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Women's health > Infertility > Flashcards

Infertility Flashcards

1
Q

How common is failure to conceive after 1 year?

A

Approx 15% couples
Up to 25% couples overall
Small increase in prevalence - greater proportion of couples seek help
Considerable psychological distress

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2
Q

What is the average age of first birth?

A

28.5
First time more babies born > 35 than < 20

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3
Q

What is more likely with increasing maternal age?

A

Miscarriage
Chromosomal abnormalities
Increased incidence of Down’s syndrome
Increased maternal risks of pregnancy

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4
Q

What are the potential causes of infertility?

A

Unexplained 25%
Ovulatory 25%
Tubal 20%
Male 30%
Uterine/peritoneal 10%

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5
Q

What are the important principles of care?

A

See both partners together
Explanation and written advice
Seen by specialist team

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6
Q

What are the psychological effects of fertility problems?

A

Relationship difficulties (frequencies of intercourse)
Support groups
Counselling

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7
Q

What is the initial advice to people with infertility problems?

A

80% couples < 40 will conceive in first year
Half remaining will conceive in second year
Inform effect of age
Preconception advice
Refer after one year

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8
Q

What are the female criteria for early referral?

A

Age > 35
Menstrual disorder
Previous abdominal/pelvic surgery
Previous PID/STD
Abnormal pelvic examination

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9
Q

What are the male criteria for early referral?

A

Previous genital pathology
Previous urogenital surgery
Previous STD
Systemic illness
Abnormal genital examination

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10
Q

What preconception advice should you give to couples struggling to conceive?

A

Intercourse 2-3x weekly
Folic acid 0.4mg (5mg high risk)
Smear
Rubella
Smoking cessation services
Pre-existing medical conditions
Drug history (prescribed/recreational)
Environmental/occupational exposure
Alcohol (women none)
Weight (BMI 18-30)

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11
Q

Name 3 reproductive disorders associated with obestiy

A

PCOS
Miscarriage
Infertility
Lower ART success
Obstetric complications

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12
Q

What affect does obesity have on reproductive success?

A

BMI > 30 - longer to conceive, lower success with IVF
Losing weight improves anovulation
BFS advice inappropriate to treat if BMI > 35
Men with BMI > 30 reduced fertility

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13
Q

What investigations should you do with a couple who have infertility problems?

A

Ovulation/ovarian function
Semen quality
Tubal patency + uterus

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14
Q

How do you check ovulation?

A

Mid-luteal progesterone
- < 16 anovulation
- > 16 but < 30 equivocal
- > 30 ovular
Don’t test - temp, LH urine test, TFTs, prolactin if ovulating, endometrial biopsy

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15
Q

How do you test ovarian reserve function?

A

FSH - > 8.9 low response, < 4 high response
Antral follicle count - < 4 low response, > 16 high response
Antimullerian hormones - < 5.4 low response, > 25 high response

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16
Q

What should you look for in semen analysis?

A

Count > 15m/ml
Motility > 40%
Morphology > 4%
Total > 39m
Repeat if abnormal
Anti-sperm antibodies not required

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17
Q

What initial investigations does the GP need to do before referral to NHS fertility clinic?

A

Hormone profile - D2, FSH, D21 prog
TFT, prolactin - if indicated
Rubella
Smear
Swabs
Semen analysis

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18
Q

What further investigations should you do for male infertility?

A

Clinical examination - secondary sexual characteristics, testicular size
If count < 5m/ml
- Endocrine (FSH, LF, test, prolactin)
- Karytotype
- CF screen
Testicular biopsy - azoospermia
Imaging - vasogram, USS, urology
Dedicated specialist infertility clinic
Tubal patency testing
Swabs before instrumentation

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19
Q

How can you treat male infertility?

A

Mild - intrauterine insemination
Moderate - IVF
Severe - intracytoplasmic sperm injection
Azoospermia - surgical sperm recovery, donor insemination
Surgery - correction of epidymal block, vasectomy reversal, varicocele no benefit
Heat - occupation
Underpants/boxers?
Smoking
Alcohol
Occupational exposure

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20
Q

How can you treat hypogonadotrophic hypogonadism?

A

Gonadotrophins

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21
Q

How can you treat hyperprolactinaemia?

A

Bromocriptine

22
Q

What diet/supplements can you give men to help with infertility?

A

Folic acid 5mg
Zinc 55mg

23
Q

What is group 1 anovulation?

A

Low FSH/LH/E2

24
Q

What can cause group 1 anovulation?

A

Stress
Weight loss
Exercise
Kallman’s

25
Q

How can you treat group 1 anovulation?

A

FSH + LH
GnRH pump
Normalise weight

26
Q

What is group 2 anovulation?

A

PCOS
Normal FSH, USS, androgens

27
Q

How can you treat group 2 anovulation?

A

Ovulation induction - clomifene

28
Q

What is group 3 anovulation?

A

Menopause
High FSH

29
Q

What is the treatment for group 3 anovulation?

A

Donor egg

30
Q

How do you treat an adenoma producing prolactin?

A

Bromocriptine

31
Q

How do you treat Sheenhan’s?

A

FSH, LH

32
Q

How can you treat clomifene/metformin resistant PCOS?

A

Laparoscopic ovarian drilling
Gonadotrophin ovulation induction

33
Q

What is the criteria for PCOS?

A

2/3 of
- Anovulation or oligo/amenorrhoea
- Polycystic ovaries on scan - one ovary/> 12 small follicles/vol > 10cc
- Raised androgens - clinical/biochemical, exclude adrenal cause

34
Q

How can you treat PCOS?

A

Normalise weight
Clomifene/tamoxifen
- Up to 6 cycles
- Monitor (progesterone and USS)
- Inform of multiple pregnancy rate
- > 12 months ovarian cancer risk
Metformin
- Less effective than clomifene alone
- Less effective in obese
- May help clomifene resistant
- GI S/E

35
Q

Where can you get tubal disease?

A

Proximal
Distal - hydosalpinx
Adhesions - ovarian, tubal

36
Q

What can cause tubal disease?

A

Infections - chlamydia/gonorrhoea
Endometriosis
Surgical - adhesions, sterilisation

37
Q

How can you treat tubual disease?

A

Tubal surgery - laparotomy/laparoscopy
Tubal catheterisation
IVF

38
Q

Does the medical treatment for endometriosis increased chances of pregnancy?

A

No

39
Q

What surgery can you do for endometriosis?

A

Laparoscopic treatment
- Ablation or resection of minimal and mild disease
- Increases pregnancy and live birth rates
Laparoscopic cystectomy for endometrioma
- Increased pregnancy rates compared with drainage and coagulation

40
Q

What is the treatment for unexplained infertility?

A

Clomiphene
SIUI
IVF - recommended after 2 years of infertility

41
Q

What can you do for assisted conception?

A

Ovulation induction
Stimulated intrauterine insemination
IVF
Donor insemination
Donor egg
Donor embryo
Host surgery

42
Q

What are the stages of IVF?

A

Intracytoplasmic sperm injection
Surgical sperm recovery
Embryo freezing
Assisted hatching
Blastocyst culture

43
Q

What are the risks of IVF?

A

Multiple pregnancy
Miscarriage
Ectopic
Foetal abnormality?
Ovarian hyperstimulation syndrome
Egg collection
Longer term - ?ovarian cancer

44
Q

What patient factors can affect the success of IVF?

A

Age - increased risks of hypertension, diabetes, IUGR, operative delivery, thromboembolism, maternal death
Cause of infertility
Previous pregnancies
Duration of infertility
Number of previous attempts
Specific medical conditions
Environmental factors

45
Q

What uterine abnormalities can you have?

A

Adhesions
Polyps
Fibroids
- Intramural - reduced chance of pregnancy with ART
- Submucous myoma - lower pregnancy rates
Septate uterus

46
Q

Does a myomectomy improve chances of pregnancy?

A

Yes compared to untreated myomas

47
Q

Why might you have intrauterine adhestions?

A

Previous uterine evacuation or surgery

48
Q

What are intrauterine adhesions associated with?

A

Oligo-amenorrhoea

49
Q

How common is a septate uterus?

A

2-3%

50
Q

What is a septate uterus compared with?

A

RPL
Preterm birth

51
Q

What IVF treatment is offered to women < 40?

A

3 full cycles
Stop once age = 40

52
Q

What IVF treatment if offered to women 40-42?

A

1 full cycle if no previous IVF and no low ovarian reserve

Women's health (9 decks)

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