Infertility Flashcards
NICE/WHO
Define Infertility
NICE: the period of time people have been trying to conceive without success, after which formal investigation is justified and possible treatment implemented
WHO: the failure to achieve a pregnancy after 12 months or more of regular unprotected sexual intercourse
Epidemiology of infertility in the UK
Affects 1 in 7 heterosexual couples
Primary Infertility
in couples who have never conceived
Secondary infertility
in couples who have conceived at least once before (with the same or different sexual partner)
Subfertility
any form of reduced fertility that results in a prolonged duration of unwanted lack of conception
- sperm formation
- egg formation
Infertility causes
- Male factors 30%
- Unexplained infertility 25%
- Ovulatory disorders 25%
- Tubal damage 20%
- Uterine / peritoneal disorders 10%
40% of infertility = both male/female causes
Ovulatory disorders
- PCOS
- Premature ovarian failure
- Pituitary tumours
- Hypothalamic amenorrhoea
- Genetic
- Adrenal causes e.g. Cushings
Tubal damage
- STIs: Chlamydia, gonorrhoea
- PID
- TOP Hx
- Postpartum infection
- Tuberculosis (worldwide)
Uterine disorders
Fibroids: prevent implantation
Endometiosis
Uterine infection
Ashermans Syndrome
Pelvic infection: appendicitis
Male infertility causes
- Azoospermia
- Oligospermia
- Pituitary tumour / Cushings
- Testicular tumour
- Cryptorchidism: Delay descending of testes
- Erectil dysfunction
Infertility Risk factors
- Increased age > 35
- STIs
- Obesity
- Low BMI
- Smoking
- Alcohol
- Stress: reduced libido
- Tight underwear
- Drugs: NSAIDs, chemo, SSRIs, antipsychotic, Sulfasalazine, alpha blockers
Female infertility Hx taking/Assessment
- Mentrual Hx
- Duration of trying to conceive
- Sexual Hx: Freq. of unprotected SI, Prev preg, prev children, single partner, Dyspareunia
- PMHx: ?Existing pelvic/cervical/uterine pathologies, STIs, CKD, DM, autoimmune
- DHx: Contraception use, cannabis, cocaine
- Social Hx: smoking, alcohol, Obesity, Low BMI, occupation, ?stress
Male infertility Hx taking/Assessment
- Duration of trying to conceive
- Sexual Hx: Freq. of unprotected SI, prev children, single partner
- PMHx: Erectile dysfunction, STIs, CKD, DM, autoimmune, orchitis, malignancy, testicular torsion
- FMHx: Klinefelter Syndrome
- DHx: Contraception use, cannabis, cocaine, anabolic steroids use
- Social Hx: smoking, alcohol, Obesity, Low BMI, occupation, ?stress, cycles, tight underwear
Female infertility Examinations
- BMI
- BP
- ?PCOS
- Abdo exam
- Vaginal exam
Male infertility examinations
- BP
- BMI
- Secondary sexual appearances
- Testicular exam
- inguinal LN exam
GP
Female infertility Ix
- Chlamydia screening
- Progesterone (mid-luteal phase) 7d before the end of cycle
- Bloods: progesterone, FSH, LH, TFTs, PRL
GP
Male infertility Ix
- Chlamydia screen
- Semen analysis
Semen analysis sample collection
- Complete ejaculation of semen sample
- At least 2days but NO more than 7days from sexual abstinence
- Reach to lab within 1h
Abnormal semen analysis result
- Repeat after 3/12
- TWO abnormal results: secondary referral
Female infertility Early (6/12) referral criteria
- Age 36 years and older (refer after 6 months).
- Amenorrhoea or oligomenorrhoea.
- Previous abdominal or pelvic surgery.
- Previous pelvic inflammatory disease.
- Previous sexually transmitted infection (STI).
- Abnormal pelvic examination.
- Known reason for infertility (for example, prior treatment for cancer).
Male infertility referral criteria
- Previous genital pathology.
- Previous urogenital surgery.
- Previous STI.
- Varicocele.
- Significant systemic illness.
- Abnormal genital examination.
- Two abnormal semen examination results.
- Known reason for infertility (for example, prior treatment for cancer).
3 types
Infertility Medical Mx
- Clomifene
- Gonadotrophins
- Pulsatile gonadotrophin-releasing hormone and dopamine agonists
Female infertility surgical Mx
- Tubal microsurgery
- Surgical ablation, or resection of endometriosis plus laparoscopic adhesiolysis
Male infertility surgical Mx
Surgical correction of epididymal blockage in men with obstructive azoospermia
