Infertility Flashcards
What is infertility?
It is defined as inability of a couple to conceive after 12 months of regular intercourse without use of contraception.
How common is infertility?
1 in 7 couples report infertility problems
What is the chance of conception?
Over 80% of couples in the general population will conceive within 1year if
- Women <40 years old
- Do not use contraception
- Having regular sexual intercourse
Of those who do not conceive in the first year, about half will do so in the second year (cumulative pregnancy rate over90%).
When should you investigate for infertility?
If haven’t conceived within 1 year despite actively trying
What are the 4 questions surrounding the cause of fertility problems?
- Are eggs available?
- Are sperm available?
- Can they meet?
- Can embryo implant ?
What should you ask about when taking a female’s history?
- Duration of infertility
- Previous contraception
- Fertility in previous relationships
- Previous pregnancies and complications
- Menstrual history
- Medical and surgical history
- Sexual history
- Previous investigations
- Psychological assessment
What examination should a female undergo?
- Weight
- Height
- BMI (kg/m2)
- Fat and hair distribution
- Galactorrhoea
- Abdominal examination
- Pelvic examination
What is hirsutism caused by?
Andorgen excess
What scoring system is used for androgen excess?
Ferriman Gallwey score
What biochemical measurents are carried out in androgen excess?
- Testosterone (T)
- Dehydroepiandrosterone sulphate (DHEAS) if is greater than 700 mcg/dL (18.9 micromol/L) adrenal computed tomography (CT) is recommended to look for an androgen-secreting adrenal tumor
- 17-OH Progesterone
Name a skin sign of androgen excess.
Acanthosis nigricans
What is looked for on pelvic examination of a female?
- Masses
- Pelvic distortion
- Tenderness
- Vaginal septum
- Cervical abnormalities
How can fibroids present?
- Pressure symptoms
- Period problems
- Infertility
What baseline investigations are done for the female?
- Rubella immunity,
- Chlamydia
- TSH
- If periods are regular: Mid luteal progesterone ( 7 days prior to expected period);
- If periods are irregular please do day 1-5 FSH, LH, PRL, TSH, testosterone
What baseline investigation is carried out on the male?
Semen analysis
What investigations are carried out at the fertility clinic?
- Pelvic Ultrasound
- Physical examination
- Testing for ovulation
- Semen analysis repeat if required
- Tubal patency test
What should women who are concerned about their fertility be asked about?
Frequency and regularity of menstrual cycles
If a women is having regular menstrual cycles, what is unlikely to be the cause of infertility?
Ovulation
How is ovulation confirmed?
A blood test to measure serum progesterone in the mid-luteal phase of their cycle (day21 of a 28‑day cycle) to confirm ovulation even if they have regular menstrual cycles
What should women who have prolonged irregular menstrual cycles be offered?
- A blood test to measure serum progesterone.
- Depending upon the timing of menstrual periods, this test may need to be conducted later in the cycle (for example day28 of a 35‑day cycle) and repeated weekly thereafter until the next menstrual cycle starts
What should women with irregular menstrual cycles be offered?
A blood test to measure serum gonadotrophins (FSH and LH )
How are tubal and uterine abnormalities screened for?
- Hysterosalpingography
- HyCoSy
Who should be offered hysterosalpinography?
Women who are not known to have comorbidities (such as pelvic inflammatory disease, previous ectopic pregnancy or endometriosis)
Why is a hysterosalpingogram carried out?
To screen for tubal occlusion because this is a reliable test for ruling out tubal occlusion, and it is less invasive and makes more efficient use of resources than laparoscopy.
