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
infertility lifestyle advice
Stop smoking
BMI 18.5 – 30
Reduce / stop alcohol
Moderate caffeine
Stop recreation drugs / methadone
Folic acid
why folic acid in pregnancy
reduce risk of the way the baby’s spine and skull form
commonest reason for ovulatory problems
PCOS
Rotterdam diagnostic criteria - what is it for
PCOS
Rotterdam diagnostic criteria (for PCOS)
two of three of the following criteria: oligo‐anovulation, hyperandrogenism and polycystic ovaries
first line management for ovulation induction
clomifene citrate (tablet)
ovulation induction treatment
- Clomifene citrate
- tamoxifen
- gonadotrophin injections
- Laparoscopic ovarian diathermy
blocked fallopian tube infertility - management
just IVF, generally no treatment for tubal disease
in a few cases cannulation using guidewire or microcatheter
