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Endocrinology > Infertility > Flashcards

Infertility Flashcards

1
Q

What percentage of couples suffering from infertility will conceive spontaneously or with relatively simple advice?

A

50%

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2
Q

What are some reasons for the increase in incidence of infertility?

A
  • Older women
  • Rise in chlamydia infections
  • Increase in obesity
  • Increase in male factor infertility
  • Increasing awareness of treatments
  • Change in expectations
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3
Q

What percentage of couples conceive within 6 months of trying?

A

75%

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4
Q

What percentage of couples conceive within 12 months of trying?

A

90%

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5
Q

What percentage of couples conceive within 24 months of trying?

A

2 years

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6
Q

How long after attempted conception is IVF offered by NHS Scotland?

A

2 years

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7
Q

What is infertility?

A

Failure to achieve a clinical pregnancy after 12 months or more of regular, unprotected sexual intercourse (In absence of a known reason) in a couple who have never had a child

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8
Q

What is meant by primary infertility?

A

The couple has never concieved before

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9
Q

What is meant by secondary infertility?

A

The couple has previously conceived, although this may not have been successful (e.g. miscarriage, ectopic pregnancy)

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10
Q

What are some factors that increase fertility?

A
  • Women aged under 30
  • Previous pregnancy
  • <3 years trying to conceive
  • Intercourse around ovulation
  • BMI 18.5 - 30 m/kg2
  • Both partners non smokers
  • Caffeine intake less than 2 cups daily
  • No use of recreational drugs
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11
Q

What are some causes of infertility in females?

A
  • Tubal disease
  • Fibroids
  • Endometriosis/adenomyosis
  • Weight
  • Age
  • Ovulatory disorders (Causing anovulatory infertility)
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12
Q

What are some conditions that can cause anovulatory infertility?

A

Ovulatory disorders
Chronic renal failure
Thyroid disease
Testosterone secreting tumours
Congenital adrenal hyperplasia
Contraceptive pills (E.g. Depo-provera, Explanon, OCP)

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13
Q

What is meant by tubal disease?

A

Tubal diseases are conditions affecting the fallopian tubes

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14
Q

What are some clinical features of tubal disease?

A
  • Abdominal or pelvis pain
  • Vaginal discharge dyspareunia
  • Cervical excitation menorrhagia
  • Dysmenorrhoea
  • Infertility
  • Ectopic pregnancy
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15
Q

What are the 2 types of cause of tubal disease?

A

Infective
Non-infective

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16
Q

What are some infective causes of tubal disease?

A
  • Pelvic inflammatory disease (Chlamydia, gonorrhoea, syphilis, TB)
  • Transperitoneal spread (Appendicitis, intra-abdominal abscess)
  • Infection following procedures (IUCD, hysteroscopy, HSG)
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17
Q

What are some non-infective causes of tubal disease?

A
  • Endometriosis
  • Surgical (Sterilisation, ectopic pregnancy)
  • Fibroids
  • Polyps
  • Congenital
  • Salpingitis isthmica nodosa (Diverticulosis of fallopian tubes)
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18
Q

What is endometriosis?

A

This is the presence of endometrial glands outside the uterine cavity

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19
Q

What are some factors that increase risk of endometriosis?

A

Retrograde menstruation
Altered immune function
Abnormal cellular adhesion molecules
Genetic factors

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20
Q

What are some symptoms of endometriosis?

A
  • Dysmenorrhoea (Before menstruation)
  • Dyspareunia
  • Menorrhagia
  • Painful defection
  • Chronic pelvic pain
  • Infertility
21
Q

What will investigation show on endometriosis?

A

Investigation will show a fixed and retroverted uterus with characteristic chocolate cysts on the ovaries

22
Q

What are some risk factors for male infertility?

A

Occupation
Smoking
Alcohol
Obesity

23
Q

What are some pre-testicular causes of male infertility?

A
  • Hypogonadism
  • Hypothyroidism
  • Diabetes
  • Erectile dysfunction
24
Q

What are some testicular causes of male infertility?

A
  • Idiopathic
  • Undescended testicles
  • Urogenital infection
  • Sexual factors
  • Varicocele
  • Torsion
25
Q

What are the 2 categories of male infertility?

A

Obstructive
Non-destructive

26
Q

How will obstructive male infertility present?

A

Obstructive infertility will present with normal testicular volume, normal secondary sexual characteristics but the vas deferens may be obstructed or absent

27
Q

What are some endocrine features of obstructive male infertility?

A
  • Normal LH
  • Normal FSH
  • Normal testosterone
28
Q

How will non-obstructive male infertility present?

A

Non-obstructive infertility will present with low testicular volume and reduced secondary sexual characteristics

The vas deferens will be present and functional

29
Q

What are some endocrine features of non-obstructive male infertility?

A
  • High LH
  • High FSH
  • Low testosterone
30
Q

What does examination of a female in infertility involve?

A
  • General examination
  • BMI testing
  • Body hair distribution assessment
  • Pelvic examination
  • Assessing for pelvic tenderness and mobility
31
Q

What are some investigations required in female infertility?

A
  • HCG (Pregnancy) test
  • Endocervical swab (For chlamydia)
  • Cervical smear
  • Blood testing (For rubella immunity)
  • Mid-luteal progesterone level (7 days prior to expected period - Progesterone >30 is normal)
  • Hysterosalpingiogram (HSG) tests tubal patency
  • Laparoscopy
  • Hysteroscopy
32
Q

What condition is shown on this hysterosalpingiogram?

A

Bilateral hydrosalpinx

33
Q

What is shown?

A

Tubal septum formation

34
Q

What is shown?

A

Tubal polyp

35
Q

What is involved in general examination of male infertility?

A
  • General examination
  • BMI measurement
  • Assessment of testicular size and position
  • Feel for presence of penile abnormalities, vas deferens and varicoceles
36
Q

What is the initial test used in male infertility?

A

2 semen analyses, 6 weeks apart

37
Q

What are normal test results in semen analysis?

A
  • Volume >1.5ml
  • pH 7.2 - 7.8
  • Concentration >16 x 10^6
  • Motility >30%
  • Morphology >4%
  • WBC < 1x10^6/ml
38
Q

What tests are carried out if semen analysis is mildly abnormal?

A

LH
FSH
Testosterone
Prolactin
Thyroid hormones

39
Q

What tests are carried out if semen analysis is severely abnormal?

A

Chromosomal analysis
CF screening
Testicular biopsy (may be required)

40
Q

What tests can be used in cases of male genital abnormality?

A

Scrotal ultrasound

41
Q

How often should intercourse be performed in conception?

A

Every 2-3 days, instead of timing intercourse with the menstrual cycle

42
Q

What are some management options used in infertility management?

A

Treatment of the underlying cause
Vitamin supplementation
Lifestyle advice
Occasionally reproductive surgery

43
Q

What vitamin supplements can be used in infertility?

A

Folic acid and vitamin D are the main 2 vitamin supplements usually required

44
Q

In whom should folic acid be given to in infertility?

A

5mg OD folic acid should be given to women who are planning pregnancy or are in the early stages of pregnancy if they:

  • (Or partner) Have a neural tube defects
  • Have had a previous baby with neural tube defect
  • (Or partner) Have a family history of neural tube defects
  • Have diabetes
45
Q

What dose of folic acid is given in pregnancy in most women?

A

400ug OD is given in pregnancy and throughout the 1st 12 weeks

46
Q

What dose of vitamin D is given in pregnancy?

A

10ug OD

47
Q

What are some indications for reproductive surgery?

A
  • Pelvic adhesions
  • Grade 1&2 endometriosis
  • Chocolate cysts in ovary
  • Tubal block
  • Enhancement of IVF
48
Q
A

Endocrinology (42 decks)

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