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Mariam Reproductive System > Infertility > Flashcards

Infertility Flashcards

1
Q

How does fertility change with age?

A

Declines with age due to ovarian egg reserve declining

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2
Q

What are the different steps of conception?

A
  1. Ovulation
  2. Sperm production
  3. Fertilisation
  4. Implantation
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3
Q

Descibe the hypothalmo-pituitary gonadal axis?

A
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4
Q

Describe the ovulation cycle?

A
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5
Q

What are the two phases of the ovarian cycle?

A

Follicular phase

Luteal phase

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6
Q

Describe the hormonal control for male reproduction?

A
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7
Q

What does FSH act on in males and what effect does it have?

A

Spermatogonia in seminiferous tubules of testes, causing spermatogenesis

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8
Q

What does LH act on in males and what effect does it have?

A

Leydig or interstitial cells of testis, causing formation of androgens (testosterone)

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9
Q

Normal conception relies on?

A
  • Functioning hormonal axis and gonads
  • Ovarian reserve
  • Regular ovulation
  • Normal sperm production
  • Fertilisation
    • Egg and sperm interaction
    • Patent fallopian tubes
  • Normal uterine cavity for implantation
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10
Q

What lifestyle factors impact ferility?

A
  • Age
  • BMI
  • Smoking
  • Alcohol
  • Recreational drug use
  • Stress
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11
Q

What is inferility?

A

Infertility = inability to conceive over a 12 month period despite regular exposure to unprotected intercourse

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12
Q

Infertility is describe as being over what period?

A

12 months

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13
Q

Describe the epidemiology of inferility (% of woman affected and fraction of couples in Western world)?

A
  • 10% of woman are effected
  • 1/7 couples in western world are affected
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14
Q

When should people be referred for infertility clinic?

A
  • No conception after one year of regular unprotected intercourse
  • Refer earlier if
    • Age > 35 years
    • Known cause for infertility
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15
Q

Describe the aetiology of female inferility?

A
  • Ovulatory dysfunction (most common)
  • Diminishing ovarian reserve
  • Endometriosis
  • Uterine factor
  • Tubal factor
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16
Q

Describe the aetiology of male infertility?

A
  • Hormone problems
    • Hormonal control
  • Erection and ejaculation problems
    • Prostate surgery
    • Damage to nerves
    • Ejaculation problems
    • Timing of intercourse
    • Medication
  • Sperm production problems
    • Genetic cause
    • Failure of testes to descend
    • Infections
    • Torsion
    • Varicocele
    • Drugs
    • Radiation damage
    • Sperm antibodies
    • Heat
  • Blockage of sperm transport
    • Infection
    • Prostate related problems
    • Absence of vas deferens
    • Vasectomy
17
Q

How is inferility investigated?

A
  • Are eggs available
    • Ovarian reserve test – blood test and scan
    • Blood tests – FSH
    • USS – antral follicular count
    • D21 serum progesterone to check if ovulation is happening
      • Levels > 20nmol/L show satisfactory ovulation
      • Couples can use LH ovulation kits or ovulation calendar themselves
  • Are sperm available
    • Semen analysis
  • Can they meet
    • Intercourse
    • Fallopian tubes
      • Check patency with hysterosalpingogram (HSG) if no pelvic infection or gynaecological problems in the past, if there are use laparoscopic dye test
  • Any other factor
    • Serum production
    • Thyroid function test
    • Chlamydia screening
    • Pelvic US for uterine problems
    • Rubella immunity
    • Cervical smear up to date
18
Q

What is the normal lower limit for the following semen reference values: volume, total sperm number, concentration, vitality, progressive motility, total motility, normal morphology?

A

Volume - 1.5 million

Total sperm number - 39 million

Concentration - 15 million/ml

Vitality - 58%

Progressive motility - 32%

Total motility - 40%

Normal morphology - 4%

19
Q

What things are looked at in semen analysis?

A

Volume - 1.5 million

Total sperm number - 39 million

Concentration - 15 million/ml

Vitality - 58%

Progressive motility - 32%

Total motility - 40%

Normal morphology - 4%

20
Q

What investigations are done to see if eggs are available?

A
  • Ovarian reserve test – blood test and scan
  • Blood tests – FSH
  • USS – antral follicular count
  • D21 serum progesterone to check if ovulation is happening
    • Levels > 20nmol/L show satisfactory ovulation
    • Couples can use LH ovulation kits or ovulation calendar themselves
21
Q

What investigations are done to see if egg and sperm can meet?

A
  • Intercourse
  • Fallopian tubes
    • Check patency with hysterosalpingogram (HSG) if no pelvic infection or gynaecological problems in the past, if there are use laparoscopic dye test
22
Q

What investigation is done to see if sperm is available?

A

Semen analysis

23
Q

Describe the management for inferility?

A
  • Egg
    • Optimise BMI, healthy lifestyle, exercise – 1st line
    • Medication (ovulation induction) – 2nd line
      • Clomiphene citrate – 1st medication to give
      • Gonadotrophins – 2nd medication to give
    • Laparoscopic ovarian drilling – 3rd line
  • Sperm – very low sperm count of no sperm (azoospermia)
    • Medical treatments – gonadotrophins
    • Surgical sperm retrieval – epididymis/testis
    • Donor sperm – intrauterine insemination
    • ICSI (intracytoplasmic sperm injection)
  • Tubes
    • Role of surgery limited to mild tubal disease
    • IVF (in-vitro fertilisation)
  • Others
    • Endometriosis – ablation or resection of spots, adhesiolysis, cystectomy for endometrioma
    • Uterine surgery – removal polyp/fibroid, adhesiolysis for synechiae
24
Q

What is the management for unresolved inferility or unknown cause?

A

IVF treatment

25
Q

What medication can be given to induce ovulation?

A
  • Clomiphene citrate – 1st medication to give
  • Gonadotrophins – 2nd medication to give
26
Q

What is the medical term for no sperm?

A

Azoospermia

27
Q

What is IVF regulated by?

A

Is regulated by Human Fertilisation & Embryology Authority (HFEA):

  • Regulating authority
  • Licensing
  • Inspections
  • Forms – registration, treatment, outcome
  • Register
28
Q

Describe the process of IVF in steps?

A
  1. If using own eggs, gonadotrophin used to induce superovulation
  2. Donor eggs may be used if – older age (poor ovarian reserves), poor quality, ovarian failure, genetic cause
  3. Sperm ejaculate from partner collected on the day or frozen sample from surgical retrieval or fertility preservation
  4. Donor sperm can be used for single woman, same sex relationship, azoospermia, genetic cause or infection (HIV, Hep B, Hep C)
29
Q

Why would donor eggs be used for IVF?

A
  1. Donor eggs may be used if – older age (poor ovarian reserves), poor quality, ovarian failure, genetic cause
30
Q

Describe the IVF process key steps in numbers?

A
  1. Controlled ovarian stimulation
  2. Follicular monitoring
  3. Timing ovulation
  4. Egg collection
  5. Lab fertilisation – insemination (partners sperm produced and mixed into dish with egg) /ICSI (used in low sperm count, sperm injected into egg) – 60/70% success rate
  6. Incubation/embryo development
  7. Embryo transfer – done under US guidance into uterine cavity
  8. Progesterone support
  9. Pregnancy test after 2 weeks, if positive scan at 7 weeks (US)
31
Q

What are the risks of IVF?

A
  • Ovarian hyper stimulation syndrome (OHSS)
  • Multiple pregnancies
  • Medication side effects
  • Procedure related
32
Q

What are IVF indications other than inferility?

A
  • Donor gametes
  • Fertility preservation
  • Ovarian tissue cryopreservation
  • Preimplantation genetic diagnosis
  • Assisted hatching
  • In vitro maturation
  • Surrogacy

Mariam Reproductive System (35 decks)

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