Infertility Flashcards
1
Q
Definition
A
Failure to conceive within 12 months given adequate opportunity
2
Q
Rates of conception at 12 months and 24 month
A
90% at 12 months
95% at 2 years
3
Q
Female causes
A
1. Amenorrhea/ovulatory dysfunction Hypothalamus/pituitary PCOS Premature ovarian failure Uterine outflow disorders 2. Tubal defect 3. Endometriosis 4. Other
4
Q
Male causes
A
- Hypogonadism->primary and secondary
- Cryptocrchidism
- XXY
- Disordered sperm transport
- GU surgery
5
Q
History
A
- Duration of trying
- Frequency of intercourse and technique->coitus every other day mid cycle
- Contraceptive history
- PID, endometriosis
- Age of partners
- Menstrual history: premenstrual symptoms, regularity, ovulation pain, vaginal secretions (thin=E, thick=P)
- FHx->PCOS, fragile X
- PMHx: surgery, infections, pain, liver/renal/heart/thyroid
- Pap smears, LLETZ (cervical incompetence)
- Medication, alcohol, smoking, drugs
- Previous pregnancies->miscarriages
6
Q
Examination
A
1. General \++Male pattern hair, acne, obesity, acanthosis nigricanc Adipose->+adrenal, PCOS, diabetes Galactorrhea (+prolactin) Thyroid examination 2. Genital Pelvic organs->fibroids, cysts, endometriosis, PID Vagina->structural, muscle spasm
7
Q
Investigations in women
A
1. Ovulatory TSH->both hyper/hypothyroid can disrupt ovulation Prolactin->elevates interferes Androgens (androgen secreting tumors), sex hormone binding globulin Day 21 serum Progesterone LH, FSH->if elevated menopause/resistant ovarian 2. Tubal damage->done by specialist infertility gynaecologist Sonohysteroscopy Hysterosalpingogram Laparoscopy 3. Other Lipids Glucose FBC VZ, rubella screen Pelvic USS
8
Q
PCOS: LH, FSH, SHBG
A
LH day 2-5 cycle If +LH, normal FSH, \+testosterone, low SHBG= PCOS Early follicular FSH/estradiol - may respond to IVF
9
Q
Investigations in men
A
Semen analysis->must not ejaculate for 2 days, semen produced by masturbation, all require (if abnormal) repetition at 3 months (duration of spermatogenesis) TSH Prolactin Karyotype Lipids Glucose
10
Q
Treatment in men
A
Treat hormonal deficiency
Donor insemination
IVF
Intracytoplasmic sperm injection
11
Q
Management in women
A
- Referral to fertility specialists
- Clomiphene cutrate->5 days in early proliferative
Anti-estrogen at pituitary= ++FSH->+follicle growth and ovulation
70-80% fertility in 12 cycles
12
Q
Side effects of clomiphene citrate
A
Hot flushes Nausea HeadA \+Menstrual pain \+Chance of multiple pregnancies
13
Q
Complication of IVF
A
- Perinatal morb/mortality
- Multiples
- Ovarian hyperstimulation
Mild= bloating, pain, ascites
Moderate= distension, NV, ascites, hematology and blood chemistry altered
Severe= ++Ascites, requiring hospitalisation, pleural effusion, prekidney failure, anuria
14
Q
Mechanisms of ascites, in ovarian hyperstimulation
A
- Ascites
extravasation and increased leakage of
protein-rich fluid from the intravascular space into the
abdominal cavity, owing to an osmolar differential.
15
Q
Pain and renal impairment in ovarian hyperstimulation
A
1. Pain Torsion Hemorrhage Rupture 2. Renal Extravasation of fluid