Human fertility and infertility Flashcards
conception key steps that need to be in order
Ovulation
Sperm production
Fertilization
Implantation
natural conception relies on
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
lifestyle factors affecting fetility
Age
BMI
Smoking
Alcohol
Recreational drug use
Stress
infertility definition
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.
when do you refer an infertility case
no conception after one year of regular unprotected intercourse
Referral earlier if-
Age>35 years
Known cause for infertility
types of infertility
primary - never tried before
secondary
investigating infertility
Are eggs available?
Are sperm available?
Can they meet?
Any other factor ?
how do we check if eggs are available?
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
what can couples use to check if ovulation happening?
natural methods(BBT, cervical mucus)
LH ovulation kits
ovulation calendar
how can you investigate whether ovulation is happening
D21 serum progesterone
natural methods to detect ovulation
check discharge
track periods
LH kits
progesterone levels
Progesterone levels taken at appropriate time - day 21 only if 28/30 day cycle
Levels > 20nmol/l show satisfactory ovulation
can egg and sperm meet?
Intercourse
Patent fallopian tubes
How to check fallopian tube patency
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
how do you treat ovulation disorders
Optimise body weight, Healthy life
style, Exercise
Medication (ovulation induction)
- Clomiphene citrate
- Gonadotrophins
Laparoscopic ovarian drilling
how do you treat sperm problem-Very low count or no sperm (azoospermia)
Medical treatments- gonadotrophins
Surgical sperm retrieval- epididymis/testis
Donor sperm- intrauterine insemination
ICSI (intracytoplasmic sperm injection)
how do you treat a tubal problem
Role of surgery limited to mild tubal disease
IVF
endo treatment
Ablation or resection of spots, adhesiolysis, cystectomy for endometrioma
when is uterine surgery used
Uterine surgery- removal polyp/fibroid, adhesiolysis for synechiae
what is an option if infertility is unresolved
IVF
Human Fertilisation & Embryology Authority (HFEA)
Regulatory authority
Licensing
Inspections
Forms - registration, treatment, outcome
Register
how can eggs be supplied for IVF
Own eggs-gonadotrophin induced superovulation
Donor eggs - age (poor ovarian reserve)
poor quality
ovarian failure
genetic cause
how can sperm be supplied for IVF
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)
key steps of the IVF process
Controlled ovarian stimulation
Follicular monitoring
Timing ovulation
Egg collection
Lab fertilization-Insemination/ICSI
Incubation/ embryo development
Embryo transfer
Progesterone support
Post embryo transfer
Progesterone pessaries
Normal activity
Pregnancy test after 2 weeks
If positive- scan at 7 weeks
Risks of IVF
Ovarian hyperstimulation syndrome (OHSS)
Multiple pregnancy
Medication side effects
Procedure related
Long term effects IVF
Children born- no difference as per short term data.
Risk of ovarian cancer not confirmed
Absolute risk to women and children low.
IVF expansions
Donor gametes
Fertility preservation-gamete/embryo cryopreservation
Ovarian tissue cryopreservation
Preimplantation genetic diagnosis
Assisted hatching
In vitro maturation
Surrogacy
