Infertility Flashcards
What is the definition of infertility and what are the two types?
Failure to achieve a clinical pregnancy after >12 months of regular unprotected sex
Primary = never had a live birth
Secondary= haven’t had a live birth >12 months
What are the causes of male infertility and how are they classified?
Pre-testicular:Klinefelters, problems in HPG axis, increased PRL
Testicular:congenital, cryptorchidism, infection STD, trauma/surgery
Post testicular:asbcence of vas deferens in CF, érectile dysf, vasectomy
What is cryptorchidism?
When the testes doesn’t descend on time and gets stuck in inguinal canal
What are the causes of infertility in women and how are they classified?
Ovarian causes: Corpus luteum insufficiency or anovulation
Tubal causes: damage to tubes due to endometriosis or infection
Uterine causes: congenital malformation or scarring/infection
Cervical causes: infection/inflammation or immunological
What is endometriosis?
What are its symptoms?
Functioning endometrial tissue outside of the uterus eg in tubes
Symptoms: increased menstrual pain, menstrual irregularities, pain during sex, infertility
What are fibroids?
What are their symptoms?
Benign tumours of the myometrium (under endometrium)
Symptoms: often asymptomatic, increased menstrual pain, menstrual irregularities, pain during sex, infertility
Label the reproductive axis
What does hyperprolactinaemia cause?
What is the treatment?
Prolactin binds to prolactin receptors on kisspeptin neurons in hypothalamus - inhibits kisspeptin release
Give Cabergoline (dopamine agonist)
What are the causes of hypogonadotrophic hypogonadism in males and females?
Congenital- anosmic (kallman syndrome) or normosic
Acquired- low bmi, stress, xs exercise
Hyperprolactinaemia
Hypopituitarism- due to tumour, surgery, radiation
What are the causes of hypogonadotrophic hypogonadism in males and females?
Congenital (Klinefelters XXY/TURNERS X0,POI)
Cryptochordism
trauma
radio
chemo
PCOS
Surgery
What is Kallmann syndrome?
Failure of migration of GnRH neurons with olfactory fibres to hypothalamus during embryonic development
= failure of puberty and anosmia
What Is klinefelters syndrome?
XXY
Symptoms: Tall stature, reduced chest hair, reduced facial hair, narrow shoulders, wide hips, breast development, small penis and testes, infertility
How do you diagnose PCOS?
Exclude other things first
Rotterdam PCOS diagnosis criteria (2 out of 3)
Oligo or anovulation
Clinical or biochemical hyperandrogenism- acne, hirsutism, high testosterone
Polycystic ovaries -perform ultrasound
How do you treat PCOS and each of their problems?
Irregular menses- give oral contraceptive pill
Infertility-IVF
Insulin resistance- Metformin and diet and lifestyle
Hirsutism-spironolactone (anti-androgen)
Increased endometrial cancer risk- progesterone causes as this will induce bleeds
What Is Turner’s syndrome?
Short stature
Low hairline
Webbed neck
Coarctation of aort
Amenorrhoea
Poor breast development
Underdeveloped reproductive tract
What is POI?
Prématuré ovarian insufficiency- unable to produce oestrogen but FSH/LH high
