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Reproductive systems > Infertility > Flashcards

Infertility Flashcards

1
Q

Define infertility

A
  • Failure to conceive after frequent unprotected sexual intercourse for one or two years
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2
Q

What is primary infertility?

A
  • Never been pregnant
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3
Q

What is secondary infertility?

A
  • Previous pregnancy (including ectopic and terminations) but struggling to conceive again
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4
Q

What is subfertility?

A
  • Generally describes any form of reduced fertility that results in a prolonged duration of unwanted lack of conception
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5
Q

What are the causes of infertility?

A
  • Unidentifiable in 25%
  • Male causes 30%
  • Ovulatory causes 25%
  • Tubal factors 20%
  • Uterine and peritoneal disorders 10%
  • Other (gamete/embryo defects, coital problems, concurrent health problems)
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6
Q

Outline the pre-testicular causes of male infertility?

A
  1. Endocrine:
    - Hypogonadotropic hypogonadism
    - Hyperprolactinaemia
    - Hypothyroidism
    - Diabetes
  2. Coital problems
    - Ejaculatory disorders
    - Erectile dysfunction
  3. General health/systemic illness
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7
Q

Outline the testicular causes of male infertility

A
  1. Genetic
    - Klinefelter syndrome
    - Y chromosome deletion
    - Immotile cilia syndrome
  2. Congenital (cryptorchidism)
  3. Infective (STIs)
  4. Antispermatogenic agents
    - Heat
    - Irradiation
    - Drugs
    - Chemotherapy
  5. Vascular
    - Torsion
    - Varicocoele
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8
Q

Outline the post-testicular causes of male infertility

A
  1. Obstructive
    - Congenital (CBAVD/CUAVD)
    - Acquired (infective/vasectomy)
  2. Coital problems
    - Sexual dysfunction
    - Hypospadias
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9
Q

Outline Group 1 ovulatory disorders

A
  • Hypothalamic-Pituitary failure - 10%
  • Hypothalamic amenorrhoea
  • Hypogonadotropic hypogonadism
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10
Q

Outline Group 2 ovulatory disorders

A
  • Hypothalamic-Pituitary-Ovarian Dysfunction - 85%
  • PCOS
  • Hyperprolactinaemic amenorrhoea
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11
Q

Outline Group 3 ovarian failure

A
  • Ovarian failure - 5%
  • Premature ovarian failure
  • Congenital e.g. Turner’s syndrome (45X0)
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12
Q

How do uterine and peritoneal disorders lead to infertility?

A
  • Physical reasons why implantation fails
  • Uterine fibroids
  • Conditions causing scarring/adhesions e.g. endometriosis, PID, previous surgery, Asherman syndrome
  • Mullerian developmental abnormalities
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13
Q

What causes tubal damage?

A
  • Conditions affecting fallopian tube causing disrupted transport of ovum
  • Endometriosis
  • Ectopic pregnancy
  • Pelvic surgery
  • PID
  • Mullerian developmental anomaly - agenesis
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14
Q

What questions do we need to ask males presenting with infertility?

A
  • Testicular trauma/disorders
  • Ejaculatory/erectile dysfunction
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15
Q

What questions do we need to ask females presenting with infertility?

A
  • Age
  • Obstetric/Gynae history (cycle and cervical)
  • Smear, procedures
  • Menstrual disorders
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16
Q

What history do we need to obtain from males and females presenting with infertility?

A
  • Full medical history
  • Surgical history
  • Social history - alcohol, smoking, occupation, previous children/pregnancies
  • Sexual health history
  • Sexual dysfunction
17
Q

How do we examine males for infertility?

A
  • Not usually required
  • Examine penis for structural abnormalities
  • Scrotal exam
  • Secondary sexual characteristics
18
Q

How do we examine females for infertility?

A
  • BMI
  • Secondary sexual characteristics e.g. hirsutism, acne
  • Abdominal/pelvic/vaginal exam for masses, tenderness, infection, uterus size/position, vaginismus
19
Q

What advice should be given to patients suffering with infertility?

A
  • Smoking cessation
  • Reduce alcohol intake
  • Lifestyle changes - stress
  • Regular intercourse
  • Weight loss
  • Reassurance
20
Q

What investigations should be done in males with infertility?

A
  • Semen analysis - sperm count, motility, liquification studies
  • Bloods - LH/FSH, testosterone
  • STI screen
  • Ultrasound scan testes
  • Karyotyping
21
Q

What investigations should be done in females with infertility?

A
  • FSH/LH
  • Mid-luteal phase progesterone (day 21/28)
  • TFTs, prolactin levels, androgens
  • STI screen
  • Pelvic USS
  • Hysterosalpingogram
  • Laparoscopy
22
Q

How do we refer infertile patients to secondary care?

A
  • Consider referral if history, exam, and investigations are normal in both partners and not conceived after 1 year
  • Consider early referral in women >36 years/after 6/12 or there’s a known cause
  • Offer counselling throughout process
23
Q

How do we manage patients with infertility?

A
  • Medical treatment - ovulation induction (Clomifene)
  • Surgical treatment - fix tubal occlusions e.g. laparoscopy
  • Assisted reproductive technology = means of conception other than normal coitus e.g. intrauterine insemination, IVF etc.

Reproductive systems (20 decks)

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