Infertility Flashcards
What are the main causes of infertility?
1) Male Factors (30%)
2) Ovulatory (25%)
3) Unexplained factors (25%)
4) Tubal (20%)
5) Uterine/peritoneal (10%)
When should a couple be referred due to infertility issues?
When they have attempted to naturally conceive for over 1 year
What would make you consider early referral for investigating infertility?
Woman: >35, menstrual disorder, previous surgery, previous PID/STI
Man: Genital pathology, previous STI, systemic illness or abnormal genital examination
What pre-conception advice would you give to a couple?
Have intercourse 2-3 times a week.
Folic acid.
Ensure smears are up to date.
Smoking cessation and reduce alcohol intake.
Manage co-morbidities.
Ensure healthy weight.
What reproductive disorders are associated with obesity?
1) PCOS
2) Miscarriage
3) Infertility
4) Obstetric complications
What 3 things are investigated in initial infertility tests?
Ovulation.
Semen quality.
Tubal patency.
Infertility investigations: what initial tests would the GP do?
Hormone profile (D2, FSH, D21 progesterone).
TFT’s.
Rubella.
Smear.
Semen analysis.
Infertility investigations: how can you check ovulation?
Measure mid-luteal progesterone.
Infertility investigations: what hormone levels are looked at in order to test ovarian reserve?
FSH.
AMH
AFC (antral follicle count) is also determined through imaging.
A sperm count less than what will indicate the need for clinical examination and further tests?
<5m/ml.
Further testing may include endocrine tests and karyotyping e.g. klinefelters.
Infertility investigations: how can tubal patency be investigated?
HSG (hysterosalpingogram) imaging.
HyCoSy (Hysterosalpingo-contrast-sonography).
Laparoscopy.
How can infertility be managed if there is a mild abnormality?
Intrauterine insemination.
How can infertility be managed if there is a moderate abnormality?
IVF
How can infertility be managed if there is a severe abnormality?
Intra-cytoplasmic sperm injection.
How can infertility be managed if azoospermia is the cause?
- Surgical sperm recovery.
- Donor insemination
Infertility: Give 3 risk factors for anovulation.
Stress.
Low weight.
Extreme exercise.
Kallmann’s + Turner’s syndrome.
What is the rotterdam diagnostic criteria for PCOS.
Anovulation/oligomenorrhoea.
Polycystic ovaries seen on imaging.
Increased androgens - clinically or biochemically.
How can PCOS be treated?
Encourage weight loss.
COCP if not wanting to get pregnant.
Symptomatic treatment of acne and hirsutism.
For pregnancy:
Clomifene/tamoxifen.
Metformin.
Ovarian drilling.
How does Clomifene work in the treatment of PCOS?
Clomifene is an anti-oestrogen. It leads to increased production of LH/FSH and so there is more follicle stimulation. It can treat menstrual disturbance and has a good pregnancy rate.
Infertility: give 3 causes of tubal disease.
1) Infections.
2) Endometriosis.
3) Iatrogenic e.g. following surgery.
Outline the process of IVF
Ovarian stimulation -> egg collection -> insemination -> fertilisation check -> embryo culture -> embryo transfer -> luteal support.
Why is only 1 egg utilised in IVF?
To avoid multiple pregnancies
Give 4 risks associated with IVF.
Multiple pregnancy.
Miscarriage.
Ectopic pregnancy.
Foetal abnormality.
Give 4 factors that can affect the likelihood of IVF being successful.
Increasing age -> reduced egg quality.
Successive cycles/longer duration infertility.
Obesity.
Environmental factors e.g. smoking, alcohol, caffeine.
Give 3 examples of uterine abnormalities that can affect fertility.
Endometrial polyps.
Fibroids e.g. sub-mucous will significantly affect pregnancy rates.
Adhesions.
