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ESA 4 - Reproductive System > Infertility > Flashcards

Infertility Flashcards

1
Q

What is infertility defined as?

A

The failure of contraception in a couple having regualr, unprotected coitus for one year

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2
Q

What % of couples will be pregnant after 12 cycles?

A

80%

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3
Q

What are the categories of infertility?

A
  • Primary
  • Secondary
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4
Q

What is primary infertility?

A

No previous pregnancy

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5
Q

What is secondary infertility?

A

Previous pregnancy, successful or not

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6
Q

What proportion of couples have difficulty conceiving?

A

Around 1 in 7

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7
Q

How many people in the UK have trouble conceiving?

A

3.5million

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8
Q

What should be included in a female infertility history?

A
  • Age
  • Duration of infertility
  • Information about menstrual cycle
  • Tubal or pelvic surgery
  • PID
    Menorrhagia
  • Pelvic pain
  • Sexual history
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9
Q

What information should be obtained about the menstural cycle in an infertility history?

A
  • Length of cycle
  • Predictability of cycle
  • Age of menarche
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10
Q

What is an important consistuent of the sexual history when taking a female infertility history?

A

Any infections?

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11
Q

What should be included in a male infertility history?

A
  • General health
  • Alcohol/smoking
  • Previous surgery to testes
  • Drug history
  • Previous infections
  • Sexual dysfunction
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12
Q

What should be included in infertility examination?

A
  • BMI
  • Signs of secondary sexual characteristics
  • Galactorrhoea
  • Pelvic examination - feel for structural abnormalities
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13
Q

When is a male infertility examination performed?

A

Do not usually perform a male examination in the absense of relevant history

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14
Q

What is looked for on a male infertility examination?

A

Testicular size and descent

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15
Q

What are the causes of infertility?

A
  • Male factors
  • Ovulatory disorders
  • Tubal damage
  • Uterine or peritoneal disease
  • Other factors, including unexplained infertility
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16
Q

What % of infertility is due to male factors?

A

30%

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17
Q

What male factors cause infertility?

A
  • Idiopathic oligospermia
  • Variococele
  • Abnormal sperm production
  • Hypothalamic/pituitary dysfunction
  • Ductal obstruction
  • Failure to deliver sperm to vagina
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18
Q

What may result in abnormal sperm production?

A

Testicular disease

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19
Q

What may cause ductal obstruction?

A
  • Post-infective epididymitis
  • Post-vasectomy
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20
Q

What may result in failure to deliver sperm to the vagina?

A
  • Hypospadias
  • Impotence
21
Q

What % of infertility is caused by ovulatory disorders?

A

25%

22
Q

What can ovulatory disorders be classified into?

A
  • Group 1 - hypothalamic pituitary failure
  • Group 2 - hypothalamic-pituitary-ovarian dysfunction
  • Group 3 - ovarian failure
23
Q

What is polycystic ovarian syndrome?

A

A syndrome consisting of polycystic ovaries and systemic features resulting from elevated androgens

24
Q

What causes polycystic ovary syndrome?

A

Unknown pathophysiology, but appears to have genetic component

25
Q

What does polycystic ovary syndrome result in?

A
  • Increased androgen secretion
  • Raised LH/FSH ratio
  • Insulin resistance
  • Multiple small ovarian cysts
  • Anovulation
26
Q

What is anovulation?

A

Amenorrhoea or oligomenorrhoea

27
Q

What are the clinical features of polycystic ovary syndrome?

A
  • Hirsuitism
  • Acne
  • Obesity
  • Male-pattern baldness
  • Oligomenorrhea
  • Psychological symptoms
28
Q

What are the psychological symptoms of polycystic ovary syndrome?

A
  • Mood swings
  • Depression
  • Anxiety
29
Q

What is the Rotterdam Diagnostic Criteria for polycystic ovary syndrome?

A

2/3 of;

  • Polycystic ovaries (12 or more follicles on ultrasound
  • Oligo-ovulation or anovulation
  • Clinical and/or biochemical signs of hyperandrogenism
  • Exclusion of other causes of androgen excess
30
Q

What % of infertility is due to tubal damage?

A

20%

31
Q

What is tubal damage caused by?

A
  • Past pelvic infection
  • Previous pregnancies
  • Pelvic surgery
  • Endometriosis
  • Mullerian developmental anomaly
32
Q

What pelvic infection can cause tubal damage?

A

Chlamydia

33
Q

What % of infertility is due to uterine or peritoneal disease?

A

<10%

34
Q

What uterine or peritoneal diseases can cause infertility?

A
  • Endometriosis
  • Asherman’s syndrome
  • Uterine fibroids
  • Cervical stenosis
  • Cervical hostility
35
Q

What is endometriosis?

A

Presence of endometrial tissue in sites other than the uterine cavity

36
Q

Where is endometriosis most common?

A

In the pelvic cavity

37
Q

What are the clinical features of endometriosis?

A
  • Dysmenorrhoea
  • Dyspaureunia
  • Chronic pelvic pain
  • Infertility
38
Q

What is cervical hostility due to?

A

Infection or female sperm antibodies

39
Q

What other factors can cause infertility?

A
  • Unexplained
  • Poorly controlled diabetes
  • Coital problems
40
Q

In what % of cases is infertility multifactoral?

A

5-10%

41
Q

When should a women be referred for investigation into infertility?

A
  • When she is of reproductive age and has not conceived after 1 year of unprotected vaginal sexual intercourse, in the absence of any known cause of infertility
  • When she is of reproductive age, and is using artifical insemination to conceive (with either partner or donor sperm), who has not conceived after 6 cycles of treatment, in the absence of any known cause of infertility
42
Q

Who should recieve early infertility referral?

A
  • Women >36 years
  • Known clinical cause of infertility, or a history of predisposing factors for infertility
43
Q

What investigations should be done in a female with infertility?

A
  • Follicular phase LH, FSH (day 2)
  • Luteal phase progesterone (day 21) if ovulating regularly
  • Prolactin, androgens, TFTs
  • Cervical smear
  • Pelvic USS
  • Tests of tubal patency
44
Q

What investigations should be done in a male with infertility?

A
  • Sperm analysis
  • Antisperm antibodies
  • FSH/LH/testosterone
  • USS
  • Karytoype
  • Cystic fibrosis
  • Testicular biopsy
45
Q

What are normal semen analysis results?

A
  • Volume >2ml
  • pH 7.2 – 7.8
  • Sperm count >20 million per ml
  • Motility >50%
  • Morphology >50% normal
46
Q

What does management of infertility depend on?

A

Underlying cause

47
Q

How is ovulation induced?

A
  • Clomifene citrate
  • Gonadotrophins
  • GnRH agonists
  • Weight loss/weight gain
  • Dopamine agonists
  • Ovum donation
48
Q

How is tubal occlusion treated?

A
  • Tubal surgery (re-anastomosis)
  • Assisted conception
49
Q

How are male factors treated in infertility?

A
  • Artificial insemination by donor
  • Intracytoplasmic sperm injection
  • GnRH agonists
  • Dopamine agonists

ESA 4 - Reproductive System (31 decks)

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