infertility Flashcards
what is infertility?
inability to conceive >12 months regular intercourse without contraception
how long regular menstrual cycle
-how long follicular
-when ovulation
-how long luteal
regular cycle 28-35 days
-follicular is variable
-ovulation usually day 14 (14 days before end of cycle)
-luteal is always 14
what is oligomenorrhoea and amenorrhoea
oligomenorrhoea: cycles >35 days
amenorrhoea: absent menstrual cycles
what hormone triggers ovulation?
LH surge triggers ovulation
what hormone peaks following ovulation?
Progesterone
what hormone does an at home ovulation predictor kit detect?
LH
what hormone is measured in medical setting when predicting ovulation and why?
For regular cycles:
Midluteal (day 21) serum progesterone !!!
-if ovulation has occured then corpus luteum will be producing progesterone which should peak mid luteal phase (before corpus luteum begins to break down)
For irregular cycles: (anovulatory)
-further hormone evaluation
investigations in GP for amenorrhoea?
-Follicular phase bloods: LH, FSH and E2
-Testosterone, SHBG, FAI
-Prolactin
azoospermia- what?
no sperm in ejaculate
asthenozoospermia- what?
% progressive motile sperm below reference limit
(sperm with low motility)
oligozoospermia- what?
total number/ concentration of sperm below reference limit
(low sperm count)
teratozoospermia- what?
% morpholoically normal sperm below reference limit
(lots of abnormal looking sperm)
what is done for women in infertility consultation?
-History
-Examination
-TVUS (looking at uterus and ovaries)
-Investigations
-Establish length of relationship and length trying to get pregnant
what is done for men in infertility consultation?
-history
-examination
-Diagnostic semen analysis
-Investigations
-Establish length of relationship and length trying to get pregnant
what investigations done to test tubal patency?
Hysterosalpingogram (HSG)
- if no known risk fators tubal/ pelvic pathology
(this is like scan of uterus)
DIAGNOSTIC= LAPARASCOPIC + HYDROTUBATION (HTB)
if suspected or known endometrial pathology= hysteroscopy
what investigation should be done if there is suspected or known endometrial patholgoy?
hysteroscopy
what lifestyle advice is given for someone trying to conceive?
-stop smoking
-BMI 18.5 to 30
-Reduce/ stop alcohol consumption
-moderate caffeine
-Stop recreaion drugs/ methadone
-Folic acid
what is the commonest reason for ovulation problems
PCOS
criteria for PCOS?
ROTTERDAM CRITERIA
2 of:
-oligo/amenorrhoea
-clinical or biochemical signs of excess androgens
-Polycystic ovaries on US (12/more 2-9 mm follicles, >10mls fluid, unilateral/ bilateral)
management decreased fertility in PCOS?
1st line= Clomifene citrate +/- metformin
alternatively letrozole (tamoxifen)
Others:
-Gonadotrophin injections
-Laparascopy ovarian drilling
treatments offered to men with abnormal semen parameters?
-Intrauterine insemination (IUI)
-In vitro fertilisation (IVF)
-Intracytoplasmic sperm injection (ICSI)
treatment for a blocked fallopian tube?
Generally no treatment:
-IVF (but hydrosaplinx decreases IVF success by 50%)
what is the ART eligibility for assisted conception?
-Stable relationship of 2 years
-Female age <40
-Female BMI 18.5 to 30
-Non smokers
-No biological children
-No illegal/ abusive substances (including methadone)
-Neither partner to have been steralised
-Duration unexplained fertility 2 years
-Up to 3 cycles of treatment
