Infertility Flashcards
Define infertility
Failure to achieve a pregnancy after 12 months or ore of regular (2-3 times a week) unprotected sexual intercourse
Define primary infertility
Never been pregnant
Define secondary infertility
Previous pregnancy (including ectopic + terminations) but struggling to conceive
Define subfertility
Describes any form of reduced fertility that results in prolonged duration of unwanted lack of conception
Causes of infertility
- unknown
- male causes
- female cases: ovulatory causes or tubal factors or uterine + peritoneal disorders
Types of male causes of infertility
Pre testicular
Testicular
Post testicular
Pre testicular causes of male infertility
Hypogonadotropic hypogonadism
Thyroid disorders
Testicular causes of male infertility
- genetic: Klinefelter syndrome XXY (testis don’t descend)
- congenital: cryptorchidism
- infective: mumps
- antispermatogenic agents e.g. chemo
- vascular: torsion, varicocele
Post testicular causes of male infertility
Obstructive:
- congenital: absent vas
- acquired: infective, vasectomy
Coital problems
- sexual dysfunction
Hypospadias
What is hypospadias?
Congenital condition where the urethral opening is lower than normal
Types of ovulatory disorders
- hypothalamic pituitary failure: hypothalamic amenorrhoea, hypogonadotropic hypogonadism
- hypothalamic pituitary ovarian dysfunction: PCOS (most common cause) , high prolactin
- ovarian failure: premature ovarian failure, congenital e.g. Turner’s syndrome 45XO
Causes of tubal damage causing female infertility
PEPE
- PID
- Ectopic pregnancy
- Pelvic surgery
- Endometriosis
- agenesis of fallopian tubes
Uterine + peritoneal disorders that can cause female infertility
- uterine fibroids
- conditions causing scarring/adhesions: e.g. endometriosis, PID, previous surgery, Asherman syndrome
- mullerian development anomalies
Female examination for investigating infertility
- BMI
- secondary sexual characteristics
- acne
- Hirsutism (excess hair)
- pelvic/abdominal exam + swab
Advice to patients experiencing infertility
- smoking cessation
- reduce alcohol intake
- lifestyle changes e.g. stress
- regular intercourse
- weight loss
- reassurance
Investigation of male infertility
- semen analysis
- bloods: LH/FSH, testosterone
- STI screen
- ultrasound scan testes
- karyotyping
Investigations of female infertility
- FSH/LH day 2
- mid luteal phase progesterone (day 21)
- TFTs, prolactin levels, androgens
- STI screen
- pelvic ultrasound scan
- hysterosalphinogram
- laparoscopy
When should you consider early referral to secondary care in infertility?
Woman is >35 after 6/12months
If cause if known
Management options of infertility
- medical treatment: ovulation induction e.g. clomifene
- surgical treatment: tubal occlusions e.g. laparoscopy
- assisted reproductive technology: IVF, intrauterine insemination
When should you consider referral to secondary care in infertility?
If history, exam and investigation are normal in both partners and not conceive after 1 year
What is placenta accreta?
Invasion of conceptus that is too deep
What percentage of couples will conceive naturally within 1 year with regular unprotected intercourse?
84%
Relationship between dopamine and prolactin
Dopamine inhibits prolactin
What is measured in a semen analysis?
- semen volume
- total sperm count
- sperm conc.
- total + progressive motility
- vitality
- sperm morphology
What is a hysterosalphinogram?
Dye inserted into uterus (hystero) and imaging is used to see if the dye spread through the uterine tubes (salphino) to see if there is a blockage
Most common cause of male infertility
Abnormal semen analysis
What is the most common cause of female infertility?
Anovulation
Primary vs secondary anovulation
- Primary: ovary has never been able to ovulate
- Secondary: ovary had normal function in past but is now unable to ovulate normally
Causes of secondary anovulation
PCOS
Emotional stress
Pregnancy
Hyperprolactinaemia
Causes of primary anovulation
Dygenetic gonads
Hypothalamic dysfunction
Hypothyroidism
