Infertility Flashcards
What is infertility?
unable to conceive at all
What is subfertility?
More than 12 months without conceiving despite unprotected intercourse
What are causes of infertility?
Ovulatory disorders
Male infertility
Tubal damage
Uterine/ peritoneal
Idiopathic
What is WHO type 1 ovulatory disorder?
hypothalamic pituitary failure - hypothalamic amenorrhoea or hypogonadotrophic hypogonadism
How is WHO type 1 ovulatory disorder treated?
Increase BMI if <19
Reduce level of exercise if high
Pulsatile GnRH
Gonadotrophins (LH)
What is WHO type 2 ovulatory disorder?
hypothalamic-pituitary-ovarian dysfunction (predominately polycystic ovarian syndrome)
e.g. overweight
How is WHO type 2 ovulatory disorder treated?
Reduce BMI if >30
Clomifene citrate
Metformin
Clomifene citrate + Metformin
(Letrozole)
Gonadotrophins (LH or FSH)
Laparoscopic ovarian drilling
What is WHO type 3 ovulatory disorder?
premature ovarian failure - i.e. early menopause
How is WHO type 3 ovulatory disorder treated?
Egg donation
What are basic investigations for infertility?
Test for ovulation -
Semen analysis -
Tubal patency tests - HyCoSy, HSG (make sure they are not pregnant)
What is the diagnostic gold standard for infertility?
Laparoscopy
Therapeutic:
- adhesions (fitz hugh curtis)
- endometriosis
- fibroid resection
What are the risks of a diagnostic laprscopy?
Pain
Bleeding
Perforation
Risk of damage to uterus/bowel/blood vessel
Why may tubal surgery be done?
Adhesions
Blocked/damaged fallopian tubes
Reversal of Sterilization
What is intra-uterine insemination (IUI)?
Oocyte and prepared sperm are brought together at the right moment
What are the fertility treatments? Why are they used?
Ovulation induction - anovulation
Intra-uterine insemination (IUI) - mild sperm defects or unexplained infertility
Surgical - tubal pathology
IVF - tubal blockage, after unsuccessful IUI, several male factor, long term infertility
