Fertility ? maybe need to finish Flashcards
What is infertility defined as?
The failure to conceive after ONE YEAR or more of frequent, unprotected sexual intercourse.
How many couples are affected by infertility in the UK?
1 in 7 couples
When should couples be referred for infertility?
After trying to conceive for 12 months after frequent (every 2-3 days), unprotected sexual intercourse.
If the woman is >35, when should couples be referred for infertility?
After 6 months
What is 1ary infertility?
Couples who have never conceived
What is 2ary infertility?
Couples who have previously conceived
In males, what is the role of LH?
Acts of Leydig cells within the testes to produce testosterone
What cells does LH act on in males?
Leydig cells
What is the pathway in sperm development?
1) The hypothalamus releases GnRH
2) GnRH acts on anterior pituitary to stimulate release of LH and FSH
3) LH acts on Leydig cells within the testes to produce testosterone
4) Testosterone and FSH interact with Sertoli cells to stimulate sperm development
How does testosterone affect GnRH secretion?
Testosterone also provides negative feedback to the hypothalamus to suppress GnRH secretion.
What are the 4 main causes of infertility?
1) Male factor infertility i.e. sperm proboelms (30%)
2) Ovulation causes (25%)
3) Tubal causes (20%)
4) Uterine/peritoneal causes (10%)
In 40% of affected couples, both male and female infertility factors are responsible for infertility.
What are causes of female factor infertility commonly separated into?
1) Disorders of ovulation
2) Fallopian tube causes
3) Uterine/peritoneal causes
General lifestyle advice for couples trying to get pregnant?
1) The woman should be taking 400mcg folic acid daily
2) Aim for a healthy BMI
3) Avoid smoking and drinking excessive alcohol
4) Reduce stress as this may negatively affect libido and the relationship
5) Aim for intercourse every 2 – 3 days
6) Avoid timing intercourse
7) Men to wear loose-fitting clothing
Is timed intercourse to coincide with ovulation recommended?
No - can lead to increased stress and pressure in the relationship.
What are the 3 main types of ovulatory disorders leading to infertility?
Group I – hypothalamic-pituitary failure
Group II – hypothalamic-pituitary-ovulation dysfunction
Group III – ovarian failure
What occurs in Group I – hypothalamic-pituitary failure?
Hypogonadotropic hypogonadism –> There is a failure to produce the required amount of LH and FSH, resulting in anovulation.
What does group II – hypothalamic-pituitary-ovulation dysfunction occur as a result of?
PCOS
What is the most common cause of female infertility?
PCOS
What does Group III –ovarian failure occur as a result of?
Hypergonadotropic hypogonadism:
There is normal hypothalamic and pituitary function but there are insufficient numbers of follicles within the ovary. Therefore, there is less oestrogen produced and follicles do not develop fully. This results in anovulatory cycles.
Give 3 other ovulatory causes of infertility
1) Sheehan’s syndrome
2) Hyperprolactinaemia
3) Pituitary tumours
What is Sheehan’s syndrome? How can it lead to infertility?
Ischaemic necrosis of the pituitary leads to hypopituitarism.
This can occur as the result of severe hypotension or haemorrhagic shock secondary to massive post-partum haemorrhage.
How can hyperprolactinaemia result in infertility?
This inhibits both FSH and LH secretion and can lead to menstrual dysfunction and galactorrhoea.
How can pituitary tumours lead to infertility?
Pituitary tumours – The tumour displaces or destroys normal pituitary tissue and can affect the production of FSH and LH
What is the most common cause of fallopian tube damage lead to infertility?
PID usually 2ary to chlamydia or gonorrhoea infection
What is the most prevalent uterine or peritoneal cause of infertility?
Endometriosis –> causes inflammation and adhesions in the pelvis that can distort pelvic anatomy
How is male factor infertility diagnosed?
Traditionally, male factor infertility is diagnosed by observing sperm abnormalities during semen analysis.
Semen analysis assesses sperm count, motility, morphology, vitality, concentration and volume.
Define a normal semen analysis:
1) volume
2) semen pH
3) concentration of sperm
4) total number of sperm
5) motility of sperm
6) vitality of sperm
7) % of normal sperm
1) >1.5ml
2) >7.2
3) >15 million per ml
4) >39 million per sample
5) >40% of sperm mobile
6) >58% of sperm active
7) more than 4% of sperm are normal
Define polyspermia (or polyzoospermia)
A high number of sperm in the semen sample (more than 250 million per ml).
Define normospermia (or normozoospermia)
refers to normal characteristics of the sperm in the semen sample.
Define oligospermia (or oligozoospermia)
A reduced number of sperm in the semen sample.
It is classified as:
a) Mild oligospermia (10 to 15 million / ml)
b) Moderate oligospermia (5 to 10 million / ml)
c) Severe oligospermia (less than 5 million / ml)
Define cryptozoospermia
very few sperm in the semen sample (less than 1 million / ml).
Define azoospermia
absence of sperm in the semen
What hormone is necessary for sperm creation?
Testosterone
What 3 categories can male factor infertility be classified into?
1) Obstructive infertility –> a problem with the sperm delivery
2) Non-obstructive infertility –> a problem with the sperm production
3) Coital infertility –> infertility secondary to sexual dysfunction
What is the most common cause of obstructive azoospermia
Previous vasectomy
Give some other causes of obstructive infertility in males
1) Cystic fibrosis
2) Ejaculatory duct obstruction
3) Epididymal obstruction
How can CF lead to obstructive azoospermia?
Congenital absence of the vas deferens
What can cause an ejaculatory duct obstruction?
Previous prostatitis, leading to fibrosis of the ejaculatory duct or by congenital prostatic cysts