Infertility Flashcards by Katie Clark

List some factors that are increasing the demand for assisted conception therapy (ACT)

Increasing parental age
Increasing chlamydia
Male factor infertility
Improved success rates of ACT

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List the main indications for ACT

Male factors
Unexplained infertility
Endometriosis
Tubal disease
Ovulatory disorder
Single parents/same sex couples

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At what age does fertility start to decrease?

27
Significantly so at 37

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What should females limit their alcohol limit to per week to improve fertility?

4 units a week

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What is the optimal weight for males + females to improve fertility?

BMI 19-29

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What medical interventions should be assessed before ACT to improve fertility?

Folic acid
Check rubella immunity
Cervical smear
Blood-borne viruses screen

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Which drug class in particular can cause male infertility/azoospermia?

Steroids (if abused)

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How long should a female wait before trying to conceive after being vaccinated against rubella?

3 months

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List all the assisted conception treatments available

Donor insemination
Intra-uterine insemination (IUI)
In vitro fertilisation (IVF)
Intra-cytoplasmic sperm injection (ICSI)
Surrogacy

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What does intra-uterine insemination involve?

Sperm are injected into the uterine cavity around the time of ovulation

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What does in vitro fertilisation involve?

Sperm and egg fertilise outside body and implanted into uterus

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How is the normal menstrual cycle down-regulated in preparation for IVF?

Synthetic GnRH agonist administered as spray/injection

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How is the ovary stimulated to cause follicular development?

Synthetic GH injection

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What are the risks to GH injection?

Allergy
Ovarian hyperstimulation syndrome

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How long must a male be abstinent before providing a sperm sample?

72 hours

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What does intra-cytoplasmic sperm injection involve?

Injecting sperm into egg outside the body (i.e. no fertilisation)

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What determines our gender?

Chromosomes (XY or XX)
Sex hormones secreted
External + internal genitalia
Psychological factor

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Which chromosome has the sex-defining region?

Y-chromosome

Which 2 hormones/factors contribute to the development of the internal genital tract in the male?

Testosterone
Mullerian inhibiting factor

There are 2 primitive genital tracts: Wolffian and Mullerian ducts. Which duct contributes to male and female genital tracts respectively?

Males = Wolffian
Females = Mullerian

Without stimulation by testosterone + Mullerian inhibiting factor, what develops in the male?

Internal genital tract resembling that of a female

The testes develop in the abdominal cavity but descend into the scrotal sac before birth. Why?

Lower temperature outside the body facilitates spermatogenesis

What is cryptorchidism?

Undescended testes, resulting in reduced sperm count and increased risk of testicular cancer

What does testicular descent depend on?

Androgenic drive

Where does spermatogenesis occur?

Seminiferous tubules

Where is testosterone secreted from?

Leydig cells

Where does LH act in the male?

Leydig cells - regulate testosterone levels

Where does FSH act in males?

Sertoli cells - enhances spermatogenesis

What are the 3 main categories of causes of male infertility?

Idiopathic (most common cause) Obstructive Non-obstructive

List some obstructive causes of male infertility

Cystic fibrosis (vas deferens defect) Vasectomy Infection

List some non-obstructive causes of male infertility

Cryptorchidism Infection Radiation (chemo/radiotherapy) Testicular tumour Genetic: Klinefelter's Semen structure abnormality Systemic/endocrine disorders

List some pituitary causes of male infertility

Tumours Acromegaly Cushing's disease Hyperprolactinaemia

List some hypothalamic causes of male infertility

Tumour Increased exercise Kallmann's syndrome Anorexia

Which drug when abused is notorious for causing male infertility?

Steroids

What would be assessed on genital examination in a male with infertility?

Testicular volume (normal = 12-25ml) Presence of vas deferens + epidydimis Penis Urethral orifice Presence of swellings/varicocele

What 5 domains are assessed on semen analysis?

Volume Density (number of sperm) Motility (how many are moving) Progression (how well they move) Morphology

How would testicular volume, secondary sexual characteristics, endocrine hormones and structure of vas deferens be affected in obstructive male infertility?

All normal Vas deferens may be absent

How would testicular volume, secondary sexual characteristics, endocrine hormones and structure of vas deferens be affected in non-obstructive male infertility?

Low testicular volume Reduced secondary sexual characteristics High endocrine hormones Vas deferens present

List some lifestyle improvements that can help male infertility

Frequent sex, 2-3x a week Avoid lubricants (toxic to sperm) Less than 4 units of alcohol a week Stop smoking BMI less than 30 Avoid tight underwear, saunas/hot baths

When is ICSI indicated over IUI?

IUI - low sperm count ICSI - very low sperm count

What is the success (pregnancy) rate of IUI and ICSI?

IUI = 15% ICSI = 30%

When is surgical sperm aspiration indicated?

Azoospermia (very low sperm count)

What is the success (pregnancy) rate of surgical sperm aspiration?

95% in obstructive 50% in non-obstructive

If IUI, ICSI and sperm aspiration fail, what is the next option?

Donor sperm