Infertility Flashcards
Risk factors to infertility
Irregular infrequent menses
History of PID
moderate/severe endometriosis
Significant prior abdominal surgery
Risk factors for decreased ovarian reserve
Advanced reproductive age
tubal etiologies of infertility
Tubal: prior tubal surgery, pelvic infections, abdominal/pelvic surgery (adhesions), prior ectopic pregnancy, endometriosis
sperm factors of infertility
Pre-testicular: erectile dysfunction, hypothalamic causes like Kallmans, tumor, hyperprolactin, severe hypothyroidism.
Testicular: genetic, congenital, infections, testicular trauma, vascular (torsion), others like testicular cancer, exposures, medications
Post Testicular: surgery, congenital absence of vas deferens, acquired blockage (infections), retrograde ejaculation
broad ovulatory causes of infertility
Ovulatory: hypogonadotropic, hypogonadism, eugonadotropic, eugonadism, hypergonadotropic, hypogonadism.
Ovulatory: hypogonadotropic, hypogonadism, eugonadotropic, eugonadism, hypergonadotropic, hypogonadism are all causes of infertility. Define these terms
Hypogonadotropic: low FSH/LH
Hypogonadism: low estradiol
- Can be due to hypothalamic causes→ eating disorders, excessive exercise, significant stress, pituitary tumors.
Eugonadotropic: → normal FSH/LH
Eugonadism: → normal/elevated estradiol
- ex/ PCOS, obesity, late onset congenital adrenal hyperplasia, Cushing syndrome.
Hypergonadotropic: high FSH/LH, but with hypogonadism (low estradiol)
- Premature ovarian insufficiency due to turners syndrome, fragile X, chemotherapy.
history for an intertile patient
Menses: regularity, length, heaviness, pain.
- If irregular, ask about associated symptoms: hirsutism/acne, galactorrhea, hot flashes, low body fat
Tubal risk factors: tubal surgeries, STI/PID historys, abdominal surgery
Uterine risk factors: fibroids, surgery, infection
intercourse/insemination: frequency, timing, lubricant use.
For males: sexual function (erectile, ejaculation), testicular risk factors → undescended, trauma, torsion, surgery, infections, pregnancy history (prior partners), outcomes.
OB/Gyn History: pregnancy history, pregnancy outcomes, PAP, STI, delivery details
Med History
Surgical
Meds
Social: occupational exposures, smoking, drug use
HFx: genetic issues, anomalies, infertility, VTE, early menopause
etiologies for anovulation
FSH, LH, estradiol
Pelvic US for antral follicle count/ovarian volume
Prolactin.
TSH
Androgens, 17-OHP, cortisol am where clinically applicable.
ovariana nd tubal investiagtions for infertility
- tubal hysterosalpinogram (make sure there are no blockages)
luteal progesterone (make sure the endometrium is being maintained)
ovarian reserve studies: day 3 FSH and estradiol ,antral follicle count on vaginal ultrasound, anti-mullerian hormone ASSESSMENT
male investigations for infertility
Treatments for Ovulation- related infertility
- weight
- aromatase inhibitor (lower estrogen levels allows for incease in FSH, which has a stimulatory effecton the growth of ovarian follicles)
- SERMS
- gonadotropins (FSH/LH)
- metformin for PCOS
- bromocriptine for prolactinemia
- levothyroxin for hypothyroid
- ovarian dilling
- gonadotropins with IVF
treatments for tubal diseases causing infertility
- IVF
surgical correction
proximal disease cannulation
hydrosalpinx
treatments for sperm factors of infertility
Lifestyle: smoking cessation/substance decrease, weight loss, medication cessation
Gonadotropins (hypothalamic hypogonadism)
Varicocele repair
Clomiphene citrate/aromatase inhibitor off label use.
Can due intrauterine insemination (IUI), intracytoplasmic sperm insemination (ICSI), surgical sperm retrival for IVF/ICSI (epididymis or testicular), donor sperm.
Treatments for UNexplained infertility
Oral superovulation + IUI (12%/cycle)
FSH + IUI (17%/cycle)
IVF (<5-60%)
note about fertility services in diverse populations
