Fertility Flashcards
What is primary and secondary infertility?
Primary- female partner has never conceived
Secondary- female partner had previously conceived, even If this resulted in a miscarriage or abortion
What is the definition of sub fertility?
A couple is sub fertile if they have had unprotected regular sex for a year and conception has not occurred.
What percentage of couples achieve pregnancy after having regular sex (every 2-3 days) without contraception for two years?
90%
What are the causes of subfertility?
Tubal disease - 25% Anovulatory infertility - 30% Endometriosis - 5% Male factor - 35% Unexplained - 15%
What lifestyle recommendations can be made to a couple trying to conceive?
Both couples should be engaged
Take folic acid 400mcg (5mg if previous NTD, epileptic or obese)
Stop smoking
Drink minimal alcohol
What are the ovarian, pituitary, and hypothalamic causes if an ovulation?
Ovarian:
Poly cystic ovary syndrome
Premature ovarian failure
Pituitary:
Hyperprolactinaemia
Hypopituitarism
Hypothalamic:
Weight loss and over exercise
Systemic illness
Idiopathic hypogonadotrophic hypogonadism
Kallmans syndrome- genetic condition resulting in low level of LH and FSH
What is the usual cause of hyperprolactinaemia?
Benign pituitary Adenoma
Also associated with pcos and psychotropic drugs
How does hyperprolactinaemia cause subfertility?
Reduces Gnrh release, which reduces LH and FSH and subsequently reduces oestrogen and prevents ovulation
How does hyperprolactinaemia present?
Oligomenorrhoea or amenorrhoea, also galactorrhoea
May also have headaches and bilateral hemianopia if due to pituitary adenoma
How are is subfertility due to hyperprolactinaemia treated?
Bromocriptine
Cabergoline
Restores ovarian function in 85%
What is poly cystic ovary?
USS appearance of the ovary in which greater than 12 small cysts (these are actually follicles) appear on the ovarian epithelium
This is found in 20% of women
What criteria must be met for polycystic ovary syndrome?
Oligo and/or amenorrhoea
Polycystic ovaries
Hyper androgenism - hirsutism, acne, obesity
Two out of three of the above
A large proportion develop diabetes later in life
Cardiovascular disease, endometrial and breast carcinoma are also more common
How is infertility managed in PCOS?
Weight loss
Chlomiphene citrate- anti oestrogen - increases FSH and LH
Gonadotropins
Laparoscopic ovarian diathermy
How is ovulation induced with Gonadotropins?
Purified FSH and LH given in the follicular phase or at regular intervals
This stimulates follicular growth
Once a follicle is the right side for ovulation, ovulation is induced by injecting hcg
What are the side effects of ovarian induction?
Multiple pregnancy, as more than one follicle may mature
Ovarian hyper stimulation syndrome - follicles become very large and painful. Vasodilation causes hypovolaemic, ascites, pulmonary oedema, dehydration
Ovarian carcinoma
What are the who definitions of normal sperm analysis?
Volume: 2ml PH 7.2-8.0 Count >15 million ml Motility > 40% Morphology >4% normal Antisperm antibodies - negative
What are common causes of abnormal/absent sperm release?
Idiopathic oligispermia and asthenozoospermia - low sperm numbers and motility
Drug exposure - alcohol, smoking, exposure to industrial chemicals
Varicocoele
Antisperm antibodies
Infections, klinefelters, kallmans
What does asthenozoospermia mean?
Reduced sperm motility
What does oligozoospermia mean?
<15 million/ml sperm
What does teratozoospermia mean?
Abnormal sperm morphology
How can make factor subfertility be managed?
Lifestyle changes and reduce drug exposure- testicular cooling
Treat causes: ligate varicocoele, treat pituitary disease with gonadotrophins
Surgical spermatozoa retrieval- testicular sperm aspiration or microsurgical sperm aspiration from the epidydimus
Intracytoplasmic sperm injection
What are the causes of tubal factor infertility?
PID Endometriosis Previous surgery - adhesions Fibroids Polyps
How is tubal factor infertility investigated?
Hysterosalpingogram in low risk women
Laparoscopy and methylene blue dye test - gold standard
How does intrauterine insemination work?
Follicle development tracked by USS
Sperm injected into uterine cavity
Tube should be patent, as ovum needs to travel from ovary to sperm
Birth rate of 15% per stimulated cycle
What is the process of IVF?
Ovaries stimulated by FSH and hMG with USS tracking
Hcg triggers oocyte maturation
Eggs aspirated from follicles
Oocytes and sperm incubated overnight
Embryo/s transferred (no more than two) into uterus three to five days later
Progesterone is given as luteal support until 12 weeks
Birth rate around 25% at best
What is ICSI?
Intracytoplasmic sperm injection
Injection of one sperm, with a very fine needle, into ooplasma, usually to treat male factor infertility when the sperm are rubbish
How does hypogonadotrophic hypogonadism present?
Hypooestrogenic symptoms:
Reduced libido
Vaginal dryness
Low levels of LH and FSH, as anterior pituitary fails to secrete LH and FSH
How can ovulation be checked?
Day 21 progesterone - should be >30nmol
What are the basic investigations for subfertility?
Semen analysis
Serum progesterone 7 days prior to expected next period
