Infertility Flashcards
Infertility
Disease of the reproductive system defined by the failure to achieve a pregnancy after 12 months or more of regular unprotected sex between a man and a woman
Primary - couple has never been able to conceive
Secondary - when a couple cannot get pregnant again, despite previously having been able to without any difficulty
Infertility aetiology
Male infertility
Ovulatory disorders
Tubal damage
Uterine or peritoneal disorders
No identifiable cause
Infertility general advice
Regular sexual intercourse
Preparation for pregnancy eg. folic acid 400mcg
Smoking cessation advice to men & women
Avoidance of alcohol
Women should aim for a BMI of 19-25 kg/m2
Infertility general management principles
Medical treatment e.g. drugs to induce ovulation
Surgical treatment e.g. tubal microsurgery in women with tubal damage
Assisted conception e.g. intrauterine insemination, IVF
Female factor infertility aetiology
Disorders of ovulation - hypothalamic pituitary failure, hypothalamic-pituitary-ovarian, ovarian failure
Tubal causes - PID, endometriosis, previous sterilisation
Uterine/peritoneal causes - endometriosis, previous surgery, fibroids
Other causes - unexplained, genetic factors
Female factor infertility primary care ix
Mid-luteal phase progesterone
Chlamydia screening
Testing for susceptibility to rubella
Following ix can be considered: serum progesterone, gonadotrophins, TFTs, prolactin
Female factor infertility secondary care ix
Tubal patency tests
No comorbid conditions: hysterosalpingography
If comorbid conditions: diagnostic laparoscopy & dye
Female factor infertility mx
Lifestyle - weight mx, psychological stress mx
Medical - clomifene (induction of ovulation), pulsatile gonadotrophin-releasing hormone, dopamine agonists
Surgical - tubal microsurgery, laparoscopy for excision of endometriosis
Male factor infertility aetiology
Primary spermatogenic failure
Genetics
Obstructive azoospermia
Varicocele
Hypogonadism
Other - medications, psychological factors, lifestyle factors
Male factor infertility primary care ix
Semen analysis
- results of first abnormal → repeat testing is offered ideally 3 months after the initial test
- if initial is normal = no need for further testing
Referral to secondary care is required following 2 abnormal semen analysis results
Chlamydia testing
Male factor infertility secondary care ix
Genetic testing
Sperm culture
Endocrine tests
Imaging of the urogenital tract
Testicular biopsy
Male factor infertility mx
Lifestyle - weight mx, psychological stress mx, lifestyle advice
Medical - gonadotrophin drugs
Surgical - correction of obstructive causes
