infertility Flashcards
what is infertility
disease of the reproductive system defined by failure to achieve a clinical pregnancy after> 12 months regular (2-3days) unprotected sex
what is primary infertility
when you have not had a live birth previously
what is secondary infertility
when you have had a live birth >12 months previously
how many couple affected by infertility
1 in 7
what is the most common cause of infertility in couples
male defect - 30%
female defect - 30%
combined factor - 30%
unknown - 10%
why do couples struggling with infertility suffer from psychological distress
no biological child impact on couples wellbeing impact on larger families investigations treatment can fail
what are some costs of infertility on society?
less births = less tax income
investigation and treatment costs
what are the pretesticular causes of infertility in males
congenital and acquired endocrinopathies
klinefelters - 47xxxy
Y chromosome deletion
problems with hpg axis - prl,gonadotrophs
what are the testicular causes of infertility in males
congenital cryptorchidism infection e.g std immunological - antisperm abs vascular - variococoele trauma/surgery toxins - chemo,dxt,drugs,smoking
post testicular causes
congenital - absebse of vans deferens
obstructive azoospermia
erectile dysfunction - retrograde ejaculation,mechanical impairment or psychological
iactogenic e.g vasectomy
what is cryptorchidism
undescended testes (90% left in inguinal canal)
what % of infertility cause in female do ovarian causes account for and what are they?
40%
anovulation - axis is defective
corpus luteum insufficiency
what % of tubule causes account for infertility
and what are they
30%
tubopathy due to infection, endometriosis and trauma
what % of uterine causes account for infertility
and what are they
10%\unfavourable endometrium due to chronic endometritis(tb) fibroid adhesions (synechiae) congenital malformation
what % of cervical causes account for infertility
and what are they
5%
ineffective sperm penetration due to
chronic cervicitis
immunological - antisperm ab
what % of infertility is unexplained
10%
what is endometriosis
presence of functioning endometrial tissue outside uterus(5%)
what symptoms does endometriosis cause
increased menstrual pain
menstrual irregularities
deep dyspareunia - painful intercourse
infertility
what are the treatments for endometriosis
hormonal - continuous cop,prog
laparoscopic ablation
hysterectomy
bilateral sapling oophorectomy
what are fibroids
benign tumours of myometrium
incidence increases with age
responds to oestrogen
where can fibroids form
subserosol
intramural
submucosal
pedunculate subserosol
what are some symptoms of fibroid
usually asymptomatic increased menstrual pain menstrual irregularities deep dyspareunia infertility
what are some treatment of fibroids
hormonal - continuous cop,prog, continuous GnRH
hysterectomy
what are causes of hypothalamic hypogonadotrophic hypogonadism in males an d females
- congenital hypogonadotrophic hypogonadism
- anosmic (kallman syndrome) or normosmic
- acquired - low bmi, stress, exercise
hyperprolactinaemia
what are some pituitary causes of hypogonadotrophic hypogonadism
hypopituitarism
- tumour, infiltration, apoplexy,surgery,radiation
what are some causes of hypergonadotrophic hypogonadism
congenital primary hypogonadism - kinefelters (47 xxxy)
crypochidism,trauma,chemo,radiation
what is Kallmans syndrome
failure of migration of Gnrh neurones from olfactory placode to hypothalamus
what can kallmans syndrome cause
anosmia
reproductive features
what reproductive features can kallmans syndrome cause
cryptorchidism failure of puberty lack of testicle development micropenis primary amenorrhoea infertility
what is klinefelters
xxy chromosome
high lh,fsh
low testosterone
what are the signs/symptoms of klinefelters
tall stature reduced facial hair breast development mildly impaired iq narrow shoulders wide hips low bone density small penis and testes infertilty female type pubic hair pattern
how to assess patients for infertility
history ->
examination -> investigation
how do you assess history for infertility for males
duration,previous children, milestones, symptoms
medical and surgical, family and social history.
how do you carry out examination for infertility for male
bmi, sexual characteristics, testicular vol, epididymal hardness, presence of vas deferens,endocrine signs,anosmia, syndromic features
what are the investigations for male infertility
semen analysis blood tests - lh,fsh,prl morning fasting testosterone shbg albumin karyotyping urine and chlamydia test imaging
what are some general lifestyle treatments for male infertility
optimise bmi
smoking cessation
alcohol reduction
specific treatments for male infertility
dopamine agonist for highprl
gonadotrophin treatment
surgery
what is name given to early menopause
premature ovarian insufficiency
prev known as premature ovarian failure
how to diagnose premature ovarian insufficiency
high fsh
.25 iU/l
causes of poi
autoimmune
genetic e.g fragile x syndrome/turners
cancer therapy
what do you expect to see in levels of hormone for pcos
high lh:fsh
normal to low oestrodiol
what are some causes of hypergonadotrophic hypogonadism
acquired primary hypogonadism poi surgery,trauma etc turnenrs congenital primary hypogonadism
how do we diagnose pcis
exclude other reproductive orders first
rotterdam pc’s diagnostic criteria (2/3)
what’s included in Rotterdam pcos diagnostic criteria
oligo/anovulation
clinical +- biochemical hyperandrogenism and polycystic ovaries
how do we know what polycystic ovaries are
> 20 follicles
>10 ml
treatment for pcos
OCP for irregular menses
and insulin resistance - metformin
hirsutism - creams, wax,laser and anti androgens
progesterone course for endometrial cancer risk
what is turners syndrome
45x0
signs and symptoms of turners
short stature low hairline shield chest and widest spaced nipples amenorrheoa poor great dev coarctation of aorta small fingernails elbow deformity webbed neck
how to take history for female infert
breastfeeding?
menstruation
fam, social history
what are some examinations for female infert
bmi,sexual characteristics, hyperangrogenism signs, pelvic examination
oendocrine signs,syndromic features,anosmia
main investigations for female infert
ash,fh,prl oestrodiol,androgens lookout follicular stage, mid luteal for congenital... alumni and ironshbg pregnancy test microbiology imaging - transvagibal us
