Infertility Flashcards
Incidence
1 in 7 couples
Risk factors
Age
Smoking
BMI (<18 and >30)
Steroids (sperm)
Seat warmers for sperm
Who can be referred before 1 year
Age 36 and over
Known clinical cause or risk factors
Ovulatory disorders cause what proportion of infertility
21%
Normal range mid-luteal progesterone
> 30
Tubal disease causes what proportion of subfertility
14%
Semen analysis parameters
Volume >1.5ml
Concentration 15m
Normal forms 4%
Motility 40%
Total sperm 39m
Vitality 58% or more live spermatazoa
Main cytokine implicated in OHSS
VEGF
Pathophysiology of OHSS
Ovarian enlargement
Systemic effects of inflammatory mediators
Increased vascular permeability
Prothrombotic effect
OHSS incidence
3-8% for moderate and severe disease
Mild in 1/3 of traditional IVF
OHSS triggers
IVF
Clomiphene
Monofollicular ovulation induction gonadotrophin induction
Pregnancy
Risk factors for OHSS
Previous OHSS
PCOS
Increased AFC
High levels of AMH
Successful conception after IVF
Multiple pregnancy after IVF
Symptoms of OHSS
Abdominal distension and pain
Nausea and vomiting
SOB
Oliguria
Oedema
Thrombosis
Classification of OHSS
Early - within 7 days of HCG trigger
Late - 10 or more days after HCG trigger
Investigations for suspected OHSS
Bloods - FBC, CRP, LFT, U&E, clotting, serum osmolality, ABG
ECG
CXR
USS
CTPA
Examination in OHSS
Hydration status
Oedema
Obs
Body weight
Abdominal girth
Palpable mass
Pleural effusion or pulmonary oedema
Mild OHSS
Abdominal bloating
Mild pain
Ovarian size <8cm3
Moderate OHSS
Moderate abdominal pain
Nausea and vomiting
Ascites on USS
Ovary size 8-12cm3
Severe OHSS
Clinical ascites +/- hydrothorax
Oliguria
Haematocrit > 0.45
Hyponatraemia <135
Hypo-osmolality <282 mOsm/kg
Hyperkalaemia >5
Hypoalbuminaemia
Ovarian size >12cm3
Critical OHSS
Tense ascites/large hydrothorax
Haematocrit >0.55
WCC >25
Anuria
VTE
ARDS
Causes of death with OHSS
Renal failure
ARDS
Ovarian rupture
VTE
OHSS duration
7-10 days
Hospital admission for OHSS
Worsening symptoms
Uncontrolled pain
Inadequate oral intake
Unable to attend for follow up
Critical OHSS
Indications for paracentesis in OHSS
Severe abdominal pain secondary to ascites
Dyspnoea secondary to ascites
Oliguria despite fluid replacement due to compression of ascites causing hypoperfusion to kidneys
Incidence of thrombosis in OHSS
0.7-10%
Pregnancy complications from OHSS
PET
PTB
Risks of uterine transplantation
> 25% emergency hysterectomy
10% further surgery
Risk of complication to donor following uterine transplant
10%
How to test for rejection of uterine transplants
Histological assessment of cervical biopsies
When can embryo transfer be done after uterine transplant
6-12 month after immunosuppressive therapy
