Infertility Flashcards
- def
- types
- نسبة كل واحد
1-Failure of conception for 1 y with regular sexual intercourse without using contraceptives
2-Primary infertility :1 y
Secondary infertility: 2 y after the previous pregnancy
3-Male 30-40%
Female 50-60%
Unexplained 10-15%
coital 5%
Causes of male
1-Smoking :affects the quality of sperms.
2-Uncontrolled DM
3-Abnormal spermatogenesis :-
•Increased scrotal temperature(Less than 1 C of body temp)
~Varicocele
~Undescended tests
•Genetic: Deletion of Y-chromosome
•Drugs :Antihypertensives. Antiepileptics. Antipsychotics. Long antibiotic administration. Chemotherapeutic drugs.
4-Failure of sperm transport(Vase deferens)
•Bilateral epididymal obstruction :Gonococcal infection is the commonest
•Bilateral vase deference ligation
~Intended :male sterilization
~Iatrogenic :bilateral inguinal hernioplasty
•Immotile celia syndrome :All sperms are immotile
5-Failure of semen deposition :
•Erection dysfunction
•Premature ejaculation
•Retrograde ejaculation
•Anejaculation.
Diagnosis of male
• بسأله عن العمليات ،الأدوية ،العدوى ،التدخين، uncontrolled DM
• inv :
•Semen analysis : after 3-4 d
~Count :15M or above
~Morphology :30% are normal
~ Motility :50% or above
~ ph: Alkaline
~Volume :2ML or above
Athenospermia ~> Motility
Teratospermia~> morphology
Oligospermia ~> >15 m
Azospermia ~> Semen with no sperm
Aspermia ~> No semen
•in Azospermia Testicular biopsyis done to differentiate between obstructive pathology and deffective spermatogenesis
Management of male
•Treat the cause
~Stop smoking
~Control DM
~Shift to drugs مش بتعمل ضعف
~Surgical
~Hormonal support to treat defective spermatogenesis
~ttt of erection : Viagra
•Multivitamins ,antioxidants
•In severe cases, ART is done.
Female causes
Ovarian 40%
Tubal and pretoneal 40%
Uterus 10-15%
Unexplained 5%
Cervical very rare
1- Ovarian
-Anovulatory disturbances
-LPD defect
? Regular ،primary dysmenorrhea, PMS, midcyclic pain, spotting, discharge.
2- tubal and pretoneal
- Salpengitis,Salpingioophritis ,Pelvic pretonitis
-Previous Pelvic Surgery
-Pelvic Endometritis
-Mechanical Obstruction
التهاب دخلك المستشفى وركبته محاليل ، عملتي عمليات فتح بطن?
3- ut
-Congenital Anomaly :
•Septate
•Hypoplastic Uterus,
-Uterine Polyp
-Uterine Liomyoma
-History of Overcurrettge in D and c
? Amount of period
++ ~> fibroids
–~> hypoplastic or synechiae
4- cervical
-Changes in physical, chemical characters : Increased viscosity, decreased volume
-Destruction of mucous glands
-Antisperm antibodies
-infection and pus cells
?Discharge.
Inv اسكيمة
•History,General and Local Examination,U.S. Hormonal, HSG,
Still Negative in f , m ?
•More-Invasive, Laproscope, and Hystroscope. To evaluate uterine, tubal, and pretoneal factors. Still Negative ?
•Unexplained
Assessment of each in female
1-Ovarian assessment:
Anovulatory INV : PRG in day 21 , US :folliculometry
If Normal
PCO INV
US : 8 items , Lab :Adams Criteria
2-Tubal Assess
-HSG (5)
1-Using water-soluble or oil-soluble dye Capturing with X-ray to see uterine ,tubal , peritoneal factors
2-Postmenstrual
3- Contra :
-Pelvic infection
-Allergy to iodine
-During pregnancy
-During bleeding
4-Complications :
-Oil embolism
-Intravasation
-Allergy
- Spread of infection
5-Diagnosis
Mullerian anomaly
Uterine anomaly
Tubal obstruction
Peritubal, peritoneal adhesions
2- laproscope with dye injection (5)
1-GOLD STANDARD IN SEVERE CASES
2-Direct visualization of uterine ,cervix, tubes, peritoneal through methylene blue injection into the cervixthen Observe of spillage through fallubion tube to evaluate its patency, ciliary function
3- Under general anesthesia ~>diff between obstructed and spasm
4-Used if there is any abnormality in HSG, unexplained causes
5- More accurate and operative laparoscope
3- ut asses
1-US TVS ,TAS ,3D us
2-HSG
3-Hysteroscope
4-Cervical
-PCT : Post-coital Test
5-Hormonal : FSH ,LH ,PRG ,PRL ,thyroid FUNCTION
Management of female
1-Ovarian
induction of ovulation: starts with clomide
2-tubal
-laparoscopic surgeries :
~removal of endometriosis, ~adenolysis
-tuboplasty but now is diminished
-ART
3-uterus :
-hystereoscopic surgeries
4-cervical
-treat the cause
-estrogen and mycolytics drugs.
Coital dysfunction
1-Superficial dyspareunia :at the level of the vulva, lower vagina during sex
2-vaginismus :violent spasm Reflex of levator ani ,gluteus muscles and adductors on attempt of sexual intercourse
3-Erection dysfunction,premature ejaculation, retrograde ejaculation anejaculation
Unexplained
Unknown but may due to
-Immunological and psychological disorder. -Occult cervical infection
-Decreased ovarian reserve
-Defective sperm fertilization capacity
What to do
-More investigations.
-ART with synthetic and purified HMG
ART
1- iuiالتلقيح الصناعي ~> cannula to cx
2- icsi : التلقيح المجهري ~> undermicroscope
3- ivf : أطفال الانابيب ~> incubation
-Indications of iui
1-Coital
2-Unexplained
3-Oligospermia
4-Erection Dysfunction
5-Cervical Factor
-Indications of icsi, ivf
1-Unexplained
2-Severe Male Factor
3-Failed Adenolysis
4-Severe Tubo-Pretoneal Adhesions
~Bilateral Proximal Obstruction
~Bilateral Distal Obstruction ( Tubal Disconnection first)
-Steps
1-Pit Gland Down Regulation by GnRH Agonist
2-Ovarian Stimulation (4) :
-IM FSH
-Growth and Maturation of Follicles
-to Reach 18 to 24
-for 11 to 14 days
3- Ovarian Trigger: HCG
4- Oocyte Retrieval (4):
-Collection of Oocytes
- via U.S. Guided Needle Aspiration
- 18 to 24
-36 hours after HCG Trigger
5- ICSI : Injection of Sperm into the Cytoplasm of Metaphase II Oocytes to become mature
6- oocyte transfer to Fresh Culture Medium to evamine
7- transfer Uterus : after 3 to 5 days via Canula 8-Luteal Phase Support : PRG and B-HCG for 2 weeks or until 1st Trimester
- succes rate
ICSI higher than IVF
•it depends on
~maternal age
~quality of oocyte
~quality of embryo
~quality of endometrium
~protocol chosen
-complications
~infection spread
~trauma during oocyte retrieval
~allergy
~OHSS
~ART complication :increased incidence of abortion, ectopic pregnancy, fetal anomalies.
Talk about ohss
•Def : ENLARGED OVARIAN MULTISYSTEMIC DISEASE DUE TO DRUGS INTAKE ~> IATROGENIC
•MILD:
-GRADE 1-2
- sym
~ABDOMINAL PAIN
~ABDOMINAL DISTENSION
~MILD ascitis
-TTT :REST ,REASSURANCE, FOLLOW-UP ,SYMPTOMATIC TREATMENT
•SEVERE
-GRADE 3-4
- sym
Fluid shifying FROM INTRAVASCULAR TO EXTRAVASCULAR ~> SEVERE ascitis , pleural EFFUSION, hypoalbuminmia HEMOCONCENTRATION, ELECTROLYTE IMBALANCE
-TTT :
~LIFE-THREATENING ~>HOSPITALIZATION
~FLUID
~ELECTROLYTE BALANCE
~ TAPPING FOR ascitis
~ NEVER DIURETICS (HEMOCONCENTRATION)
• p :
~TVS WHILE USING
~ monitoring HMG, HCG.
