infertility Flashcards
what is infertility
defined as inability to conceive after 12 months regular intercourse without contraception
general causes of infertility
-not ovulating
-tubal blockage
-something wrong with sperm
surge of what hormone triggers ovulation
LH
when does progesterone peak
following ovulation
how do you predict someone has good ovulation
midluteal serum progesterone >30
initial investigations for infertility (to get IVF etc)
-day 21 progesterone - establish ovulation
-TSH
-rubella immunity
-chlamydia screen
-ensure cervical smear up to date
-diagnostic semen analysis
diagnostic semen analysis
what other investigations need to be done
-ultrasound
-tubal patency test (hysterosalpingogram, diagnostic laparoscopy and hydrotubation)
-hysteroscopy
abnormal findings on USS
lifestyle advice for assisted conception
-stop smoking
-BMI 18.5-30
-reduce/stop alcohol consumption
-moderate caffeine
-stop recreational drugs
-folic acid
commonest reason for ovulatory problems
PCOS
rotterdam diagnostic criteria for PCOS
Revised Rotterdam diagnostic criteria: 2 of
1. Oligo/Amenorrhoea
2. Polycystic ovaries (scan appearance)
12/more 2-9mm follicles
Increased ovarian volume >10ml
Unilateral / bilateral
3. Clinical and/or biochemical signs of hyperandrogenism (acne, hirsutism)
forms of ovulation induction
-clomifene citrate
-gonadotrophin injections
-laparoscopic ovarian diathermy
what is given to women with PCOS that don’t respond to clomifene
metformin
treatment for blocked fallopian tubes
-generally no treatment may have to get IVF
-cannulation
