Fertility and infertility - definition, causes and investigations Flashcards

1
Q

what is infertility defined as? WHO

A

Inability to conceive over a 12 month period despite exposure to regular , unprotected intercourse. Represents a prognosis based approach and provides practical guidance on when to initiate investigations.

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2
Q

Epidemiological definition of infertility?

A

Lack of conception after 2 years in women of reproductive age (15-49 years) who are at a risk of becoming pregnant (sexually active, not using contraception

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3
Q

Demographic definition of infertility?

A

Inability to become pregnant with a live birth, within 5 years of exposure, based upon a consistent union status, lack of contraceptive use, non-lactation and continuation of a desire or a child

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4
Q

how many couples are affected in western and developing counties?

A

1 in 7

1 in 4

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5
Q

When to refer a couple with fertility problems? - when may you refer a couple earlier?

A

No conception after one year of regular unprotected intercourse

Referral earlier if-

Age>35 years

Known cause for infertility

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6
Q

Type of Infertility (2)

A

Primary - never had a child before

secondary - have had a Chile before but can’t get pregnant again

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7
Q

Female factors for infertility? (5)

A
  • ovulatory dysfunction
  • diminishing ovarian reserve
  • endometriosis
  • uterine factor
  • tubal factor
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8
Q

Male factors for infertility? (4)

A
  • hormonal producing problems for sperm production
  • sperm production problems
  • Ejection and ejaculation problems
  • blockage of sperm transport
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9
Q

Why may you get a blockage of sperm transport? (4)

A
  • infection
  • prostate rated problems
  • absence of vas deferens
  • vasectomy
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10
Q

why may you get sperm proaction problems? (8)

A

genetic causes

  • failure of testes to descend
  • infections
  • torsion
  • varicocele
  • drugs
  • radiation damage
  • sperm antibodies
  • heat
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11
Q

why may there be erection and ejaculation problems? (5)

A
  • prostate surgery
  • damage to nerves
  • ejaculation problems
  • timing of intercourse
  • medication
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12
Q

Are eggs available? - what investigations can you do?

  • when can they be done?
A

Age
Ovarian reserve test- blood test and scan

  • Blood test- FSH, D1-D5 of cycle (<10 iu/L)
    AMH (5.0-25.0pmol/L)
    UltrasoundScan- Antral follicular count
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13
Q

is ovulation happening - how can couples test themselves? (3)

A
  • natural methods (BBT, cervical mucus)
  • LH ovulation kits
  • ovulation calendar
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14
Q

ovulation - test done?

what day?

A

D21 serum progesterone
day 21 of cycle
any level above 20 shows ovulatory cycles

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15
Q

ovulation detection - mucus discharge - describe some of the changes you would see in discharge if you are fertile

A

most and stick

  • white or cream in colour - thick/stretchy
  • breaks easily when you pull
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16
Q

highly fertile discharge will be like..?

A

thin, watery, transparent, egg white - increase in total

17
Q

post ovulatory discharge will be like ..?

A

dry, moist , sticky thick, opaque,

18
Q

What are LH kits?

A

peak of the hormone that happens mid cycle

19
Q

Ovulation diagnosis (2)

A

Progesterone levels taken at appropriate time - day 21 only if 28/30 day cycle

Levels > 20nmol/l show satisfactory ovulation

20
Q

test for sperm availability?

A

semen analysis

21
Q

semen analysis -per ml of sperm - what do you expect to see?

motility and morphology?

A

15 million sperm

32%
4%

22
Q

can egg and sperm meet? (2)

A

Intercourse - any pain, ejaculation problems?

Patent fallopian tubes

23
Q

How to check fallopian tube patency (2)

A

If no pelvic infection or gynaecological problem in past- Hysterosalpingogram(HSG)

If any of above- Laparoscopic dye test

24
Q

what is HSG?

A

small plastic Catheter through cervix- blue dye added - cray taken

25
Q

Laparoscopy - what is this?

A

surgical - laparoscope - inspect pelvic organs - put dye in and see the flow out of the tubes

26
Q

Other routine tests (5)

should have immunity to?

A
  • Serum prolactin
  • Thyroid function test
  • Chlamydia screening
  • Pelvic Ultrasound for uterine problems

Also check- Rubella immunity
- Cervical smear uptodate