Infertility Flashcards
Infertility
failure to conceive after 1 year of unprotected intercourse
How many cases of infertility are due to a female disorder?
- 2/3 cases = female disorder
- 1/3 cases = male disorder
Causes of infertility
- occlusive tubal disease or endometriosis
- ovulation disorders
- cervical factors
- luteal phase abnormalities
- idiopathic
Infertility: occlusive tubal disease or endometriosis
- 30-50% of infertility causes
- egg or sperm can’t get through tube due to scarring issue from endometriosis or even surgeries
Infertility: ovulation disorders
- 40% of infertility causes
- pituitary isn’t sending enough LH for follicle to rupture from ovary
- PCOS
Infertility: cervical factors
- 10% of infertility causes
- mucus or pH is not balanced, detrimental to sperm trying to move through
Infertility: luteal phase abnormalities
- 5% of infertility causes
- get pregnant but can’t hold onto it or never implanted well
- both can be caused by lack of progesterone
Infertility: idiopathic
- 5-10% of infertility causes
- no idea what is causing infertility
What is the most common cause of infertility?
hormonal causes
Hormonal causes of infertility
- hormone imbalance, particularly w/ estrogen
- in initial days of fertile cycle, low levels of estrogen cause infertility
- after conception, high levels of estrogen or low levels of progesterone could cause infertility
Reproductive causes of infertility
- birth defects
- PCOS
- endometriosis
- scarred ovaries
Environmental causes of infertility
- workplace hazards
- pesticides
- lead
Assisted Reproductive Technology (Therapy) ART
- follicular stimulation (human menopausal gonadotropin)
- mimics menopause so body produces eggs but doesn’t ovulate them yet
- oral or injections
Oral ART
clomid-clomiphene citrate
Injection ART
- repronex
- bravelle
- follistim
- gonal-f
What does ART require?
gnRH block/agonist (blocks pituitary): lupron, synarel, zoladex
What should we be monitoring on the patient and why?
-monitor estrogen levels & ovaries so not too many follicles are getting too big too quickly (hyperstimulation)
ART medication cycle
- start medication on Day 1 of cycle
- pt comes in every other day to get labs drawn & endo/ovary ultrasound
- endo needs to get thicker & ovaries shouldn’t be too out of control
- about 11 days of medication
What risk comes with ART?
risk of multiples increases
ART: Ovulation induction-hCG injection
- timed intercourse
- IUI - intrauterine insemination
- FSP - fallopian sperm perfusion
ART: egg retrieval
- 2 procedures
- IVF = in-vitro fertilization
- IVF-ICSI = intracytoplasmic sperm (fertilized outside body)
- embryo transfer - put fertilized eggs back in uterus
What is required for ovulation induction-hCG injection & egg retrieval?
sperm retrieval
Role of sonography in infertility
diagnosis & treatment
How do we assist in the diagnosis of infertility in sonography?
- 2-D gray-scale & color doppler
- variants
- pathology
- physiology
How do we assist in the treatment of infertility in sonography?
- monitoring patient
- oocyte retrieval
- embryo transfer
Infertility: finding variants & pathologies
- 2D imaging
- sonohysterography (hystero refers to uterus)
- sonosalpingography (salping refers to tubes)
- polyps, fibroids, adenomyosis, Asherman’s syndrome (ligament in the way)
Infertility: looking at physiology
- look at endometrial thickness/perfusion
- look at follicular development & ovulation
Imaging PCOS (polycystic ovarian syndrome)
- lots of follicles that never really mature or go through ovulation
- FSH never reaches it’s peak b/c suppressed by LH
Imaging LUFS (luteinized unruptured follicle syndrome)
- LH surges but isn’t strong enough to cause the follicle to rupture
- becomes corpus luteum instead of ovulating
Imaging luteal phase defect
hormones aren’t there to promote or secure implantation
What is our role as sonographers when it comes to infertility treatment?
- follicular monitoring: number & size
- oocyte retrieval: transvaginal guidance
- embryo transfer: transabdominal guidance
What is the size of a mature follicle?
18 mm
