Infertility Flashcards
1
Q
Criteria for infertility referral
A
- No conception after one year of regular unprotected sex
- Age >35 years
- Known cause of infertility
2
Q
Definition of infertility
A
- Clinical → Inability to conceive in 12 month period despite regular unprotected intercourse
3
Q
Lifestyle factors affecting fertility
A
- Age
- BMI
- Smoking
- Alcohol
- Recreational drugs
- Stress
4
Q
Human fertility
A
- Inefficient compared to other mammals
- Conception per cycle of 20% at peak
- Declines with age
5
Q
Why does age matter in fertility
A
- With age there is a reduction in ovarian reserve
- Predetermined egg reserve at birth
- Also a reduced egg quality with age
6
Q
Factors affecting normal conception
A
- Functional hormonal axis and goads
- Ovarian reserve
- Regular ovulation
- Normal sperm production
- Fertilisation → egg and sperm interaction in a patent Fallopian tube
- Normal uterine cavity → implantation
7
Q
Key processes for normal conception
A
- Ovulation (F)
- Sperm production (M)
- Fertilisation (F)
- Implantation (F)
8
Q
Female infertility examination
A
- Weight
- Height
- BMI
- Fat and hair distribution
- Galactorrhoea
- Abdominal and pelvic examination
9
Q
Hirsutism
A
- Abnormal growth of excess body hair due to excess male sex hormone (Androgens)
10
Q
What to look out for in pelvic examination
A
- Masses
- Pelvic distortion
- Tenderness
- Vaginal septum
- Cervical abnormalities
11
Q
Initial investigations for infertility
A
- Body mass index (low could indicate anovulation, high could indicate PCOS)
- Semen analysis
- Rubella immunity
- Chlyamdia
12
Q
Further investigations
A
- Serum LH and FSH (days 2-5)
- Serum progesterone (7 days before end of cycle)
- Anti-Mullerian hormone
- Thyroid function test
- Prolactin
- Pelvic ultrasound
- Hysterosalpingogram
- Laparascopy and dye test
13
Q
HyCosy scan
A
- Scan to tests for damage and blockage of the fallopian
- Substitute for HSG or laparoscopy and dye
14
Q
Hysterosalpingogram
A
- Screen for shape uterus and patency of Fallopian tubes
- Injection of contrast medium into cervix filling uterine cavity and Fallopian tube
- X-ray image taken
15
Q
Laparoscopy and dye test
A
- Dye injected into uterus and should enter Fallopian tubes and spill out the ends of the tubes laparoscopically
- This will not be seen during obstruction
- Assessment for endometriosis and pelvic adhesions
16
Q
Important features of male infertility history
A
- Developmental history
- Testicular descent
- Changes in shaving frequency
- Loss go body hair
- PMH
- Infections → mumps, STIs
- Varicocele repair
- Vasectomy
- Previous fertility
- Drugs
- Anabolic steroids
- Chemotherapy
- Recreation drugs
- Social history
- Radiation exposure
- Alcohol
- Smoking
17
Q
Important features of male infertility examination
A
- Weight
- Height
- BMI
- Fat and hair distribution (hypoandrogenism
- Increased body fat
- Decreased muscle mass
- Loss of axillary, pubic and facial hair
- Genital examination
- Epididymis
- Testes
- Vas deferens
- Varicocele
18
Q
Epididymitis
A
- Inflammation of epidermis
- Causes seminiferous tubule necrosis
- Disrupts spermatogenesis
- Cause
- STDs
- Chlamydia
- Gonorrhea
- TB and mumps
19
Q
Varicocele
A
- Dilatation of pampiniform plexus of spermativ veins in scrotum
- Causes low sperm concentration → infertility
*
20
Q
Kinlefelter syndrome
A
- Genetic conditions with an extra copy of X chromosome
- Commonest cause of primary hypogonadism → impaired spermatogenesis and testosterone deficiency
21
Q
Absent vas deferens
A
- Normal function development of testes
- Sperm cannot travel through vas deferens to be ejaculated
- Can be a sign of cystic fibrosis
22
Q
Classification of ovulatory disorder
A
- Group 1 → hypothalamic pituitary failure
- Group 2 → hypothalamic-pituitary-ovarian dysfunction
- Group 3 → ovarian failure
23
Q
Management of anovulation
A
- Weight loss → overweight patients with PCOS
- Ovulation induction
- Clomifene
- Letrozole
- Gonadotropins
- Ovarian drilling → for PCOS
- Metformin → in insulin insensitivity in conjunction with obesity (PCOS)
24
Q
Clomifene
A
- Selectie oestrogen receptor modulator
- Stops negative feedback of estrogen to hypothalamus
- Causes greater release of FSH and LH
25
Gonadotropin
* Induction of multiple follicles
* Alternative to Clomifene
* Risk of multiple pregnancies and ovarian hyper stimulation syndrome
26
Management of tubal factors
* Tubal cannulation during hysterosalpingogram
* Laparascopic removal of adhesions or endometriosis
* In vitro fertilisation
*
27
Management of infertile males
* In vitro fertilisation and intracytoplasmic sperm injection
* Intra-uterine inseminsation
* Surgery
* Reversal of vasectomy
* Surgical sperm retrieval
* Surgical correction → vas deferens
* Donor insemination
28
Unexplained infertility
* Contraindications → oral ovarian stimulation agents (Clomifene)
* Over IVF