Fertility Flashcards
Which hormone should be tested in the luteal phase of any woman experiencing difficulty conceiving?
Progesterone (day 21)
Which hormones (in addition to progesterone) should be tested in a woman with irregular periods?
FSH and LH
+ prolactin and free testosterone
???? this card ???? When should prolactin be measured?
Not for subfertility; only for
an ovulatory disorder, galactorrhoea (excessive or inappropriate production of milk) or a pituitary tumour
What 3 things are used to estimate likely ovarian response to gonadotrophin stimulation in IVF?
Also give you ovarian reserve
- FSH - high is bad (if it needs a lot of FSH to get the eggs going there can’t be many of them)
- AMH (anti - Mullerian hormone) - low is bad
- total AFC (antral follicle count) - low is bad
Semen analysis
What is a normal value for semen volume?
1.5ml +
Semen analysis
What is a normal value for semen pH?
7.2 +
Semen analysis
What is a normal value for sperm concentration?
15 million spermatozoa / ml
Semen analysis
What is a normal value for total sperm number?
39 million / ejaculate
Semen analysis
What is a normal value for total motility?
40% motile or 32% progressive motility
Semen analysis
What is a normal value for sperm vitality?
58% + live spermatozoa
Semen analysis
What is a normal value for sperm morphology?
4% + normal forms
If a semen analysis is abnormal when should you repeat?
In 3 months (allows a full cycle)
- unless gross abnormality in which case ASAP!
What 2 drugs are helpful for PCOS women trying to conceive?
Metformin and clomiphene
What 2 treatments are helpful for PCOS if woman doesn’t want to get pregnant?
COCP +/- Weight loss
Why might tubal damage occur? (3)
- infection (particularly chlamydia and gonorrhoea, PID)
- endometriosis
- previous surgery resulting in the formation of peri-tubal adhesions.
What is HSG?
What does it assess
Hysterosalpingography
Assesses shape of the uterine cavity and patency of the fallopian tubes
Where is endometriosis most commonly found?
Ovaries
What are the symptoms of endometriosis?
- Pain - gynae
- chronic pelvic pain
- dysmenorrhoea - pain often starts days before bleeding
- deep dyspareunia
- Pain - elsewhere
- Dyschezia (painful bowel movements)
- Dysuria
- Can present as: Subfertility
- Non-gynaecological: urinary symptoms e.g. urgency, haematuria.
What are the signs of endometriosis on examination?
on pelvic examination
- reduced organ mobility,
- tender nodularity in the posterior vaginal fornix
- and visible vaginal endometriotic lesions
What is the gold standard for investigation of endometriosis?
Laproscopy
What is the medical management of endometriosis?
Management depends on clinical features - there is poor correlation between laparoscopic findings and severity of symptoms
- NSAIDs and/or paracetamol are the recommended first-line treatments for symptomatic relief
- hormonal treatments such as
- COCP or Mirena
- progestogens e.g. medroxyprogesterone acetate
- GnRH agonists (not long term solution)
What is the surgical management of endometriosis?
laparoscopic excision and laser treatment of endometriotic ovarian cysts may improve fertility
What treatment should those with tubal factors have for infertility?
IVF
What medication could you give in endometriosis AND shrink fibroids that prevents ovulation / creates artificicial menopause?
Gonadotropin-releasing hormone (Gn-RH) antagonists / agonists
