Fertility Flashcards
infertility in women
Fallopian tube damage
Ovarian dysfunction: Amenorreah, oligomenorreah, PCOS, hyperprolactinaemia, perimenopause, premature ovarian failure
Pituitary dysfunction
Intact hymen
Vaginal and uterine congenital malformations
Lifestyle (Exercise and BMI
amenorrhea
primary- never had a period (genetic Turners) (autoimmune)
secondary- stopped
disorders of gondotrophin regulation, gonadtrophin deficiency, PCOS
causes of infertility
unexplained (25%)
ovulatory disorders (25%)
tubal damage (20%)
factors in the male causing infertility (30%)
pathophysiology
varicocele
primary spermatogenic failure - congenital/genetic, Klinfelter syndrome
acquired- trauma/torsion/mumps/orchitis
obstructive azoospermia- ejaculatory duct obsturction
hypogonadism
1’ testicular failure (hypergonadotropic hypogonadism)
2’ (hypogonadotropic hypogonadism) insufficent GnRH and LH
andorogen insensitivity
drugs- sulfalazine, andogens anaolic soteroids, chemotherapy
other causes:
ejaculation disorder, erectile dysfunction, spermatozoa antibodies.
exposure to head, pesticide, xray, solvents
lifestyle- obesity, smoking, recreational drug use, excessive alcohol intake
diagnosis of male subfertility/infertility
semen analysis
semen volume 1.5ml or more
ph 7.2 or more
sperm conc 15 million spermatozoa per ml or more
total sperm number 39 million spermatooa per ejaculation or more
total motility (40% or more)
vitality (58% or more live spermatozoa sperm morphology
screening for antisperm anitbodies is not routinely offers
if first semen analysis isabonrla REPEAT confirmatiory test within 3 months to allow time for the cycle to be completed.
if gross spermtozoa (azzoospermia or severe oligozoospermia). is detected then repeat asap
hormonal assay- FSH, testosterone
genetic: CF
sweat test for CF
testicular biopsy if paient has azoospermia
subfertility management
non-pharmaclogical
regular (every 2-4 days) unprotected intercourse
stress management, smoking, weight
pharmacological
if pt has hypogonadotropic hypogonadism started gonadotrophin dugs
antioestrogens
systemic corticosteroids
abx treatment
surgical
correction, retrieval for IVF
menopause hot flushes
hot flush and sweating followed by chills. this is due to problems with thermoregulation
- hyposecrteion of noradrenaline
- low levels of seretonin
PCOS symptoms
hyper secretion of androgens by the ovaries
- obesity (hyperinsulinaemia)
- hirsutism (hyperandrogegism)
- amenorrhoea / oligomenorrhea
- acne (androgens)
treatment of PCOS
contraceptive pill
clomifene (promotes the LH surge)
what is Asherman syndrome
intrauterine adhesions. consider this if there is history of intrauterine problems that effects the endometrium (curettage) or endomeritis
‘sticky uterus syndrome
symptoms: infertility recurrent pregnancy loss menstrual irregularies absence of periods (scar tissue) cyclic pelvic pain uterine cramping
imperforate hymen
in newborns, they typically present with a hymenal bulge from maternal estrogen
in adolescents, an imperforate hymen presents as cyclic or persistent pelvic pain and primary amenorrhea.
severe- back pain, pain with defectation, constipation, N+V, urinary retention, hydronephrosis
premature ovarian failure
loss of normal function of ovaries before 40 years old.
can be a cause of premature menopause. other causes include damage to ovaries from chemotherapy / radiation / surgical removal of the ovaries.
symptoms: hot flushes difficulty conceiving night sweats vaginal dryness irritability or difficulty concentrating decreased sexual desire.
genetic causes of infertility
kallman's klinfelters CG noonan androgen insensitivity
turners
congenital adrenal hyperplasia
what is congenital adrenal hyperplasia
there is an enzyme deficiency which results in an inability to make coristol. this causes an excessive production of androgen and so there is a back up which results in masculinisation of female genitalia. male physically normal so can go undetected.
turner’s syndrome 45 XO
female phenotype sexual infantism short stature webbed neck wide spaced nipples wide carrying angle heart and kidney defects
TX: COCP
