Infertility Flashcards
What is infertility?
Inability to conceive over a 12 month period despite exposure to regular , unprotected intercourse.
What can naturally cause a decrease in fertility?
Increasing age
How does age have an effect on fertiltiy?
Decline in the number of eggs
Decline in the ability of cell division
What does natural conception depend on in terms of the female?
- Functioning hormonal axis and gonads
- Ovarian reserve
- Regular ovulation
What does natural conception depend on in terms of fertilisation?
Egg and sperm interaction
Patent fallopian tubes
Normal uterine cavity for implantation
What lifestyle factors contribute to fertility?
- Age
- BMI
- Smoking
- Alcohol
- Recreational drug use
- Stress
When would you refer a couple for infertiltiy?
No conception after one year of regular unprotected intercourse
When would you refer a couple for infertility early?
Older than 35
Known cause for infertility
What is primary infertility?
They have never had a pregnancy before
Or the man has never fathered a child
What is Secondary infertility?
They have had a previous pregnancy in this or a previous relationship but can’t get pregnant in this one
What is the most common cause of female infertility?
Ovulation dysfunction- A woman not releasing an egg regularly
What are other possible causes of female infertility?
- Tubal factor (fallopian tube)
- Diminishing ovarian reserve
- Endometriosis
- Uterine factor
What are male causes of infertility?
- Problem with producing hormones for sperm production
- Blockage of sperm transport
- Sperm production problems
- Erection or ejaculation problems
What are the 4 things to investigate for infertiltiy?
Eggs available
Ovulation happening
Sperm available
Can the egg and sperm meet
How would you test for the availability of eggs?
Blood test
What would you look for in the blood to check for the availability of eggs?
FSH level
AMH level
What is the most reliable test for egg availability?
AMH
(Anti-Müllerian hormone)
When would you measure FSH?
Between day 1 and day 5 of the cycle
When would you measure AMH?
Any point throughout the cycle
What scan can you do for egg number?
Ultrasound scan
What can an ultrasound scan tell you?
Antral Follicular count
What is used to check if ovulation is happening?
D21 serum progesterone
When should D21 serum progesterone be measured?
Day 21 of a 28-30 day cycle
What level of progesterone would suggest satisfactory ovulation?
Progesterone more than 20nmol/l
How would you check the sperm availability?
Semen analysis
What should the concentration of the semen be?
About 15million/ml
What should the volume of semen be?
1.5ml
What 2 things are important for the egg and sperm to be able to meet?
Patent fallopian tube
Intercourse
How would you check the patency of the fallopian tubes if there was no pelvic infection or gynaecological problem?
Hysterosalpingogram
How would you check the patency of the fallopian tubes if there was a pelvic infection or gynaecological problem?
Laparoscopic dye test
