Fertility Problems Flashcards
What is subfertility
Failure of conception in a couple having regular (2-3 times/week) , unprotected coitus for one year
What are primary and secondary infertility
Primary infertility: When someone who’s never conceived a child in the past has difficulty conceiving
Secondary infertility: When someone has had one or more pregnancies in the past, but is having difficulty conceiving again (Includes abortion and ectopic pregnancy)
What are the main causes of subfertility
•Factors in the male - 30%
•Unexplained infertility -25%
•Ovulatory disorders - 25%
•Tubal damage -20%
•Uterine or peritoneal disorders 10%
•Other- coital problems, concurrent health problems
In about 40% of cases, problems are found in both the man and the woman.
What are the male causes of subfertility
See slide
What are 3 classes o ovulation disorders
Can be classified into 3 groups: Group 1-hypothalamic-pituitary failure– 10% ◦ Hypothalamic amenorrhea ◦ Hypogonadotrophic hypogonadism Group 2-hypothalamic-pituitary-ovarian dysfunction – 85% ◦ Polycystic ovary syndrome ◦ Hyperprolactinaemic amenorrhoea Group 3-ovarian failure - 5% o Congenital (Eg Turners X0) o Premature ovarian failure / Primary ovarian insufficiency
What are uterine/peritoneal disorders
Uterine Fibroids Asherman syndrome Endometriosis Pelvic inflammatory disease Previous surgery Cervical stenosis
Müllerian developmental anomaly
• Agenesis - failure for the uterus or tubes to form • Didelphys- Complete duplication of the uterus, cervix, and vagina • Bicornuate - two uteri sharing a single cervix and vagina • Septate - a single uterus with a fibrous band going down the centre of the uterus
Describe tubal damage
Endometriosis Ectopic pregnancy Pelvic surgery Past pelvic infection e.g. Chlamydia
Müllerian developmental anomaly
• Agenesis - failure of the tubes to form
What questions should the gP ask
MALE General health ? Father already Alcohol/smoking Surgical history- ie previous surgery to the testes Drug History Sexual health history Sexual dysfunction
Age General health (PMH) Drug history Alcohol/smoking history Obstetric/gynae history Menstrual cycle –length and predictability of cycle, age of menarche Surgical history- Tubal or pelvic surgery Sexual health history - PID or STIs
What investigations might gp do
Male
Semen analysis- sperm count, motility Blood test-
◦ Anti -spermantibodies
◦ FSH/LH/ Testosterone Penile/urethral swabs USS testes Karyotype Cystic fibrosis
Female Blood test • Follicular phase LH, FSH (Day 2) • Luteal phase progesterone (Day 21) • Prolactin, androgens, TFTs Cervical smear Vaginal/cervical swabs (rule out STI) Pelvic USS Tests of tubal patency- Hysterosalpingogram
What examinations might the gp do
Do not usually perform a male examination in the absence of relevant history.
If needed: Testicular examination to check for descent, swellings, avricocoelea etc.
FEMALE BMI Signs of secondary sexual characteristics Breast examination - ?Galactorrhoea Pelvic examination ◦ visual external inspection ◦ insertion of the speculum ◦ bimanual examination to determine the size and character of the uterus and ovaries
What ight the gp advise
Male Stop smoking Reduce alcohol intake Reduce stress levels Healthy diet
Female Stop smoking Reduce alcohol intake Reduce stress levels Loose weight Regular sexual intercourse
Who should be referred to a fertility clinic
A women of reproductive age who has not conceived after 1 year of unprotected vaginal sexual intercourse, in the absence of any known cause of infertility
Early referral for:
Women >36yrs Known clinical cause of infertility or a history of predisposing factors for infertility
GPs follow strict referral criteria within the NHS- varies locally Consider the emotional/psychological impact of the couple GP will begin to investigate at their discretion
What are 3 types of treatment recedes by specialist clinic
Once a diagnosis has been established, treatment falls into 3 main types: • Medical treatment to restore fertility
• Examples include use of drugs to stimulate follicular development and ovulation
eg Clomiphene, GNRH agonist/antagonist and gonadatrophins
•Surgical treatment to restore fertility
• Examples include laparoscopy for ablation of endometriosis, removal of fibroids
•Assisted reproduction techniques (ART) Any treatment that deals with means of conception other than vaginal intercourse.
• Examples include artificial insemination and IVF
