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Reproductive Physiology - Y3 > Human fertility and infertility > Flashcards

Human fertility and infertility Flashcards

1
Q

conception key steps that need to be in order

A

Ovulation

Sperm production

Fertilization

Implantation

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2
Q

natural conception relies on

A

Functioning hormonal axis and gonads
Ovarian reserve
Regular ovulation
Normal sperm production
Fertilization- egg and sperm interaction
patent fallopian tubes
Normal uterine cavity for implantation

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3
Q

lifestyle factors affecting fetility

A

Age
BMI
Smoking
Alcohol
Recreational drug use
Stress

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4
Q

infertility definition

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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5
Q

when do you refer an infertility case

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

types of infertility

A

primary - never tried before
secondary

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7
Q

investigating infertility

A

Are eggs available?
Are sperm available?
Can they meet?
Any other factor ?

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8
Q

how do we check if eggs are available?

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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9
Q

what can couples use to check if ovulation happening?

A

natural methods(BBT, cervical mucus)
LH ovulation kits
ovulation calendar

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10
Q

how can you investigate whether ovulation is happening

A

D21 serum progesterone

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11
Q

natural methods to detect ovulation

A

check discharge
track periods
LH kits

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12
Q

progesterone levels

A

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

Levels > 20nmol/l show satisfactory ovulation

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13
Q

can egg and sperm meet?

A

Intercourse

Patent fallopian tubes

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14
Q

How to check fallopian tube patency

A

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

If any of above- Laparoscopic dye test

Hysterosalpingography (HSG)
Laparoscopy

Alternate tests
Serum prolactin
Thyroid function test
Chlamydia screening
Pelvic
Ultrasound for uterine problems

Also check- Rubella immunity
Cervical smear uptodate

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15
Q

how do you treat ovulation disorders

A

Optimise body weight, Healthy life
style, Exercise

Medication (ovulation induction)
- Clomiphene citrate
- Gonadotrophins

Laparoscopic ovarian drilling

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16
Q

how do you treat sperm problem-Very low count or no sperm (azoospermia)

A

Medical treatments- gonadotrophins

Surgical sperm retrieval- epididymis/testis

Donor sperm- intrauterine insemination

ICSI (intracytoplasmic sperm injection)

17
Q

how do you treat a tubal problem

A

Role of surgery limited to mild tubal disease

IVF

18
Q

endo treatment

A

Ablation or resection of spots, adhesiolysis, cystectomy for endometrioma

19
Q

when is uterine surgery used

A

Uterine surgery- removal polyp/fibroid, adhesiolysis for synechiae

20
Q

what is an option if infertility is unresolved

A

IVF

21
Q

Human Fertilisation & Embryology Authority (HFEA)

A

Regulatory authority
Licensing
Inspections
Forms - registration, treatment, outcome
Register

22
Q

how can eggs be supplied for IVF

A

Own eggs-gonadotrophin induced superovulation

Donor eggs - age (poor ovarian reserve)
poor quality
ovarian failure
genetic cause

23
Q

how can sperm be supplied for IVF

A

Partner-
Fresh sample on day of egg collection
Frozen sample (thawed)from surgical retrieval or fertility preservation

Donor sperm-
Single women
Same sex relationship
Azoospermia(no sperm)
Genetic cause
Infection (HIV, HepB,HepC)

24
Q

key steps of the IVF process

A

Controlled ovarian stimulation
Follicular monitoring
Timing ovulation
Egg collection
Lab fertilization-Insemination/ICSI
Incubation/ embryo development
Embryo transfer
Progesterone support

25
Q

Post embryo transfer

A

Progesterone pessaries

Normal activity

Pregnancy test after 2 weeks

If positive- scan at 7 weeks

26
Q

Risks of IVF

A

Ovarian hyperstimulation syndrome (OHSS)

Multiple pregnancy

Medication side effects

Procedure related

27
Q

Long term effects IVF

A

Children born- no difference as per short term data.

Risk of ovarian cancer not confirmed

Absolute risk to women and children low.

28
Q

IVF expansions

A

Donor gametes
Fertility preservation-gamete/embryo cryopreservation
Ovarian tissue cryopreservation
Preimplantation genetic diagnosis
Assisted hatching
In vitro maturation
Surrogacy

Reproductive Physiology - Y3 (12 decks)

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