Infertility Flashcards
infertility definition
inability to conceive after 12 months regular intercourse without contraception
what percentage of couples are affected by infertility
15%
secondary infertility
they have been pregnant before (may have ended in miscarriage though)
3 main concepts in infertility
ovulating?
tubal blockage?
sperm?
how does ovulation predictor kit work
detects LH surge (but only works in 97% so not clinically used)
how we assess ovulation
regular cycles very suggestive of ovulation
confirm by midluteal serum progesterone (>30) - but we accept >20 because of timings of the test
tested at day 21 for a 28 day cycle - adjust for cycle length
initial infertility investigations
- Day 21 progesterone: establish ovulation
- TSH
- Rubella immunity
- Chlamydia screen
- Ensure cervical smear up to date
semen analysis
initial infertility investigations if amenorrhoeic/cycle longer than 42 days
Follicular phase bloods: LH, FSH, E2
Testosterone, SHBG, FAI
Prolactin
azoospermia
no sperm in ejaculate
asthenozoospermia
% progressive motile sperm below reference limit
oligozoospermia
low sperm count
what scan is done at infertility consultation
transvaginal US
abnormal findings on scan
- Congenital uterine abnormalities
- Fibroids
- Endometrial polyp
- Hydrosalpinx
- PCOS
- Ovarian cyst
tubal patency testing
- hysterosalpingogram (HSG)
- diagnostic laparoscopy and hydrotubation (longer wait time for this surgery though)
when is hysteroscopy used
suspected or known endometrial pathology i.e. uterine septum, adhesions, polyp
