Infertility Flashcards
Definition of Infertility
Infertility — inability of a couple to conceive within one year of unprotected sexual intercourse.
Define the following
Sterility
Infertility implies
Primary infertility
Secondary infertility
Sterility implies an intrinstic inability to achieve pregnancy.
Infertility implies a decrease in an ability to conceive.
Primary infertility applies to those who have never conceived.
Secondary infertility applies to those who have conceived at some time in the past regardless of live birth or not.
Q1. Are the couple normal or abnormal? (statistic)
Q2. Why can’t they conceive ? (reason)
Q3. What tests should they take? (evaluation)
Q4. How can we help them? (treatment)
Q5. If they need ART at last, What means ART?
Q1. Are the couple normal or abnormal? (statistic)
Ans. 1: abnormal or normal?
•~ 90% of couples conceive within 1 year of unprotected intercourse.
•incidence ranges from 7~28%
•incidence increase with age
Q2. Why can’t they conceive ? (reason)
factors • ovulatory dysfunction • tubal disease • uterine factor • cervical and immunologic factor • unexplained factor
ovulatory dysfunction 30-40%
• polycystic ovarian syndrome (PCOS)
• simple anovulation
• decreased ovarian reserve
tubal and peritoneal factors 30-40%
• tubal injury
• tubal blockage
• paratubal adhesion
uterine factor
• uterine abnormalities
• uterine myoma
• adhesions of uterine cavity(Asherman’s syndrome )
•Endometritis
•Polyp of endometrium
cervical factor is estimated to be a cause of infertility in no more than 5% of infertile couples.
Endometriosis’s prevalence increases to 30-40% among infertile women.
The reasons of endometriosis induced infertility are multiple.
• abnormality of semen
• abnormality of sexual activity
• immune factor
• abnormal intercourse
• immune factor
• unexplainded reason
Q3. What tests should they take? (evaluation)
Ans. evaluation
The Most Important Factor in the Evaluation of the Infertile Couple Is:
history
•menstrual history
•Pelvic pain
•Previous pregnancy outcomes
•PID, IUD, pelvic surgery
•Pituitary, adrenal, thyroid function
•Galactorrhea, hirsutism, weight change
•Developmental defects
•Past genital surgery
•Mumps orchitis
•Genital trauma
•Medications
•Occupational exposures
•Sexual history
Family history
•Infertility
•Premature ovarian failure
•Congenital or developmental defects
•Mental retardation
Physical examination
•Height,weight,body habitus
•Hair distribution
•Thyroid gland
•Pelvic examination
Basic investigations
•Semen analysis
•Confirmation of ovulation
•Documentation of tubal patency
Semen analysis
• performed after at least 48 hours of abstinence
• examination within 0ne-half to one hour of collection
Characteristics of semen analysis(normal)
• Volume – 1.5-5ml
• concentration - ≥20million/ml
• Motility - >50% with forward movement
• Morphology - >30% normal
• Several specimens are necessary to verify an abnormality.
• Caffeine, alcohol, and smoking has been associated with diminished semen quality.
ovarian function
•Document ovulation:
–BBT
–Luteal phase progesterone
–LH surge
–Ultrasound monitoring
–The only convincing proof of ovulation is pregnancy
BBT
•Basal body temperature chart
•Temperature be determined before arises, eats, drinks, smoking
•secretion of progesterone causes a temperature increase of about 0.5 ℃
•Cheap and easy, but…
–Provides evidence after the fact (retrospectively)
–May delay timely diagnosis and treatment
–the exact time of ovulation is difficult to determine
–Inconsistent results
–Biphasic profiles can also be seen with LUF syndrome
Luteal phase progesterone
•peak progesterone secretion in the midluteal phase
•Performed 7 days after presumptive ovulation
•>3ng/ml consistent with ovulation
Luteinizing Hormone Monitoring
•Ovulation occurs 34 to 36 hours after the onset of the LH surge
•about 10 to 12 hours after the LH peak.
Ultrasound Monitoring
•Ovulation is characterized by a decrease in the size of a monitored ovarian follicle.
•It most often occurs when follicular size reaches about 21 to 23 mm.
Methods of Analyzing Ovulation
•Endometrial biopsy
•Cervical mucus changes
Follow-up Tests
•FSH LH PRL T TSH
•Hypothalamic-pituitary disorder
hypothyroidism
PCOS polycystic ovarian syndrome
POF premature ovarian failure
Tubal Function
•Evaluate tubal patency whenever there is a history of PID, endometriosis or other adhesiogenic condition
•Tests
–HSG
–Laparoscopy
Procedure (HSG)
•A speculum is inserted into the vagina，
•A catheter is then inserted into the cervix
•Contrast material is injected into
the uterine cavity through the
catheter
•Fluoroscopic images are
then taken
Use of HSG
•used to evaluate infertility or with frequent miscarriages
•Uterine abnormalities
•Congenital uterine anomalies
•Fibroids or tumor masses
•Adhesions
Benefits of HSG
•minimally invasive procedure
•Minimal exposure to radiation
•Can detect intrauterine and tubal disorders but not always definitive
•Increase subsequent pregnancy rates
Factors of infertility
•ovulatory dysfunction
• tubal disease
• uterine factor
• cervical and immunologic factor
• unexplained factor
ovulatory dysfunction 30-40%
• polycystic ovarian syndrome (PCOS)
• simple anovulation
• decreased ovarian reserve
tubal and peritoneal factors 30-40%
• tubal injury
• tubal blockage
• paratubal adhesion
uterine factor
• uterine abnormalities
• uterine myoma
• adhesions of uterine cavity(Asherman’s syndrome )
•Endometritis
•Polyp of endometrium
cervical factor is estimated to be a cause of infertility in no more than 5% of infertile couples.
Endometriosis’s prevalence increases to 30-40% among infertile women.
The reasons of endometriosis induced infertility are multiple.
• abnormality of semen
• abnormality of sexual activity
• immune factor
• abnormal intercourse
• immune factor
• unexplainded reason
Evaluation
History:
•menstrual history
•Pelvic pain
•Previous pregnancy outcomes
•PID, IUD, pelvic surgery
•Pituitary, adrenal, thyroid function
•Galactorrhea, hirsutism, weight change
•Developmental defects
•Past genital surgery
•Mumps orchitis
•Genital trauma
•Medications
•Occupational exposures
•Sexual history
Family history
•Infertility
•Premature ovarian failure
•Congenital or developmental defects
•Mental retardation
Physical Examination
Physical examination
•Height,weight,body habitus
•Hair distribution
•Thyroid gland
•Pelvic examination
Basic Investigations
Basic investigations
•Semen analysis
•Confirmation of ovulation
•Documentation of tubal patency
Semen analysis
• performed after at least 48 hours of abstinence
• examination within 0ne-half to one hour of collection
Characteristics of semen analysis(normal)
• Volume – 1.5-5ml
• concentration - ≥20million/ml
• Motility - >50% with forward movement
• Morphology - >30% normal
• Several specimens are necessary to verify an abnormality.
• Caffeine, alcohol, and smoking has been associated with diminished semen quality.
Ovarian function
ovarian function
•Document ovulation:
–BBT
–Luteal phase progesterone
–LH surge
–Ultrasound monitoring
–The only convincing proof of ovulation is pregnancy
Basal body temperature
BBT
•Basal body temperature chart
•Temperature be determined before arises, eats, drinks, smoking
•secretion of progesterone causes a temperature increase of about 0.5 ℃
Cheap and easy, but…
–Provides evidence after the fact (retrospectively)
–May delay timely diagnosis and treatment
–the exact time of ovulation is difficult to determine
–Inconsistent results
–Biphasic profiles can also be seen with LUF syndrome
Luteal Phase Progesterone
Luteal phase progesterone
•peak progesterone secretion in the midluteal phase
•Performed 7 days after presumptive ovulation
•>3ng/ml consistent with ovulation
Luteinizing Hormone Monitoring
Luteinizing Hormone Monitoring
•Ovulation occurs 34 to 36 hours after the onset of the LH surge
•about 10 to 12 hours after the LH peak.
Ultrasound Monitoring
Ultrasound Monitoring
•Ovulation is characterized by a decrease in the size of a monitored ovarian follicle.
•It most often occurs when follicular size reaches about 21 to 23 mm.
Methods of Analyzing Ovulation
Methods of Analyzing Ovulation
•Endometrial biopsy
•Cervical mucus changes
Follow up test
Follow-up Tests
•FSH LH PRL T TSH
•Hypothalamic-pituitary disorder
hypothyroidism
PCOS polycystic ovarian syndrome
POF premature ovarian failure
Tubal function
Tubal Function
•Evaluate tubal patency whenever there is a history of PID, endometriosis or other adhesiogenic condition
•Tests
–HSG
–Laparoscopy
