Fertility and infertility - definition, causes and investigations Flashcards
what is infertility defined as? WHO
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.
Epidemiological definition of infertility?
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
Demographic definition of infertility?
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
how many couples are affected in western and developing counties?
1 in 7
1 in 4
When to refer a couple with fertility problems? - when may you refer a couple earlier?
No conception after one year of regular unprotected intercourse
Referral earlier if-
Age>35 years
Known cause for infertility
Type of Infertility (2)
Primary - never had a child before
secondary - have had a Chile before but can’t get pregnant again
Female factors for infertility? (5)
- ovulatory dysfunction
- diminishing ovarian reserve
- endometriosis
- uterine factor
- tubal factor
Male factors for infertility? (4)
- hormonal producing problems for sperm production
- sperm production problems
- Ejection and ejaculation problems
- blockage of sperm transport
Why may you get a blockage of sperm transport? (4)
- infection
- prostate rated problems
- absence of vas deferens
- vasectomy
why may you get sperm proaction problems? (8)
genetic causes
- failure of testes to descend
- infections
- torsion
- varicocele
- drugs
- radiation damage
- sperm antibodies
- heat
why may there be erection and ejaculation problems? (5)
- prostate surgery
- damage to nerves
- ejaculation problems
- timing of intercourse
- medication
Are eggs available? - what investigations can you do?
- when can they be done?
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
is ovulation happening - how can couples test themselves? (3)
- natural methods (BBT, cervical mucus)
- LH ovulation kits
- ovulation calendar
ovulation - test done?
what day?
D21 serum progesterone
day 21 of cycle
any level above 20 shows ovulatory cycles
ovulation detection - mucus discharge - describe some of the changes you would see in discharge if you are fertile
most and stick
- white or cream in colour - thick/stretchy
- breaks easily when you pull
highly fertile discharge will be like..?
thin, watery, transparent, egg white - increase in total
post ovulatory discharge will be like ..?
dry, moist , sticky thick, opaque,
What are LH kits?
peak of the hormone that happens mid cycle
Ovulation diagnosis (2)
Progesterone levels taken at appropriate time - day 21 only if 28/30 day cycle
Levels > 20nmol/l show satisfactory ovulation
test for sperm availability?
semen analysis
semen analysis -per ml of sperm - what do you expect to see?
motility and morphology?
15 million sperm
32%
4%
can egg and sperm meet? (2)
Intercourse - any pain, ejaculation problems?
Patent fallopian tubes
How to check fallopian tube patency (2)
If no pelvic infection or gynaecological problem in past- Hysterosalpingogram(HSG)
If any of above- Laparoscopic dye test
what is HSG?
small plastic Catheter through cervix- blue dye added - cray taken
Laparoscopy - what is this?
surgical - laparoscope - inspect pelvic organs - put dye in and see the flow out of the tubes
Other routine tests (5)
should have immunity to?
- Serum prolactin
- Thyroid function test
- Chlamydia screening
- Pelvic Ultrasound for uterine problems
Also check- Rubella immunity
- Cervical smear uptodate
