Infertility Flashcards
What is the chance of conception per cycle?
20%. Declines steeply after 35.
How long does it usually take for a couple to conceive?
2 years
What aspects have to work for conception to occur?
- Ovulation - HPG axis
- Sperm production - motility + outflow
- Fertilisation - good tubal muscle spasms to move sperm
- Implantation
What is the definition of infertility?
No conception after 1 year of regular unprotected sex
When should you be referred for infertility?
If you fit definition but earlier if:
• Age >35
• Known cause for infertility
What is primary infertility?
Never managed to have a pregnancy or father a child
What is secondary infertility?
Have had a pregnancy/child before but are now unable to
What are the investigations for female infertility?
- Ovarian reserve test/scan
- Blood test: FSH at day 1-5 of cycle
- Antimullerian hormone
- Figure out if ovulation is happening
How do you figure out if ovulation is happening?
- Natural methods
- LH ovulation kits
- Ovulation calendar
- D21 serum progesterone: Levels > 20nmol/l shows satisfactory ovulation
How to investigate patency of fallopian tubes?
- Hysterosalpingogram
* Laparoscopic dye test - pelvic infection or past gynae problem
What other potential causes/investigations of infertility?
- Hormones: Serum prolactin, TFT
- STIs: Cervical smear update, Chlamydia screening
- Infection: Rubella immunity
- Imaging: Pelvic USS for uterine problems
Following on from what you need to make conception happen, what are the potential issues causing infertility?
- Ovulation disorders
- Sperm problems
- Tubal problems
- Other treatments
What is the management for
ovulation disorders?
- Optimise body weight + lifestyle
- Medication: clomiphene citrate, gonadotrophins (direct FSH)
- Laparoscopic ovarian drilling (PCOS)
What is the management for
Sperm problems?
- Gonadotrophins
- Surgical sperm retrieval
- Donor sperms
- Intracytoplasmic sperm injection
What is the management for Tubal problems?
- Surgery for mild tubal disease
* IVF
What are the other causes of infertility?
- Endometriosis
* Polyps/fibroids/adhesiolysis for synechiae
What is the management of endometriosis?
Ablation or resection of spots, adhesions, cystectomy for endometrioma
What is the management for Polyps/fibroids/adhesiolysis for synechiae?
Uterine surgery
If infertility is still unresolved, what main areas do we manage?
- Eggs
* Sperm
When is IVF offered?
• Offered after 2 years
If it’s an egg issue, how to manage?
- Own eggs –> gonadotrophin induced superovulation
* Donor eggs –> age, poor quality, ovarian failure, genetic cause.
If it’s a sperm issue, how to manage?
- Fresh sample on the day of egg collection
- Frozen sample thawed from surgical retrieval or fertility preservation
- Donor sperm
What is the process of IVF?
- Ovarian stimulation
- Follicular monitoring
- Timing ovulation
- Egg collection
- Lab fertilisation
- Incubation
- Embryo transfer
- Progesterone support with pessaries - Pregnancy test after 2 weeks, If +ve, scan at 7 weeks.
What are the risks of IVF?
- Ovarian hyperstimulation syndrome (OHSS)
- Multiple pregnancy
- Medication side effects
- Procedure related
What are the long term effects of IVF?
- No difference to children born :)
- Risk of ovarian cancer not confirmed
- Absolute risk to women and children low
Interesting information about other fertility options:
- Donor gametes
- Fertility preservation
- Ovarian tissue cryopreservation
- Preimplantation genetic diagnosis
- Assisted hatching
- IV maturation
- Surrogacy
