Fertility, Subfertility And Infertility Flashcards
Subfertility
Delayed/reduced capacity to conceive
Infertility
reproductive system disease defined by failure to achieve clinical pregnancy after 12 months of regular unprotected sex with no other reason
Primary infertility
Couple have never been able to conceive
Secondary infertility
Person has had first baby with no difficulty then cannot get pregnant again, or has conceived and has miscarriage or ectopic
What is a main cause of rising infertility rates
Having children later in life
How does age affect fertility
Decrease, women more than men
When does female fertility start decreasing dramatically
30
How long after ovulation is an egg viable
~2 days
Female causes of infertility
Erratic ovulation
Blocked uterine tubes
Endometriosis
Pituitary or ovarian tumour
Pelvic inflammatory disease
Antisperm antibodies
Age
4 classes of ovulatory causes of infertility
Hypothalamic
Pituitary
Ovarian
PCOS
Hypothalamic ovulatory causes of infertility
Hypothalamic amenorrhea
Anorexia
Genetic
Autoimmune GAIN
Iatrogenic
Neoplasm
Pituitary ovulatory causes of infertility
Hyperprolactaemia - decreased LH and FSH
Functional
Infectious. FIT
Inflammatory
Trauma+Vascular
Ovarian ovulatory causes of infertility
Premature ovarian failure
Physiological
Idiopathic. PIE
Endocrine
What are the 3 components of the Rotterdam criteria and how many are needed for a PCOS diagnosis
Clinical hyperandrogenaemia
Oligomenorrhea
Polycystic ovaries on ultrasound - 12+ follicles
2/3 needed
Oligomenorrhea
Less than 6-9 periods per year
PCOS symptoms
Menstrual disturbance
Infertility
Hirsutism
Acne
Male pattern hair loss
Central obesity
Acanthosis nigricans
Hormone abnormalities in PCOS
Raised LH with normal FSH
Raised free testosterone >5ng/L
AMH >3.5ng/mL
Why are metabolic abnormalities associated with PCOS
Abnormal serum lipid concentrations
Insulin resistance
Tubal and uterine causes of infertility
Pelvic inflammatory disease
Previous tubal surgery
Endometriosis
Fibroids
Cervical mucus defect
Endometriosis
Presence of tissue similar to endometrium outside uterus, often on uterus, Fallopian tubes, or GI system
Why does endometrial tissue outside uterus grow and bleed in endometriosis
Tissue responds to oestrogen and progesterone
What causes pelvic inflammatory disease
Bacterial infection spreading from vagina or cervix
Fibroid/leiomyoma
Non cancerous smooth muscle growth
Fibroid/leiomyoma symptoms
Heavy periods
Pain on intercourse
Abdominal swelling
Fibroid types
Redunculated subserosal - abdominal
Subserosal
Submucosal
Intramural
Redunculated submucosal - vaginal
Repeated miscarriage causes and treatments
Anatomical abnormalities - no treatment
Cervical incompetence - close cervix
Endocrine/hormonal abnormalities - hormone blockers
Genetic/chromosomal abnormalities - no treatment
Blood coagulation protein/platelet defects - low dose aspirin
B CAGE
Most common cause of repeated miscarriage
Blood coagulation protein abnormalities
Blood coagulant protein/platelet defects that can cause repeated miscarriage
Factor XIII defects
Factor XII defects
Anticardiolipin antibodies
Lupus anticoagulant
Antophospholipid syndrome
Endocrine abnormalities that can cause repeated miscarriage
Luteal phase defect
LH hypersecretion on day 8
Is infertility easier to detect and treat in men or women
Easier to detect in men
Easier to treat in women
Male causes of infertility
<120 million sperm
Hormone imbalance
Anti sperm antibodies
Varicocele
Sperm quality and movement
Undescended testis
Obstruction - vasectomy, cystic fibrosis
Ejaculatory problems - premature, retrograde
Erectile dysfunction
Combined infertility
Both man and woman infertile or subfertile
Genetic causes of infertility
NR5A1 gene mutations
46XY
Male idiopathic infertility
Semen analysis abnormal but unclear why
Female idiopathic infertility
Ovulation abnormal but unclear why
Why can a MTHFR gene mutation cause infertility
Folate deficiency as Cannot convert folic acid to folate
General advice to improve conception
Intercourse throughout cycle
Stop smoking
Stop/decr alcohol
Take folic acid
Lose weight
Decr stress
Decr caffeine
GP investigations before referral
Sexual/ contraception/family history
PCOS screen
Thyroid function
Vitamin D
HbA1C
Viral screen
STI screen
Semen analysis
When are women referred by a GP to infertility services
Aged 36+ and known clinical cause
What is assessed in a semen analysisf
Volume - lower limit 1.5ml
Progressive motility - lower limit 32%
Morphology - lower limit 4%
DNA integrity
Ovulatory function investigations
Blood test
Response to gonadotropin stimulation in IVF, ultrasound, hormones - ovarian reserve
Hysterosalpingogram - tubal function
Laparoscopy - uterine function
Assisted reproductive options
Intrauterine insemination
In vitro fertilisation
Intra cytoplasmic sperm injection
Intrauterine insemination
Sperm collected and slow sperm removed then inseminated into parter/donor
IVF
Sperm and eggs collected, Eggs fertilised outside body then inseminated
How many cycles of IVF are offered and when
3 if woman under 40
1 if woman 40-42 and never previously had IVF and no evidence of low ovarian reserve
Offered after 2yrs unprotected intercourse or 12 cycles IUI
intracytoplasmic sperm injection
Single spermatic injected directly into egg
Who is IUI offered to
Unable to have vaginal intercourse
Sperm wash needed
Who is ICSI offered to
Severe sperm deficiency
Obstructive azoospermia
Non obstructive azoospermia
Previous Failed IVF
What causes ovarian hyperstimulation syndrome
Drugs used to stimulate ovarian function in IVF or PCOS, esp hCG
Ovarian hyper stimulation syndrome
Multiple luteinised cysts in ovaries due to drugs used to stimulate ovaries
What risks are slightly increased in children born by IVF to mothers over 35
Birth defects
Cancer
Types of 3rd party reproduction
Egg donation
Sperm donation
Embryo adoption
Surrogacy
What precautions can be taken for cancer patients who wish to have children in the future
Cryopreservation of sperm, embryos, or oocytes
