infertility Flashcards
how does fertility change with age?
declines with age due to ovarian egg reserve declining
what are the different steps of conception?
- ovulation
- sperm production
- fertilisation
- implantation
descibe the hypothalmo-pituitary gonadal axis
describe the ovulation cycle?
what are the two phases of the ovarian cycle?
follicular phase
luteal phase
describe the hormonal control for male reproduction?
what does FSH act on in males and what effect does it have?
spermatogonia in seminiferous tubules of testes, causing spermatogenesis
what does LH act on in males and what effect does it have?
leydig or interstitial cells of testis, causing formation of androgens (testosterone)
natural conception relies on?
- functioning hormonal axis and gonads
- ovarian reserve
- regular ovulation
- normal sperm production
- fertilisation: egg and sperm interaction; patent fallopian tubes
- normal uterine cavity for implantation
what lifestyle factors impact ferility?
- age
- BMI
- smoking
- alcohol
- recreational drug use
- stress
what is inferility
inability to conceive over a 12 month period despite regular exposure to unprotected intercourse
infertility is describe as being over what period?
> 12 months
describe the epidemiology of inferility (% of woman affected and fraction of couples in Western world)?
- 10% of woman are affected
- 1/7 couples in western world are affected
when should people be referred for infertility clinic?
- no conception after one year of regular unprotected intercourse
refer earlier if:
- > 35 years
- known cause for infertility
describe the aetiology of female infertility?
- ovulatory dysfunction (most common)
- diminishing ovarian reserve
- endometriosis
- uterine factor
- tubal factor
describe the aetiology of male infertility?
hormone problems: hormonal control
erection and ejaculation problems
- prostate surgery
- damage to nerves
- ejaculation problems
- timing of intercourse
- medication
how is infertility investigated?
are eggs available?
are sperm available?
can they meet?
what investigations are done to see if eggs are available?
ovarian reserve test – blood test and scan
blood tests – FSH
USS – antral follicular count
D21 serum progesterone to check if ovulation is happening
- levels > 20nmol/L show satisfactory ovulation
- couples can use LH ovulation kits or ovulation calendar themselves
what investigations are done to see if sperm are available?
semen analysis
what things are looked at in semen analysis?
volume - 1.5 million total sperm number - 39 million concentration - 15 million/ml vitality - 58% progressive motility - 32% total motility - 40% normal morphology - 4%
what investigations are done to see if egg and sperm can meet?
intercourse
patent fallopian tubes
- hysterosalpingogram (HSG): no pelvic infection or gynaecological problems
- laparoscopic dye test
describe the management for infertility?
egg
- optimise BMI
- healthy lifestyle
- exercise
- medication: ovulation induction
- laparoscopic ovarian drilling
sperm
- medical treatments – gonadotrophins
- surgical sperm retrieval – epididymis/testis
- donor sperm – intrauterine insemination
- ICSI (intracytoplasmic sperm injection)
tubes
- role of surgery limited to mild tubal disease
- IVF (in-vitro fertilisation)
what medication can be given to induce ovulation?
- clomiphene citrate
- gonadotrophins
what is the medical term for no sperm?
azoospermia
what is IVF regulated by?
Human Fertilisation & Embryology Authority (HFEA)
- regulating authority
- licensing
- inspections
- forms – registration, treatment, outcome
- register
describe the process of IVF in steps?
If using own eggs, gonadotrophin used to induce superovulation
donor eggs may be used if – older age (poor ovarian reserves), poor quality, ovarian failure, genetic cause
sperm ejaculate from partner collected on the day or frozen sample from surgical retrieval or fertility preservation
donor sperm can be used for single woman, same sex relationship, azoospermia, genetic cause or infection (HIV, Hep B, Hep C)
why would donor eggs be used for IVF?
older age (poor ovarian reserves), poor quality, ovarian failure, genetic cause
describe the IVF process key steps in numbers?
controlled ovarian stimulation follicular monitoring timing ovulation egg collection lab fertilisation – insemination (partners sperm produced and mixed into dish with egg) /ICSI (used in low sperm count, sperm injected into egg) – 60/70% success rate incubation/embryo development embryo transfer – done under US guidance into uterine cavity progesterone support
pregnancy test after 2 weeks, if positive scan at 7 weeks (US)
<p>What are the risks of IVF?</p>
- ovarian hyper stimulation syndrome (OHSS)
- multiple pregnancies
- medication side effects
- procedure related
<p>What are IVF indications other than inferility?</p>
<ul> <li>Donor gametes</li> <li>Fertility preservation</li> <li>Ovarian tissue cryopreservation</li> <li>Preimplantation genetic diagnosis</li> <li>Assisted hatching</li> <li>In vitro maturation</li> <li>Surrogacy</li> </ul>
