Infertility Flashcards
What are the key factors that must work effectively in order for conception to occur?
- Ovulation
- Sperm production
- Fertilisation
- Implantation
Definition of infertility?
Unable to conceive after 12 months exposure to regular unprotected sex
When do you refer someone for infertility?
- No conception after 1 year of regular unprotected intercourse
Early referral if:
- Age >35yrs
- Known cause for infertility
How is infertility investigated?
- Are eggs available?
- Are sperm available?
- Can they meet?
- Any other factor?
How do you investigate whether eggs are available?
- Maternal age
- Ovarian reserve test (blood test and scan)
- Blood test (FSH, D1-D5 of cycle, AMH)
- US (antral follicular count)
How do you investigate if ovulation is occurring?
Used by couples:
- BBT, Cervical mucus
- LH ovulation kits
- Ovulation calendar
Used to investigate:
- D21 serum progesterone
What level of progesterone is satisfactory for ovulation?
20nmol/l
How do you test for sperm availability?
Semen analyisis
How do you check fallopian tube patency?
- If no pelvic infection or gynaecological problem in the past > hysterosalpingogram (HSG)
- If any of above > laparoscopic dye test
Other tests to be done for infertility?
- Serum prolactin
- TFT
- Chlamydia screening
- Pelvic US for uterine problems
- Rubella immunity
- Cervical smear upto date
Conservative management for ovulation disorders?
- Optimise body weight, healthy lifestyle, exercise
Medical management for ovulation disorders?
Ovulation induction
- Clomiphene citrate
- Gonadotrophin
Surgical management for ovulation disorders?
Laparoscopic ovarian drilling
What is the management for problems with sperm?
- Gonadotrophins
- Surgical sperm retrieval
- Donor sperm
- ICSI (intracytoplasmic sperm injection)
What is the management for tubal problems?
- Role of surgery limited to mild tubal disease
- IVF
Treatment for endometriosis?
- Ablation or resection of spots
- Adhesiolysis
- Cystectomy for endometrioma
Other treatments for infertility?
Uterine surgery for removal of polyps/fibroids
Adhesiolysis for synechiae
How is unresolved infertility managed?
IVF
Sperm and egg retreival in IVF?
- Given gonadotrophin injections to produce multiple eggs in one cycle (donor eggs also can be used)
- Sperm sample collected on day of egg recovery (fresh from partner/frozen samples/donor sperm)
Key steps in IVF?
- Controlled ovarian stimulation
- Follicular monitoring
- Timing ovulation
- Egg collection
- Lab fertilisation (insemination/ICSI)
- Incubation/embryo development
- Embryo transfer
- Progesterone support
What happens once the embryos have been transferred to the female?
- Progesterone pessaries
- Normal activity
- Pregnancy test at 2 weeks
- If positive scan at 7 weeks
What are the risks of IVF?
- Ovarian hyperstimulation syndrome
- Multiple pregnancy
- Medication side effects
- Procedure related risks
What are the long term effects?
- Children born (no difference noted only got short term data)
- Risk of ovarian cancer not confirmed
- Absolute risk to women and children low
