Infertility Flashcards
What is the normal conception rate?
monthly 25%
What is primary vs. secondary infertility?
primary: inability of couple to conceive after 1 year of sex w no contraception (or 6 mos if >35)
secondary: female has conceived before (even if miscarriage/termination)
What is the overall chance of infertility?
15%
How can antral follicles be used to work up infertility?
normal around 5/ovary = prelim to an egg
What is the most common cause of ovarian dysfunction?
PCOS
What are the causes of anovulation?
PCOS, hypo hypo, premature ovarian failure
How can mid-luteal progesterone help work up infertility?
> 3 ng/ml means ovulation
What is ovarian reserve testing and when is it used?
if female >35: day 3 FSH and estradiol (high is bad), AMH and inhibin B (should be measurable - low is bad), antral follicle counts
What factors can indicate tubal dysfunction?
hx of pelvic inf or pain (dysmenorrhea), prior surgery, family hx of endometriosis
How can tubal factors be tested?
HSG
laparoscopy in operating room = gold standard
What factors can indicate uterine dysfunction?
hx of D&C, recurrent miscarriage, IUD, prior pregnancy outcome
What tests can be used to work up uterine dysfunction?
HSG, ultrasound, hysterosonogram, endometrial biopsy to diagnose luteal phase defect
What factors can suggest cervical obstacles in infertility?
prior abnormal pap or cervical inf, mid cycle mucus quality
What testing can be done to work up cervical obstacles?
pap, post coital test - mucus quality, cultures for gonorrhea and chlamydia
In addition to regular menstrual cycles, what other tests can be done to work up ovarian fxn?
TSH, prolactin*, testosterone and DHEA-S if signs of elevated androgens
fasting glucose and insulin levels
What are normal values for male sperm: volume count motility morphology WBCs?
2-4 ml >20 million sperm/ml 50-60% motile WHO normal >50%, strict normal = 6-14% <1 million wbc/ml
What other tests can be done to work up male infertility?
endocrine (FSH, LH, testosterone, prolactin) - look for azoospermia, moderate oligospermia
genetic eval w karyotype - azoospermia not due to blockage, severe oligospermia - Y chromosome microdeletions?
When is the best time for: semen analysis imaging ovulation predictor kit biopsy lab work?
after 2-3 days abstinence cycle day 6-10 shortest menstrual cycle and subtract 18 10-12 days after ovulation cycle day 3
What are the treatment options for ovulation induction in PCOS?
oral clomiphene citrate - blocks estrogen feedback at hypothalamus, low multiple gestation, inexpensive
injectable FSH - greater response, multiple gestations, risk of hyperstimulation, expensive
What are the treatment options for hypo hypo?
clomiphene citrate ineffective due to axis problem
gonadotropins best option
What is the best treatment for ovarian failure?
donor egg/embryo
What is the best treatment for tubal/pelvic problems?
usually surgery, IVF
What are the treatment options for cervical problems?
treat abnormal pap or positive culture, consider IUI = intra-uterine insemination
What are the treatment options for male infertility?
hormonal treatment, IUI for mild (>5 mil total motile), IVF/ICSI for severe oligospermia (5 mil), donor sperm
What pts will be unable to conceive w/o therapy?
complete tubal occlusion, premature ovarian failure, hypo hypo, azospermia
What pts will conceive eventually even with no therapy?
mild endometriosis, oligospermia, unexplained
