infertility Flashcards
aetiology
sperm problems ovulation problems tubal problems uterine problems unexplained
When should investigation of infertility be initiated
Couple been trying to conceive without success for 12 months.
Reduced to 6 months if women >35
General infertility advice
400mcg folic acid daily Healthy BMI Avoid smoking & excess alcohol Reduce stress intercourse every 2-3 days avoid timing intercourse (lead to increased stress and pressure)
Initial investigations infertility
BMI chlamydia screening semen analysis Female hormonal testing rubella immunity Thyroid function tests Prolactin (if symptoms of galactorrhea or amenorrhoea)
Female hormone test
Serum LH and FSH: Day 2 -5 of cycle
- High FSH: poor ovarian reserve
- High LH: consider pCOS
Serum progesterone on day 21
- RIse: ovulation has occured
Anti-mullerian hormone
- accurate marker of ovarian reserve.
- Released by granuloma cells in follicle and falls as eggs are depleted
Further investigations
US pelvis
Hystersalpinogram
- potency of fallopian tubes
- therapeutic benefit
Laparoscopy and dye test
-patency of Fallopian tubes, adhesions and endometriosis
management of an ovulation
Weight loss
Clomifene (stimulates ovulation)
Letrozole (alternative to Clomifene)
Gonadotrophins (if resistant to Clomifene)
Ovarian drilling
- Patients with PCOS
Metformin
- insulin insensitivity and obesity (usually associated with PCOS).
management of tubal factors
tubal cannulation during hysterosalpingogram
Laparoscopy to remove adhesion or endometriosis
In vitro fertilisation (IVF)
management of uterine factors
Surgery
- correct polyps, adhesions or structural abnormalities
management of sperm problems
surgical sperm retrieval
surgical correction of an obstruction in vas deferent may restore male fertility
Intra-uterine insemination
Intracytoplasmic sperm injection
