Infertility Flashcards
def. of infertilty
no preg after trying for 12 months
- secondary if have had a child
incidence of infert
- 10-15% of couples
- 80% preg. after first year
2 main causes of infert.
- male factor
- tubal
- then
- ovulation
- endo
- cervical
- mixed
how does age play a role
increases with age
tubal factors involved
- PID and endo
- adhesions
- ruptured appendix
4, imperforate hymen leading to retrograd menstruation
what is test for tubal facotrs
hysterosaplingogram (HSG) with dye
what is normal HSG
fluid filled and spilled
what is seen in tubal issues
maybe not filled, maybe not spilled
what is seen hydrosalpinx
filled and swollen
what is relat between endo and fertility
30-40% of endo PTs will be infertile
- found in 35% of women undergoing infert lapro
what can help
treatment of stage 1 and 2 endo can improve fert
what are 4 uterine factors
- congential anomalies
- ashermans - scarring inside the uterus
- fibroids
- polyps
how to diagnose uterine probs
HSG or sonohystogram
2 treatments
- hyseroscopy or open surgery
2. metroplasty - rare
** what is diff. between uterine septum and bicornate
can see a bicornate from the outside, but septum will look normal
what are cervical factors
- previous cervicitis
- cone biposy
- antisperm AB
2 tests for cervical factors
- post coital test - not really done
2. sperm peenetration test - mix mucus and semen under a microscope and watch them swim
2 main classes of male problems
- not enough
2. poor delivery
what is normal semen analysis
volume - 2-5 cc conc. 20-40 mill motility: 50% morphology : >4% leukocytes: ideall 0
what is DNA fragmentations
test the sperm - poor > 30% good
possible causes of male factor
- congential - undescended
- trauma
- varicocoele
- infection
- cancer/chemo
- smoking, pot, heat
- CF
- retrograd ejac
treatment of ovulation problems
- fix underlying cause if possible
- stim ovulation if possible
- donor egg if not
- same workup as ammen
3 drugs for infert.
- SERM - clomiphene
- est. aromatase inhibitor - letrozole
- rFSH - expensive
3 treatments of tubal disease
- tuboplasty
- IVF
- remove hydrosalpinx before IVF
