Infertility Flashcards
General advice for infertility?
Reduce stress- affect libido/relationship
Folic acid daily
healthy BMI (low= anovulation, high= PCOS)
dont smoke/drink less alcohol
intercourse every 2-3 days- don’t time as can lead to stress/pressure
What can cause infertility?
Male factor- sperm problems, ovulation failure, tubal damage, other
Investigations for infertility
Semen analysis
Serum progesterone on day 21- high shows ovulation occured and CL secreted progesterone if high, anti-mullerian (shows ovarian reserve is good if high- released by granulosa cells in follicles)
LH/FSH= high FSH poor ovarian reserve, LH= PCOS
USS= structural/ hysterosalpingogram/laproscopy/dye test- tubal cannulation opens tubes, treat adhesions in laproscopy.
Treatment for women infertility
Ovarian drilling- PCOS
weight loss- PCOS
Metformin- PCOS and insulin insensitivity
Clomifene stimulates ovulation
Tubal cannulation, laproscopy remove adhesions/endometriosis
IVF
Surgery to correct polps, adhesions, fibroids
How to manage sperm problems
Surgical sperm retrieval if blockage along vas defenrens (w/ needle)
Surgical correction of blockage
Intrauterine insemination (inject high quality sperm into uterus)
Intracyoplasmic sperm injection
Donor insemination
What can affect sperm quality/quantity?
hot bath, tight underwear, smoking, alcohol, raised BMI, caffeine
How to investigate male infertility?
Semen analysis sample, history examination, ultrasound of testes
Hormonal analysis, genetic, vasography, testicular biopsy
Testicular causes of infertility
Mumps, undescended, trauma, radio, chemo, cancer, genetics/congential- klinefelter, Y chromosome deletion, sertolicell-only abscene, absent testes, damage to testicle/vas deferens from trauma, ejaculatory duct obstruction, retrograde ejaculation, scarring from epididymitis- chlamydia, abscence of vas deferencs (CF), young syndrome (obstructvie azoospermia, bronchiectasis, rhinosinusitis)
Pre-testicular causes of infertilitiy
Testosterone low, due to hypogonadotrophic hypogonadism- pathology of pit gland/ hypothalamus, supression due to stress, chornic conditions, hyperprolactinaemia, Kallman syndrome
describe process of IVF
Supress natural menstruation cycle= w/ GnRH agonist/antagonist
Stimulate ovulation- w/ FSH +hCG
Oocyte collection with USSS and needle to aspirate fluid
OOcyte insemination- thousand of sperm and one egg in culture medium or ICSI
Left in culture- 2-5 days/
Highest quality embryos selected for transfer, injected into uterus. only 1 or 2 in older women, rest can be frozen for future attempts.
16 days later pregnancy test done
Progesterone giving from oocyte collection- 8 wks gestation to mimic release by CL, placenta takes over 8 weeks after. USS in 7 weeks gestation to rule out miscariage look for heartbeat
Main complications with IVF
Failure, multiple pregnancy, ectopic pregnancy risk, ovarian hyperstimulation syndrome
PAIN, BLEED, pelvic infection, damage to bladder/bowel
What is the mechanism for ovarian hyperstimulation syndrome
Increased vascular endothelial growth factor released by granulosa cells- causing vascular permaebility and fluid to leak from capillaries= oedema, ascites, hypovolaemia
FSH/LH during ovarian stim= multiple follicles and trigger injection before collectiomn stimulates release of vegf from follicles.
If risk of ovarian overstimulation syndrome is high which should be used? GnRH antagonist or agonist?
GnRH antagonist
within 7-10 days of hCG injection, OHSS can occur, what symptoms are there?
Abdo pain/bloat, N/V, diarrhoea, hypotension/hypovolaemia, ascites, pleural effusion, renal failure, peritonitis (from rupturing follicles releasing blood, prothrombic state (DVT/PE)
Activates RAAS= raised renin
What blood test can assess volume of fluid in intravascular space
Haematocrit- conc of RBC in blood. IF it is high then less fluid as blood is more conc= dehydration.
