Infertility Flashcards
Define infertility
inability of heterosexual couple to conceive within 12 months
Difference between primary and secondary infertility?
primary= no previous pregnancies
List three factors that affect fertility
Female age
Previous pregnancy
Timing of intercourse
Weight (low or high BMI)
What is the viability of sperm within female?
72 hours
How often should people have sex to conceive?
2-3 times/week
List two issues associated with increased weight
miscarriage
gestational diabetes
PE
DVT
PIH= pregnancy induced hypertension
How to assess semen?
Volume
Concentration
Total motility
Progressive motility
Normal forms
Vitality
(WHO standard)
How does semen collection work?
Sample provided after 3-5 days of abstinence and must be analysed in lab within 1 hour of being produced
What might cause low concentration? =oligospermia
genetic abnormality- kleinefelter’s
Cystic fibrosis
Y microdeletion
List three investigations for oligospermia/azoospermia
karyotypr
Y microdeletion
CF status
FSH
SSR
Define azoospermia
no sperm production
List two causes of azoospermia
- Obstructive- blockage or epididymis or vas deferns, congenital absence of vas deferens
- Non obstructive
- testicular failure (high FSH, e.g. kleinefleter’s), or low FSH (hypogonadotrophic hypogonadism)
Couple struggling to conceive. Man has azoospermia and low FSH. What condition does he have?
hypogonadotrophic hypogonadism
When is baseline level test done?
Day 1-3
Which days to test ovulation?
based on 28 day cycle, if 30 day cycle then you do day 21 +2= day 23.
What is the WHO classificaiton of irregular or no cycle?
group 1- primary or secondary amennorrhoea
group 2
group 3
What are the causes of group 1 amenorrhoea/irregular menses?
weight
stress
exercise
craniopharygioma
kallman’s syndrome
What is the physiological cause of group 1 irregular cycle?
hypothalmic pituitary failure
What are the levels of FSH, LH, E2 in group 1 patients?
Low FSH, low LH, low E2
What is the management of group 1?
GnRH agonist
FSH/LH
What happens to the feedback cycle in group 2?
hypothalamic pituitary dysfunction
Which is the main condition associated with hypothalamic pituitary dysfunction?
PCOS/PCO
Name two other conditions associated with group 2
hyperprolactinaemia
hypothyroid
hyperthyroid
adrenal insufficiency
How to test group 2?
induce withdrawal bleed with progesterone
hormone tests day 1 and day 3
What are the hormone levels in group 2?
E2 normal
prolactin norma
increased free androgen index
reversed FSH/LH ratio
How to diagnose PCOS
2/3 features Rotterdam criteria
1. Clinical or biochemical evidence
2. Oligomenorrhoea/amenorrhoea
3. USS findings
String of pearls in ovary is a sign of?
PCOS
What is the most common cause of anovulatory infertility?
PCOS
What is the effect of PCOS on fertility
oocyte quality= poor
ovulatory function
endometrial receptivity
+secondary to obesity, metabolic and inflammatory disturbance
Cause= hormone imbalance and insulin resistance (increase in testosterone)
What is the management of PCOS?
weight loss!!
ovarian drilling?
Letrozole= 1st line
What is the MOA of letrozole?
aromatase inhibitor
blocks oestrogen biosynthesis, blocks negative feedback, increase FSH, ovulation stimulation
WHat is the original use of letrazole?
breast cancer (anti-oestrogenic effect)
Other than latrazole, name one other agent to treat infertility in PCOS
clomiphene
What is the MOA of clomiphene
Selective oestrogen receptor modulator
What is the risk of clomiphene
ovarian cancer risk
How to improve fertility in PCOS?
weight loss
latrozole or clomiphene
IVF
What is the cause of group 3?
ovarian failure/insufficiency (pituitary/hypothalamus fine)
What happens to the levels of FSH and E2 in group 3?
increased FSH
Reduced E2
List three causes of group 3?
idiopathic
chemo
surgical removal of ovaries
autoimmune
chromosomal
turner’s syndrome
androgen insensitivity (46 XY but Y is unresponsive)
fragile X
What is the management of group 3 in regard to having children?
oocyte donation with IVF
adoption
fostering
embryo donation
accept childlessness
What are the components of the holy triad?
Fallopian tubes
oocyte
sperm
(+endometrium, uterus anomalies)
What is the elgibility for IVF treatment?
<43 years by the time treatment is completed
BMI 18.5-30
No smoking for at least 3 months no smoking
no biological child from either partner
no sterilisation
cohabiting stable relationship for >2 years
What is ICSI?
single sperm injucted into a mature egg (increased risk of congenital abnormality)
What is the technique for IVF?
sperm fertilised egg on its own (sperm has to do the work itself)
What is IUI?
directly inserting sperm into uterus (female same sex)
Can someone with hep B/C/HIV have IVF?
yes! specialised centres
What is ovarian hyperstimulation?
ovaries over respond to gonadotrophin injections
What are the complications of ovarian hyperstimulation?
thrombosis
renal dysfunction
liver dysfunction
adult respiratory distress syndrome
Why do complications arise with ovarian hyperstimulation?
release of vasoactive producted from hyperstimulated ovaries
Which condition increases the risk of ovarian hyperstimulation?
PCOS
