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Year Three - Reproductive System > Infertility > Flashcards

Infertility Flashcards

1
Q

What is infertility?

A

The inability to conceive over a 12 month period despite exposure to regular, unprotected sexual intercourse

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2
Q

How many couples are affected by infertility?

A

One in seven couples

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3
Q

What percentage of couples conceive within one year?

A

84%

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4
Q

What percentage of couples conceive within two years?

A

92%

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5
Q

What is primary infertility?

A

It refers to a patient who’s never conceived a child in the past experiencing fertility issues

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6
Q

What is secondary infertility?

A

It is the inability to conceive after previously giving birth to a baby – either in this relationship or a previous one

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7
Q

What are the five causes of infertility?

A

Sperm Problems

Ovulation Issues

Tubal Problems

Uterine Problems

Unexplained

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8
Q

What percentage of infertility issues are caused by sperm problems?

A

30%

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9
Q

What percentage of infertility issues are caused by ovulation problems?

A

25%

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10
Q

What percentage of infertility issues are caused by tubal problems?

A

15%

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11
Q

What percentage of infertility issues are caused by uterine problems?

A

10%

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12
Q

What percentage of infertility issues are unexplained?

A

20%

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13
Q

What are the four risk factors of infertility?

A

Age

Smoking

Alcohol

Obesity

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14
Q

What are the four risk factors of infertility?

A

Age - A woman’s fertility gradually declines with age, specifically after the mid 30s

Smoking

Alcohol

Obesity

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15
Q

Why does a woman’s fertility decrease with age?

A

This is due a decrease in the ovarian reserve and a decrease in the quality of the eggs

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16
Q

Why does smoking increase the risk of infertility in females?

A

It accelerates the decline in the ovarian reserve in females

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17
Q

Why does smoking increase the risk of infertility in males?

A

It decreases the sperm count in men

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18
Q

Why does obesity increase the risk of infertility in females?

A

It decreases the quality of eggs

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19
Q

Why does obesity increase the risk of infertility in males?

A

It decreases sperm count

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20
Q

When do we refer patients to a fertility clinic?

A

When there has been no conception after one year of regular unprotected intercourse

This can be reduced to six months if the woman is older than 35 years old or there is a known cause of infertility

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21
Q

What are the five investigations used to diagnose female infertility?

A

Blood Tests

Chlamydia Screening

Ultrasound Scan

Hysterosalpingogram

Laparoscopy Dye Test

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22
Q

What are the six blood tests used to diagnose infertility in females?

A

Serum LH Levels

Serum FSH Levels

Anti-Mullerian Hormone

Serum Progesterone Levels

Serum Prolactin Levels

Thyroid Function Test

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23
Q

When do we measure LH levels to diagnose infertility?

A

On day one to five of the menstrual cycle

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24
Q

How are LH levels used to help investigate infertility?

A

A high LH may suggest polycystic ovarian syndrome, which is a condition associated with infertility

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25
Q

What is the normal LH level?

A

Under 10miu/ml

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26
Q

When do we measure FSH levels to diagnose infertility?

A

On day one to five of the menstrual cycle

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27
Q

How are FSH levels used to help investigate infertility? Why?

A

A high FSH may suggest a poor ovarian reserve

This is because is indicates the pituitary gland is producing excess FSH in an attempt to stimulate follicular development

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28
Q

What is anti-mullerian hormone?

A

It is the most accurate marker of ovarian reserve

It is a hormone released by the granulosa cells in the follicles and falls as the eggs are depleted

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29
Q

What are the normal levels of anti-mullerian hormone?

A

These levels should be between 1.5-4 ng/ml in women under the age of 35

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30
Q

How are anti-mullerian hormone levels used to help investigate infertility?

A

A high level indicates a good ovarian reserve

A low level indicates a low ovarian reserve

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31
Q

When do we measure progesterone levels to diagnose infertility?

A

They should be measured seven days prior to the expected next period

In a typical 28 day cycle, this is conducted on day 21

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32
Q

How are progesterone levels used to help investigate infertility?

A

This test is used to determine if the process of ovulation is occurring as at this point in the cycle, ovulation should’ve occurred, and levels should be at peak

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33
Q

What are the normal levels of progesterone?

A

Over 30nmol/L

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34
Q

How is an ultrasound scan used to investigate infertility?

A

It is used to assess the antral-follicular count, which is the number of follicles present in the ovary

It is also used to determine the presence of any uterine or ovarian disease

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35
Q

How is a hysterosalpingogram used to investigate infertility?

A

It is a type of scan used to assess the shape of the uterus and the patency of the fallopian tubes

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36
Q

Describe the procedure of a hysterosalpigogram

A

It involves the insertion of small tube into the cervix

A contrast medium, methylene blue dye, is injection through the tube and fills the uterine cavity and fallopian tubes

An x-ray image is taken with the contrast giving an outline of the uterus and tubes

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37
Q

What hysterosalpingogram result indicates infertility?

A

If the dye doesn’t fill one of the tubes, tubal obstruction is indicated

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38
Q

When is hysterosalpingogram contraindicated?

A

Gynaecological problems

Pelvic infections

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39
Q

How is a laparoscopy dye test used to investigate infertility?

A

It is a type of scan used to assess the shape of the uterus and the patency of the fallopian tubes

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40
Q

Describe the procedure of a laparoscopy dye test

A

During the procedure, a laparoscope is inserted into the uterus to observe the pelvis organs

A methylene blue dye is then injected into the uterus

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41
Q

What laparoscopy dye test result indicates infertility?

A

This dye should spread into the fallopian tubes; however, this will not occur if there is obstruction present

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42
Q

What investigation is used to investigate male infertility?

A

Semen Analysis

43
Q

How is semen analysis used to investigate infertility?

A

It is used to examine the quantity and quality of the semen and sperm

44
Q

What is the normal semen volume?

A

> 1.5ml

45
Q

What is the normal semen pH?

A

> 7.2

46
Q

What is the normal sperm concentrations?

A

> 15 million per ml

47
Q

What is the normal sperm motility percentage?

A

> 40%

48
Q

What is the normal sperm morphology percentage?

A

> 4%

49
Q

What is anovulation?

A

The lack or absence of ovulation

50
Q

What is the most common cause of anovulation?

A

Polycystic ovarian syndrome

51
Q

Which investigation result indicates that infertility is due to anovulation?

A

When serum progesterone levels are low

52
Q

How do we conservatively manage anovulation?

A

It involves advising patients about weight loss, through a balanced diet and regular exercise

53
Q

What is the first line treatment option for anovulation in overweight patients with polycystic ovarian syndrome?

A

Conservative management

54
Q

What three drugs are prescribed for anovulation? What is their function?

A

Clomiphene

Letrozole

Gonadotrophins

These medications stimulate ovulation in a regular and cyclical manner

55
Q

How do we surgically manage anovulation?

A

Laparoscopic ovarian drilling

56
Q

What is laparoscopic ovarian drilling?

A

The surgeon punctures multiple holes in the ovaries using a surgical needle or laser therapy

57
Q

What are the two sperm problems that cause infertility?

A

Low sperm count

Azoospermia

58
Q

What are the two causes of sperm problems?

A

Insufficient hormone production

Testicular problems

59
Q

Which investigation result indicates that infertility is due to sperm problems?

A

It is indicated by abnormal semen analysis results

60
Q

What class of drugs are prescribed for sperm problems? What is their function?

A

It involves prescription of gonadotrophins

These medications increase hormone synthesis production

61
Q

What are the three surgical procedures used to manage sperm problems?

A

Surgical Sperm Retrieval

Intrauterine Insemination

Intracytoplasmic Sperm Injection (ICSI)

62
Q

When is surgical sperm retrieval conducted?

A

It is used when there is a blockage somewhere along the vas deferens preventing sperm from reaching the ejaculated semen

63
Q

How is surgical sperm retrieval conducted?

A

The procedure involves a needle and syringe collecting sperm directly from the epididymis through the scrotum

64
Q

What is intrauterine insemination?

A

It involves collecting and separating out high-quality sperm, then injecting them directly into the uterus to give them the best chance of success

This can be done with the male partner’s sperm or a donor’s sperm

65
Q

What is ICSI?

A

It involves injecting a single sperm directly into the cytoplasm of an egg

The sperm selected is of the highest quality

These fertilised eggs become embryos and are injected into the uterus of the woman

66
Q

In which three circumstances is ICSI conducted?

A

When there are significant motility issues

A very low sperm count

When there are other issues with the sperm

67
Q

What are the three surgical procedures used to manage fallopian tube problems?

A

Tubal Cannulation

Endometriosis Ablation

In Vitro Fertilisation (IVF)

68
Q

What is tubal cannulation?

A

It uses hysteroscopy to guide a cannula through the cervix and the uterus into the fallopian tube

This increases the patency of the fallopian tube

69
Q

When is tubal cannulation conducted?

A

The procedure should only be conducted in those with mild blockage in the distal part of their fallopian tube

70
Q

What is endometriosis ablation?

A

It is a procedure that surgically ablates the endometrium

71
Q

What procedure is most commonly used to manage fallopian tube problems?

A

IVF

72
Q

What is IVF?

A

It involves mature eggs being collected from the ovaries and fertilised by sperm in a lab

The fertilised eggs are then transferred to a uterus

This procedure can be conducted with the partner’s own egg and sperm; however, donor options are also available

73
Q

How are uterine problems managed?

A

They are managed by removal of polyps, adhesions or other structural abnormalities affecting fertility

74
Q

How do we manage infertility when there is an unexplained cause?

A

IVF

75
Q

What are the seven steps of IVF?

A

Menstrual Cycle Suppression

Ovarian Simulation

Oocyte Collection

Oocyte Insemination

Embryo Culture

Embryo Transfer

Pregnancy

75
Q

What are the seven steps of IVF?

A

Menstrual Cycle Suppression

Ovarian Simulation

Oocyte Collection

Oocyte Insemination

Embryo Culture

Embryo Transfer

Pregnancy

76
Q

How is the menstrual cycle suppressed before IVF?

A

The prescription of GnRH agonists or GnRH antagonists

77
Q

What GnRH agonist is prescribed before IVF? How is it given?

A

Goserelin

An injection of a goserelin is given in the luteal phase of the menstrual cycle, around 7 days before the expected onset of the menstrual period

78
Q

How does a GnRH agonist suppress the menstrual cycle?

A

It initially stimulates the pituitary gland to secrete a large amount of FSH and LH

However, after this initial surge in FSH and LH, there is negative feedback to the hypothalamus, and the natural production of GnRH is suppressed

79
Q

What GnRH antagonist is prescribed before IVF? How is it given?

A

Cetrorelix

Daily subcutaneous injections of cetrorelix are given starting from fay 5-6 of ovarian stimulation

80
Q

When do we stimulate the ovaries for IVF?

A

This starts at the beginning of the menstrual cycle

81
Q

How do we stimulate the ovaries before IVF?

A

FSH subcutaneous injections

82
Q

How long do we stimulate the ovaries before IVF?

A

10-14 days

83
Q

At what follicle size do we stop ovarian stimulation?

A

18mm

84
Q

After the FSH injections, what other drug do we use to stimulate the ovaries?

A

An injection of hCG

85
Q

When are hCG injections given before IVF?

A

This injection is given 36 hours before collection of the eggs

86
Q

Why do we give hCG injections before IVF?

A

The hCG stimulates the final maturation of the follicles, ready for collection

87
Q

How are oocytes collected?

A

A needle is inserted through the vaginal wall into each ovary to aspirate the fluid from each follicle under guidance of a transvaginal ultrasound scan

This fluid contain the mature oocytes from the follicles

88
Q

When do we ask males to produce a semen sample for IVF?

A

Around the time of oocyte collection

Frozen sperm from earlier samples may be used

89
Q

What two fertilisation methods are used for IVF?

A

Insemination

Intracytoplasmic Sperm Injection (ICSI)

90
Q

What is insemination?

A

It involves the sperm being mixed in a culture dish which contains the collected egg

91
Q

How long are fertilised eggs incubated for?

A

Over 2-5 days

92
Q

At what development stage do we transfer the embryos from incubation to the uterus? When does this usually occur?

A

Blastocyte

Day five

93
Q

What is the maximum incubation period for IVF?

A

6 days

94
Q

How are embryos transferred to the uterus for IVF?

A

A catheter is inserted under ultrasound guidance through the cervix into the uterus

A single embryo is injected through the catheter into the uterus, and the catheter is removed

95
Q

What do we do with the remaining fertilised eggs after embryo transfer?

A

The remaining embryos can be frozen for up to ten years in case of future attempt

96
Q

When is a pregnancy test conducted after IVF?

A

16 days after egg collection

97
Q

When do we prescribe progesterone during IVF?

A

From the time of oocyte collection until 8-10 weeks’ gestation

98
Q

In what form is progesterone prescribed for IVF?

A

Pessary

99
Q

Why do we prescribe IVF patients progesterone?

A

This is used to maintain the endometrium

100
Q

Why do we no longer prescribe IVF patients progesterone after 8-10 weeks gestation?

A

From 8-10 weeks, the placenta takes over the production of progesterone

101
Q

When is an ultrasound scan conducted after IVF? Why?

A

7 weeks gestation

To check for a fetal heartbeat and rule out miscarriage or ectopic pregnancy

102
Q

What are the four complications of IVF?

A

Ovarian Hyperstimulation Syndrome

Multiple Pregnancy

Ectopic Pregnancy

Failure

Year Three - Reproductive System (52 decks)

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