressive motility): 40% or more motile or 32% or more with progressive motility
Vitality: 58% or more live spermatozoa
Sperm morphology (percentage of normal forms): 4% or more
What is the advice for couples planning to conceive, after travel to an area with Zika prevalence?
If both members or male partner travelled - no UPSI 3 months
If female partner travelled - no UPSI 2 months
At how many months should a couple be referred for fertility investigations?
Routine - 12 months
If any clinical cause for sub fertility (Endometriosis) or age >35 then refer at 6 months
What is the rate of multiple pregnancy in IVF?
About 1 in 4 IVF pregnancies resulting in live birth babies were multiple pregnancies (1 in 80 for spontaneous pregnancies).
2 out of 5 live born babies from IVF were from multiple pregnancies (1 out of 40 for spontaneous pregnancies)
What is the sensitivity and specificity in HSG (with lap and dye as gold standard)?
SENSITIVITY 0.65
SPECIFICITY 0.83
When HSG suggests that the tubes are patent, this will be confirmed at laparoscopy in 94% of women, and so HSG is a reliable indicator of tubal patency.
However ,when HSG suggests the presence of tubal obstruction this will be confirmed by laparoscopy in only 38% of women.
What percentage of men are sterile?
Approximately 1% of men are permanently sterile
About 20% of men having sperm quality below the threshold thought compatible with normal fertility (conception within 1 year)
How much copper is on a copper coil?
380mm2, and should be around arms (banded) to be most effective
What is the failure rate of female vs male sterilisation?
Female 1 in 200
Male 1 in 2000
