Fertility and Infertility Flashcards
what does FSH and LH act on in males?
- FSH: spermatogonia in seminiferous tubules of testes > spermatogenesis
- LH: leydig or interstitial cells of testes > androgen production > sustenacular cells in seminiferous tubules and secondary male sex characteristics
what factors does natural conception rely on?
- functioning hormonal axis and gonads
- ovarian reserve
- regular ovulation
- normal sperm production
- fertilisation: egg and sperm interaction, patent fallopian tubes
- normal uterine cavity for implantation
what lifestyle factors can affect fertility?
- age
- BMI
- smoking
- alcohol
- recreational drug use
- stress
what is the clinical definition (WHO) of infertility?
- inability to conceive over a 12 month period despite exposure to regular, unprotected intercourse.
what is the epidemiological definition (WHO) of infertility?
- lack of conception after 2 years in women of reproductive age (15-49 years) who are at risk of becoming pregnant (sexually active, not using contraception).
when should you refer a couple for fertility treatment?
- no conception after one year of regular unprotected intercourse
- referral earlier if: age > 35 years or known cause for infertility
when investigating infertility, how can we determine if eggs are available?
- age
- blood test: FSH, D1-5 of cycle (< 10iu/L), AMH (5-25pmol/L)
- ultrasound scan - antral follicular count
which methods can be used by couples to track ovulation?
- natural methods (BBT, cervical mucus)
- LH ovulation kits
- ovulation calendar
what blood test can be used to investigate if ovulation is happening?
day 21 serum progesterone
- levels > 20nmol/l show satisfactory ovulation
how can the patency of fallopian tubes be checked?
- if no pelvic infection of gynaecological problem in the pase: Hysterosalpingogram (HSG)
- if pelvic infection or gynaecological problem in the past: laparoscopic dye test
list some other tests that can be important in determining fertility
- serum prolactin
- thyroid function test
- chlamydia screening
- pelvic ultrasound for uterine problems
- also check - rubella immunity, cervical smear up to date
what medications can be used to induce ovulation?
- comiphene citrate
- gonadotrophins
what options are available if there is very low sperm count or no sperm (azoospermia)?
- medical treatments: gonadotrophins
- surgical sperm retrieval: epidiymis/testis
- donor sperm: intrauterine insemination
- ICSI (intracytoplasmic sperm injection)
what are the options if infertility is caused by a fallopian tube problem?
- surgery limited to mild tubal disease
- IVF
what are some treatment options for infertility caused by endometriosis?
- ablation or resection of spots, adhesiolysis, cystectomy for endometrioma
what does HFEA stand for?
human fertilisation and embryology authority
what are the indications for use of donor sperm?
- single women
- same sex relationship
- azoospermia (no sperm)
- genetic cause
- infection (HIV, HepB, HepC)
what are the key steps of the IVF process?
- controlled ovarian stimulation
- follicular monitoring
- timing ovulation
- egg collection
- lab fertilisation - insemination/ICSI
- incubation/embryo development
- embryo transfer
- progesterone support
what monitoring takes place post-embryo transfer?
- progesterone pessaries
- normal activity
- pregnancy test after 2 weeks
- if positive- scan at 7 weeks
what are the risks associated with IVF?
- ovarian hyperstimulation syndrome (OHSS)
- multiple pregnancy
- medication side effetcs
- procedure related
