Infertility Flashcards
What defines infertility in a couple?
Infertility is the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse, in a couple who have never had a child, and with no known cause
What are the two types of infertility?
(1) Primary infertility
(the couple has never conceived)
(2) Secondary infertility
(couple previously conceived, but pregnancy was unsuccessful)
What factors increase the chance of conception?
- Women under 30
- Previous pregnancy
- Intercourse around ovulation
- BMI 18.5-30
- Non-smokers
- Limited caffeine
- No recreational drug use
What is a common cause of male infertility related to testicular volume?
Non-obstructive infertility
(eg, Klinefelter syndrome) presents with
(1) low testicular volume
(2) reduced secondary sexual characteristics
(3) high LH and FSH
What is anovulatory infertility?
Infertility due to the lack of ovulation, which physiological factors can cause
= puberty, menopause, pregnancy
or conditions like PCOS, premature ovarian failure, or pituitary disorders
What test is used to evaluate female ovulation?
Midluteal progesterone level on Day 21 of a 28-day cycle or 7 days before the expected period. Progesterone >30 nmol/L suggests ovulation
What is the significance of rubella immunity in infertility evaluation?
Checking rubella IgG levels ensures the woman is immune.
If not, rubella infection during pregnancy can cause severe birth defects like microcephaly and patent ductus arteriosus
What lifestyle changes are recommended for improving fertility?
- stop smoking
- maintain a BMI between 18.5 and 30 3. reduce alcohol intake
- avoid recreational drugs
- limit caffeine
How is female infertility managed with surgery?
(1) Reproductive surgery can treat infertility by removing pelvic adhesions, tubal blockages, or polyps/fibroids
(2) Salpingectomy may be recommended before IVF for women with hydrosalpinges
What are the risks of ovulation induction and assisted conception?
- Ovarian hyperstimulation
(mild to severe) - Multiple pregnancies
(increased risks for maternal and fetal health) - Theoretical risk of ovarian cancer
What is the process of IVF?
IVF involves ;
(1) ovarian stimulation
(2) monitoring, ovulation induction
(3) egg retrieval
(4) sperm preparation
(5) fertilisation
(6) embryo transfer
(7) luteal support
What does semen analysis assess in male infertility?
It evaluates sperm count, motility, and morphology
= typically performed twice, 6 weeks apart
A 35-year-old woman and her husband attend the fertility clinic for assessment. They have been trying to conceive unsuccessfully for the past 2 years. The male partner has a normal semen analysis.
She has irregular menstrual periods but no other known medical problems. Hormonal tests reveal that she is having anovulatory cycles.
What is the most common cause of anovulation in women?
Polycystic ovarian syndrome (PCOS)
A 39-year-old woman attends her general practitioner, as she has been trying to get pregnant for the last 10 months. In an attempt to increase her success, she has started using ovulation test strips to work out when she is most likely to conceive
What hormone do ovulation test strips most likely detect?
Luteinising hormone (LH)
A 24-year-old man and a 23-year-old woman with no medical history visit their GP with concerns about infertility. They have been trying to conceive for 1.5 years. A private blood test reveals that the woman has a normal FSH level and day 21 progesterone
What is the next most appropriate step in management? and why have you decided upon that answer?
Semen analysis
= NICE recommend investigations (and consideration for onward referral) for couples who have tried to conceive unsuccessfully for one year.
The woman has already had first-line investigations
(1) mid-luteal phase progesterone
The man also requires investigation with (2) semen analysis
Both partners should be screened for (3) STIs - especially Chlamydia
A 34-year-old lady attends a fertility clinic due to her inability to get pregnant for over two years. She is concerned that she is not ovulating even though her menstrual cycle lasts for 35 days and is regular. She is not on any contraceptive and her pregnancy test is negative.
What is the best way to detect ovulation?
Day 21 progesterone test is the most reliable test to confirm ovulation
What is the purpose of measuring serum progesterone?
Measuring serum progesterone helps confirm ovulation by checking if progesterone levels peak 7 days after ovulation
When should serum progesterone be measured in a 28-day cycle?
Measured on day 21
When should serum progesterone be measured in a 35-day cycle?
Measured on day 28
What phase of the menstrual cycle does progesterone peak?
Progesterone peaks during the luteal phase, which lasts 14 days after ovulation
Why is progesterone measured 7 days before the expected period?
Progesterone peaks 7 days after ovulation, and this timing helps confirm whether ovulation has occurred
A 29-year-old woman attends the fertility clinic with her partner. She has a history of regular 35-day menstrual cycles. What investigation is the best measure of ovulation?
Day 28 progesterone
A 22-year-old woman and her male partner present to their GP as they have been unsuccessfully trying to conceive for 4 months. Her periods have been regular and there is no obvious cause in her history. What is the most appropriate next step in her management?
Address how the couple are having sexual intercourse and reassure the patient
What is the first investigation for a couple after 12 months of trying to conceive without success?
Male - Semen analysis
Female - Blood tests for progesterone (to check ovulation
Both - Chlamydia test (to assess for tubal blockage)
A couple presents to their GP asking for fertility advice. They have been having unprotected sexual intercourse 3 times a week for 1 year.
The GP suggests semen analysis and measuring serum progesterone levels.
When is the most appropriate time to measure serum progesterone levels?
7 days prior to the expected next period
What is hypogonadotropic hypogonadism and what is it caused by?
Hypogonadotropic hypogonadism is when the gonads (ovaries or testes) fail to hormones (gonadotropins) from the pituitary gland, leading to low sex hormone levels
= This is the case in Turner’s syndrome
