Infertility Flashcards
What is infertility?
The failure to achieve a clinical pregnancy after >12 months of regular, unprotected sexual intercourse
What is primary infertility?
When the person has NOT had a live birth previously
What is secondary infertility?
When they have had a live birth >12 months previously
How common is infertility?
- 1/7 couples affected
- half will conceive in the following 12 months
How often do struggling couples seek help?
55%*
* positive association with socioeconomic status
What are the most common causes of infertility in a couple?
- male factor (30%)
- female factor (30%)
- combined male and female factor (30%)
- unknown factor (10%)
What is the impact of infertility on the couple?
- psychological distress to the couple
- no biological child
- impact on the couples wellbeing
- impact on the larger/extended family
- investigations
- treatments (can be costly, often fail)
What is the impact of infertility on society?
- less births
- less tax income
- investigation costs
- treatment costs
What are pre-testicular causes of male infertility?
Congenital and acquired endocrinopathies
- klinefelters
- Y chromosome deletion
- HPG axis, testosterone and prolactin issues
What are testicular causes of male infertility?
- Congenital
- Cryptorchidism
- Infections (STIs)
- Immunological (Antisperm Abs)
- Vascular
- Trauma/surgery
- Toxins (Chemo, DXT, Drugs, Smoking)
What are post-testicular causes of male infertility?
- Congenital (no vans deferens in CF)
- Obstructive Azoospermia
- Erectile Dysfunction (Psychological, Retrograde Ejaculation, Mechanical Impairment)
- Iatrogenic (Vasectomy)
What is Cryptorchidism?
Undescended testes (90% in the inguinal canal)
What are the pelvic causes of infertility in women?
(5%)
- endometriosis
- adhesions
What are tubal causes of infertility in women?
(30%) Tubopathy due: - infection - endometriosis - trauma
What are ovarian causes of infertility in women?
(40%)
- anovulation (endo)
- corpus luteum insufficiency
What are the cervical causes of infertility in women?
(5%)
Ineffective sperm penetration due to:
- chronic cervicitis
- immunological (antisperm Ab)
What are the uterine causes of infertility in women?
(10%) Unfavourable endometrium due to: - chronic endometritis (TB) - fibroid - adhesions (synechiae) - congenital malformation
What is endometriosis?
presence of functioning endometrial tissue outside of the uterus, that responds to Oestrogen
(5% of women)
What are the symptoms of endometriosis?
- increased menstrual pain
- menstrual irregularities
- deep dyspareunia (pain during intercourse)
- infertility
What are the treatments available for endometriosis?
- hormonal (continuous OCP, progesterone)
- laprascopic ablation
- hysterectomy
What are fibroids?
- Benign tumours of the myometrium, responds to oestrogen
- 1-20% of pre-menopausal women - increases with age
What are the symptoms of fibroids?
Usually asymptomatic
- increased menstrual pain
- menstrual irregularities
- deep dyspareunia
- inferility
What are the treatments available for fibroids?
- Hormonal (continuous OCP, progesterone, continuous GnRH agonists)
- Hysterectomy
What are the secretion patterns of GnRH and LH?
pulsatile