Infertility Flashcards
Define infertility?
Difficulty becoming pregnant despite having regular sex when not using contraception
- Regular sex = 2-3 times a week
- Will not see a specialist unless >2 years
What are the causes of female infertility
IDIOPATHIC*
DISEASES
- Early menopause
- PCOS
- Hormonal - thyroid, prlactin
- Chronic conditions (diabetes, cancers, CKD)
- Genetic conditions
- Infections of reproductive organs
- Endometriosis
- Large fibroids
DRUGS
- Tobacco
- Alcohol
- Illicit substances
OTHER
- Excessive exercise
- Malnutrition
What are the male causes of infertility?
DISEASE
- Sperm reduced motility, number, abnormal form
- Infections e.g. MUMPs
- STI Hx
- Tumours of testes
- Undescended testicles
- Hormones: Cushing’s, hyperprolactinaemia
- Obesity
DRUGS
- Tobacco
- Alcohol
- Illicit substances
When will infertility be investigated?
PRIMARY CARE
-Trying to conceive for a month
SPECIALIST
-Trying to conceive at least 18 months
What tests may primary care practictioners order?
Sperm test
Blood test in female
-Check ovulation is occurring
Ultrasound scan depending on female symptoms to check abnormalities (e.g. fibroids)
What blood test is done to check for female ovulation?
Progesterone measured
- Highest just after ovulation
- Test done on day 21 of regular 28 day cycle
What advice is given in regards to sex and fertility?
- Having sex two to three times a week will maximize chance of pregnancy
- Timing sex to ovulation generally not recommended as can cause anxiety and relationship stress (studies have not shown that using fertility kits is more beneficial)
What are the medical management of fertility?
(NB: medications sometimes used alone or in conjunction to assisted conception)
CLOMIFENE
-Pituitary gland produces more gonadotrophins that stimulate ovaries to ovulate
GONADOTROPHINS
-Stimulate ovaries to ovulate
METFORMIN
-Prescribed in PCOS for those that are insensitive to insulin and so have trouble conceiving
What are the surgical options for fertility?
Used if cause of infertility found e.g.
- Fibroid removal
- Fallopian tube clearance
What are the options for assisted conception?
INTRAUTERINE INSEMINATION
- Washed sperm placed in womb
- 15% chance of success
IN VITRO FERTILIZATION
- Eggs removed fertilized and then put back in
- Increased risk of multiple births
What are the main eligibility criteria for IVF?
- Woman between 23-39 years
- Cause for fertility problem identified
- Infertility > 3 years
What are the other alternatives if infertility can not be resolved?
SPERM/EGG DONATION
- Donors can no longer remain anonymous
- Child legally entitled to find identity of donor when 18
ADOPTION
