infertility Flashcards
what is the definition of infertility?
failure to achieve a clinical pregnancy after 12 months of more of regular unprotected sexual intercourse (in absence of known reason) in a couple who have never had a child
what are the common causes of secondary infertility?
tubal disease
fibroids
endometriosis/adenomyosis
weight related
age related
what are the gynaecological causes of anovulatory infertility?
Hypothalmic: anorexia/bulimia, excessive exercise,
Pituitary: hyperprolactinaemia, tumours, Sheehan syndrome
Ovarian: PCOS, premature ovarian failure
what are some non-gynaecological causes of anovulatory infertility?
Systematic disorder: e.g. chronic renal failure.
Endocrine disorder: e.g. testosterone secreting tumours, congenital adrenal hyperplasia, thyroid
Drugs: e.g. depo-provera, explanon, OCP
what are the clinical and endocrine feature of PCOS?
Clinical Features: obesity, hirsutism or acne, menstrual cycle abnormalities and infertility
Endocrine features: high free androgens, high LH, impaired glucose tolerance
how do you diagnose PCOS?
score 2 out of three:
chronic anovulation
polycystic ovaries
hyperandrogenism (clinical or biochemical)
what causes premature ovarian failure?
idiopathic, genetic, chemotherapy, radiotherapy, oophorectomy
what are the clinical & endocrine features of premature ovarian failure?
clinical: hot flushes, night sweats, atrophic vaginitis, amenorrhoea, infertility
endocrine: high FSH, high LH, low oestradiol
what are the infective causes of tubal disease?
Pelvic inflammatory disease (chlamydia, gonorrhoea, other: anaerobes, syphilis, TB)
transperitoneal spread: appendicitis, intra-abdominal abscess
following procedure: IUCD insertion, hysteroscopy, HSG
what are non-infective causes of tubal disease?
endometriosis
surgical (sterilisation, ectopic pregnancies)
fibroids
polyps
congenital
salpingitis isthmica nodosa
what is hydrosalpinx?
A hydrosalpinx is fluid blockage in your fallopian tubes that may make it difficult for you to become pregnant. Damage to your fallopian tubes, most often from an untreated infection, can cause a hydrosalpinx.
what are the clinical features of hydrosalpinx due to pelvic inflammatory disease?
abdominal/pelvic pain febrile
vaginal discharge dyspareunia
cervical excitation menorrhagia
dysmenorrhoea
infertility
ectopic pregnancy
what is the definition of endometriosis?
presence of endometrial glands outside uterine cavity
what are the causes of endometriosis?
Retrograde menstruation (blood flowing back into pelvis instead of out of the vagina) is most likely cause, altered immune function, abnormal cellular adhesion molecules, genetic
what are the clinical features of endometriosis?
dysmenorrhoea (classically before menstruation), dysparenuia, menorrhagia, painful defaecation, chronic pelvic pain, uterus may be fixed and retroverted, scan may show characteristic ‘chocolate’ cysts on ovary, infertility, asymptomatic
what are some non-obstructive causes of male infertility?
47 XXY (klinefelter’s), chemotherapy, radiotherapy, undescended testes, idiopathic
what are some obstructive causes of male infertility?
congenital absence (cystic fibrosis), infection, vasectomy
what investigations do you do for female infertility?
endocervical swab for chlamydia
cervical smear if due
blood for rubella immunity
midluteal progesterone level , progesterone > 30nmol/l suggestive ovulation
Test of tubal patency: hysterosalpingiogram (HSG) /hycosy or laparoscopy
Others if indicated: e.g. hysteroscopy, ultrasound scan, endocrine profile and chromosomes
what investigations do you do for male infertility?
examination & semen analysis- twice over 6 weeks
if abnormal can do hormone levels, endocrine profile, chromosome analysis, biopsy
what vitamin supplements should be taken during pregnancy?
400micrograms of folic acid daily before pregnancy and in 1st trimester
10 micrograms vit D daily for pregnant & lactating people
what treatment is done to induce ovulation in PCOS?
clomifene citrate
gonadotrophin therapy, daily injections
laparoscopic ovarian diathermy
when is surgery used as a primary treatment for infertility?
-pelvic adhesions
-grade 1&2 endometriosis
-chocolate cysts in ovary
-tubal block
