Infertility Flashcards
Define infertility (2)
Failure to establish clinical pregnancy after 12 months of regular, unprotected sex
Or caused by the impairment of persons capacity to reproduce,
Results in disability
Name 6 prevention strategies against infertility
- Promote safe sex and prevent STI with screening at every visit
- maintain healthy weight - fertility decreased if BMI > 25 or <20
- avoid delaying pregnancy
- avoid smoking, drugs, alcohol
- avoid unnecessary use steroids in men
- avoid exposure to environmental toxins, pesticides, chemicals
How long is fertilisation capacity of sperm and oocytes
Sperm up to 5 days in fallopian tubes
Oocyte 12-18 hours
Name 4 broad causes of female infertility
- Tubal factor infertility
- endometriosis induced infertility (47%)
- uterine factor infertility: uterine leiomyomata, intrauterine adhesions, congenital uterine anomalies, isthmocele
- ovulation disorders (30%): hypogonadotropic hypogonadism, eugonadotropic hypogonadism, hypergonadotropic hypogonadism, hyper prolactinaemia, hyper and hypothyroidism
What causes tubal factor infertility? Pathophysiology? (4)
STI! (Also genital tract tb, bilharzia)
Fallopian tube mucosa contains glands which produce various secretions. When occluded → secretions accumulate → hydrosalpinx.
Repeated infections may → PID → pyosalpinx
This impairs natural infertility and implantation: fluids in damaged fallopian tubes has substances toxic to blastocyst and endometrium.
Treatment options tubal factor infertility? (2)
- IVF (offer salpingectomy or prox tubal occlusion to all with thick fibrotic tubes, previous tubal surgery and ultrasound visible hydrosalpinges before IVF)
- salpingectomy and tuboplasty (if can’t afford IVF)
Mechanisms of infertility caused by endometriosis? (4)
- Decreased fertilisation rates
- lower implantation rates (reduced endometrial expression of implantation molecules)
- follicle depletion with ovarian endometriosis or endometriOma
- tubal damage (inflammation)
Adhesions
Treatment options infertility caused by endometriosis? (3)
Severe (equally effective)
- surgical treatment
- IVF
Mild-moderate
- intrauterine insemmination
Name and describe 4 causes uterine factor infertility
- Uterine fibroids: submucosal fibroids and fibroids within junctional zone between endometrial and myometrial layers only.
- Intrauterine adhesions / Asherman syndrome: present with hypomenorrhoea, infertility and or recurrent pregnancy losses. Small, distorted cavity seen on hysterosalpingogram or on saline infusion sonography. Often due to unsafe top
- congenital uterine anomalies: cause pregnany loss, abnormal foetal lie and presentation, prematurity etc
- isthmocele: common pouch-like defect in c/s scar of endometrium. Contains blood debris and mucus → post menstrual bleeding and discharge.
Name and describe 5 ovulation disorders that cause infertility
- Hypogonadotropic hypogonadism: anorexia, elite athletes, chronic stress. Low fsh,llt, estradiol. BMI < 18 stops ovulation. Lifestyle intervention only.
- eugonadotropic hypogonadism: PCOS! Normal hormone profile. Rx lifestyle.
- hypergonadotropic hypogonadism: primary ovarian insufficiency. Eg spontaneous premature ovarian failure, prior chemo/radiation, previous mumps, ovarian reserve damaged by surgery. Rx donor oocyles for assisted reproduction
- hyperprolactinaemia: rx daily bromocriptine or weekly carbogoline (dopamine agonists ). Rarely transsphenoïdal surgery on pituitary
- hypo and hyperthyroid
Name 5 treatment options female infertility
- Intrauterine insemination: indicated mild - moderate endometriosis and PCOS. Preferred option for same sex couples and HIV. Success rate low (<15%) so should be offered at least 3 cycles
- ovulation induction: letrozole best. Alternative = clomiphene citrate; metformin ( add to clomiphene in patients BMI >25 and in clomiphene resistance)
- IVF: indicated for blocked fallopian tubes, severe endometriosis, failed Intrauterine insemination, AMA. Success rate > 50% in young.
- laparoscopic ovarian drilling: second line. Only if booked for another procedure in theatre bc risk tissue damage and reduction in reserve.
- Gonadotrophins: second line in PCOSwho didn’t respond to first line.
