Infertility Flashcards
What’s infertility
Infertility is the inability to conceive after 12 months of regular unprotected sexual intercourse
What is the difference between fecundability and fecundity?
The probability of achieving a pregnancy in one menstrual cycle is termed fecudability
•Similarly, fecundity is the probability of achieving a live birth in one menstrual cycle.
The 2 types of infertility??
•1. Primary infertility: it refers to couples who have not become pregnant after at least 1 year of having sex without birth control methods
•2. Secondary infertility: refers to couples who have been able to get pregnant at least once, irrespective of the outcome but now are unable to do so.
•Infertility can result from problems that interfere with any of which steps?
In order for a woman to get pregnant, the following events has to occur:
• - Ovulation (egg must be released from one of her ovaries)
• - Egg must go through the fallopian tube toward the uterus
• - Fertilization (sperm must join with the egg in the fallopian tube)
• - Implantation (fertilized egg must attach to the uterine wall)
CAUSES OF INFERTILITY IN FEMALES
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Conditions that affect fertility are divided into four main categories:
•1. Ovulatory disorders
•2. Tubal damage
•3. cervical factor
•4. uterine factor
•5. peritoneal factor
• 6. Male factors (20%)
•7. Unexplained or other conditions (15%)
Pelvic factor
•Endometriosis
•Adhesions
Uterine factor
unfavorable endometrium for nidation/implantation
Chronic endometritis
Fibroid
Adhesions
Congenital malformation
Cervical factor
Ineffective sperm penetration
Chronic cervictis
Immunological; presence of antisperm antibody
Ovarian factor
•Disovulatory ;
Anovulation
Corpus luteum insufficiency
Tubal factor
•Tubal pathology
Pelvis endometriosis
Following tubal infection
EVALUATION OF INFERTILITY;
History?
•Biodata ( name, age, occupation, address, religion, tribe, marital status, educational level, parity, last menstrual period)
•- presenting complaint: inability to conceive.
•Ask for the duration of marriage and the type of marriage, since when has she been trying to get pregnant, contraceptive use and for how long, frequency of coitus, if husband has fathered a child before, any pre/post costal practice; lubricants/ douching
•Gynecological history: age of menarche, length of menstrual cycle and duration of menses, ask about history of: (menorrhagia, dyspareunia,
•Hypothalamic- pituitary – ovarian axis: any premenstrual symptoms. History of milk discharge from the breast(hyperprolactinaemia), history of cold intolerance, weight gain, decreased appetite, neck swelling (hypothyroidism), history of heat intolerance, weight loss, neck swelling (hyperthyroidism), visual disturbances (pituitary tumour)
•Tubal and uterine factor: history of infection, history of tubal surgery, previous history of D&C, abortions and where
•Peritoneal: past history of appendicitis, typhoid perforation, post abortal infection
•Past medical and surgical history should be recorded
•drug Hx immunosuppressants use; metaclopramide phenothiazine, NSAIDS
•Social history: smoking, any recreational drug, alcohol
•Exposure to irradiation, cytotoxic chemotherapy
Ask about male partner
Occupation
Hx of genital infection
Hx of surgery in the genital /inguinal region
Does he ejaculate into the vagina during coitus
Erectile dysfunction
Exposure to irradiation chemotherapy,
EVALUATION OF INFERTILITY:
PHYSICAL EXAMINATION??
General:
•Note the body habitus: obesity, hirsutism, acne(PCOS), short with webbed neck (turner’s syndrome), galactorrhoea, thyroid enlargement, BMI, presence or absence of secondary sexual characteristics.
•Abdomen: presence of scar, abdominal mass
Pelvic: patency of vagina
Pelvic mass
Pattern of pelvic hair Distribution
Did the testes descend or not
Hypo/epispadias
EVALUATION OF INFERTILITY:
Investigation
OVARIAN FACTOR
Hormonal Assessment: FSH, LH, Estrogen, progesterone, testosterone , prolactin, thyroid hormones
•Serum progesterone estimation: This test should be performed at day 21 of a 28 day menstrual cycle.
•Basal body temperature measurement reveals a characteristic biphasic temperature curve during most ovulatory cycles. A slight drop then raise in temperature, rise in 0.3° indicates ovulation.
Cervical mucus: changes in the cervical mucus may be useful in the presumptive diagnosis of ovulation. Billing method, Cervical mucus becomes clear, thin and elastic around the time of ovulation.
•ENDOMETRIAL BIOPSY: Endometrial Biopsy is preferably done between days 21 and 24 of the luteal phase of the cycle.
The two reasons Endometrial Biopsy is preferably done between days ?? and ?? of the luteal phase of the cycle?
(1) to document a secretory endometrium,which is indirect evidence that ovulation has occurred, and (2) to evaluate whether the maturity of the secretory endometrium is in phase ( consistent with menstrual cycle date) or out of phase ( luteal phase defect).
EVALUATION OF INFERTILITY:
Investigation
Uterine FACTOR. ?
Assessment of the uterus and endometrial cavity can be accomplished with laparoscopy, hysterosalpinogram, hysteroscopy and also endometrial biopsy in cases of tuberculosis endometritis
