Infertility Flashcards
What is infertility?
Unprotected sex for 3+/week for 12+ months and not getting pregnant
How many couples suffer from infertility and what % couples conceive within 1 year of unprotected sex?
1/7 couples
80%
What is primary and secondary infertility?
1 = never had children
2 = difficulty having subsequent babies
What are some female causes of infertility?
-Low reserve = menopause and Sheehans
-Anovulation (PCOS, High T4, Eating disorders, chronic stress, High Prolactin)
-Structural (endometriosis, fibroids + turners, ashermans)
-Tubular (PID)
What are some male causes of infertility?
Poor sperm quality
low testosterone
High prolactin
(+ haemochromatosis, Kallmans, Testicular Ca, Noonans, klinefelter syndrome)
What investigations are done in Males for infertility?
Sperm and semen analysis
Blood hormone levels:
-testosterine
-prolactin
-FSH,LH
For the sperm and semen analysis, what should these be:
-pH
-Volume
-Conc
-Motility
-Normal morphology
pH = >7.2
Vol = 1.5 mL (1.4-1.7)
Conc = 1.6 million/mL (1.2-1.6)
Motility = >42%
Normal morphology = >4%
What would be done if the male infertility test is abnormal?
Repeat in 3 months (take within 3-5 days abstinence)
What are the investigations done for infertility in females?
Bloods: Oestrogen, progesterone, LH:FSH, Prolactin, shBG
Mid luteal (day 21) progesterone = High
AMH any day = High
FSH day 2-5 = Low
TV USS
NAAT swab
+ tubal patency testing :
-HSG (Hysterosalpingogram) + contrast (better, less invasive, no anaesthetic)
-Laparoscopy + contrast (under GA - Less common)
Tx for infertility in young people?
Try for further 6 months then come back
>35y = earlier referral
What is a medical Tx for infertility?
Clomifene
Clomifene
Mechanism?
SE?
Success rate?
Stimulates ovulation, oestrogen modulator –> inhibits HPG -ve feedback on GnRH, High GnRH, High FSH + LH, High ovulation
Flushing, Mittelschmirtz (ovulation pain), blurred vision
50% success rate
What can clomifene also help with?
spermatogenesis
What is Last line for infertility Tx?
IVF
IUI (Intrauterine insemination)
ICSI (Intracytoplasmic sperm injection)
Not conceived for 2+ years
What is the mechanism of IVF?
In Vitro Fertilisation
Culture egg + sperm in vitro 3-5 days them implant into uterus (often concomitant bhCG given) - monitor with serial serum bhCG
IVF has a higher success in who?
how many cycles can be done and what age?
higher success in younger Px
Can have 3 or less cycles on NHS under 40y
What are 3 main complications of IVF?
Ectopic preg
Twin preg
Ovarian hyperstimulation syndrome (OHSS)
What is the mechanism behind ovarian hyper stimulation syndrome?
Tx?
High bhCG = High vascular endothelial GF = Ascites + oliguria + ovaries >10cm
Tx = ABCDE, IV Colloid + monitor urine output + LMWH
