Infertility Flashcards
At what age does fertility rapidly start to decline in females?
35yrs
->peak fertility is between 20-30yrs
What happens to fertility with age?
Declines with age
->quantity and quality of eggs decreases
What are the key factors which need to be working efficiently for conception of a child to take place?
Ovulation
Sperm production
Fertilization
Implantation
List some of the lifestyle factors associated with infertility.
Age
BMI
Smoking
Alcohol
Recreational drug use
Stress
Define infertility.
Inability to conceive over a 12 month period despite exposure to regular, unprotected intercourse
When would you refer a couple for infertility investigations?
No conception after one year of regulated unprotected intercourse
Refer earlier if:
Age >35
Known cause for the infertility
Primary infertility?
Couple have never managed to have a pregnancy or man has never fathered a child
Secondary infertility?
Couple have had pregnancy before, in this or a previous relationship but are struggling to fall pregnant again
Which investigations may be used to determine if eggs are available?
Ovarian reserve test- blood test and scan
Blood test- FSH, D1-D5 of cycle
AMH- anti-Mullerian hormone
Ultrasound scan - antral follicular count
->remember that age is a good indicator
Which ways can couples determine if ovulation is happening?
Natural methods- Basal body temperature or cervical mucus
LH ovulation kits
Ovulation calendar e.g. mobile apps
What is the one test which is used clinically to determine if a person is having ovulation?
D21 serum progesterone
-D21= day 21 of period, levels >21nm/L show satisfactory ovulation
Per ml of sperm, how many are expected to be seen in a healthy individual?
15 million / ml
-if reduced, does not mean complete infertility but reduced chances
Which methods can be used to check if the fallopian tubes are patent?
If no pelvic infection or gynae problems in the past = hysterosalpingogram (HSG)
If any of above= Laparoscopic dye test
In addition to the previous tests, which routine tests are carried out in investigation of an infertile couple?
Serum prolactin
Thyroid function test
Chlamydia screening
Pelvic Ultrasound for uterine problems
Also check rubella immunity and run a cervical smear update
What is one of the most common reasons that someone would not be ovulating?
Polycystic ovaries
First line management of ovulation disorders?
Optimise body weight
Healthy lifestyle
Exercise
Which medications may be give for ovulation induction?
Clomiphene citrate
Gonadotrophins
->clomiphene citrate works in most cases but direct hormones (gonadotrophins) are given as second line med
If lifestyle measures and medication does not restore ovulation, what can be done?
Surgical- laparoscopic ovarian drilling
Azoospermia?
Very low or no sperm
Medical treatment for azoospermia?
Gonadotrophins
What are the other options for someone with azoospermia if medical treatment does not work?
Surgical sperm retrieval from testes/epididymis
Donor sperm- intrauterine insemination
ICSI- intracytoplasmic sperm injection
If there is a problem with fertility because of issues with the fallopian tubes, what can be done?
Surgery- limited to mild tubal disease
IVF
If a women is infertile and has been found to have endometriosis, what can be done for treatment?
Ablation or resection of spots, adhesiolysis, cystectomy for endometrioma
If a women is infertile and has been found to have uterine problems, what can be done for treatment?
Removal of polyp/fibroid, adhesiolysis for synechiae
What is the final management of unresolved infertility?
IVF
What is IVF?
In-vitro fertilisation
Oocyte is fertilised by sperm outside of the body
What are the two egg options for IVF?
Use own eggs- gonadotrophin induced superovulation
Donor eggs if:
-patient is of increased age,
-eggs of are poorer quality,
-there has been ovarian failure
-genetic cause which will be passed onto foetus
What are the two sperm options for IVF?
Use own sperm- fresh sample of the day or frozen
Donor sperm if:
-single mother
-same sex relationship
-azoospermia
-genetic cause
-infection e.g. HIV, HepB, HepC
What are the two fertilisation techniques which may be used in IVF?
Insemination
Intracytoplasmic sperm injection
Embryo transfer is done under which imaging technique?
Ultrasound
How long after the embryo transfer can a pregnancy test be taken?
Two weeks after
After the embryo transfer in IVF, what happens after a positive pregnancy test?
Scan at 7wks
Risks of IVF?
Ovarian hyperstimulation syndrome (OHSS)
Multiple pregnancies
Medication side effects
Procedure related risks
->OHSS and multiple pregnancies are most common
