Fertility Flashcards
What is subfertility?
Infertility
a disease of the reproductive system defined by the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse.”
What is Primary Infertility
When woman is unable to ever bear a child
What is secondary infertility?
When woman is unable to bear child, possibly due to previous pregnancy
What are reasons for subfertility?
Ovulatory disorders
Tubal damage
Uterine/peritoneal disorders
Male factors
What general conception advice can be given?
Intercourse throughout the cycle Smoking Alcohol Folic acid Weight Stress Caffeine Drugs Occupation
What are the 3 classificiations of ovulatory causes?
Type 1: Hypopituitary Failure
Type 2: Hypopituitary Dysfunction
Type 3: Ovarian Failure
What causes hypopituitary failure?
Anorexia nervosa
What causes hypopituitary dysfunction?
PCOS
Hyperprolactinaemia
What is the Rotterdam criteria for Polycystic Ovarian Syndrome?
i) Clinical hyperandrogenaemia
ii) Oligomenorrhoea
iii) Polycystic ovaries on ultrasound
What are symptoms of PCOS?
Raised LH with normal FSH
Raised testosterone
Ovarian cysts
What are Tubal and Uterine causes of infertility?
Pelvic inflammatory disease Previous tubal surgery Endometrioses Fibroids Cervical mucous defect
What is pelvis inflammatory disease?
Upper reproductive system infection which may be asymptomatic
What are main causes of PID?
Chlamydia trachomatis
Neisseria gonorrhoeae
What are S+S of PID?
Pelvis pain
Vaginal discharge
Cervical tenderness
What is endometriosis?
Endometrium (uterine tissues) growing in the wrong place
What are symptoms of endometriosis?
Pain
Infertility
Is there a genetic link for endometriosis?
Yes
What are fibroids?
Benign, smooth muscle tumours of the uterus
What do fibroids do?
Cause regular, heavy periods
How to treat fibroids?
Tranexamic acid
COCP/LARCs
Surgery
How are fibroids named?
Due to their location
What are male causes of infertility?
Testicular Azoospermia w or w/o sperm antibodies Reversal of vasectomy Ejaculatory problems Hypogonadism
How do you treat hypopituitary failure?
Increase weight
Decrease exercise or pulsatile GnRH release
How do you treat PCOS?
Weight loss so BMI <30
Metformin
Clomiphene
How do you treat ovarian failure?
Donor eggs
What is intrauterine insemination?
Sperm is separated in lab and slower samples are removed
Sperm is then inseminated into partner
How many cycles of intrauterine insemination occur before IVF?
12 cycles
Who do you offer intrauterine insemination to?
Unable to have vaginal intercourse
Sperm wash for HIV-positive men
Same sex relationships
What is IVF?
Fertilisation of an egg outside the body
What is intracytoplasmic sperm injection?
ICSI, sperm directly injected into egg rather than rely on natural fertilisation
When is intracytoplasmic sperm injection used?
Semen quality defects
Obstructive azoospermia
Previous IVF failure
