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RED > Infertility > Flashcards

Infertility Flashcards

1
Q

What is fertility?

A

The number of children born to an individual/couple as an actual outcome of the reproductive process

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2
Q

What is fecundability?

A

The probability of conceiving each month from an individual over time or for a population. Monthly fertility rate.

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3
Q

What is fecundity?

A

A measure of the ability to conceive and produce a live birth

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4
Q

What is infertility?

A

The inability to conceive after a 2yrs of regular unprotected intercourse or the inability to carry a pregnancy to term.

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5
Q

What is subfertility?

A

Reduced fertility but able to carry to term

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6
Q

After how long should couples seek fertility advice?

A

After 1 year as 85% of people will conceive within a year.

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7
Q

Will a person with subfertility conceive naturally?

A

Yes given time

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8
Q

How many men have a low sperm count?

A

1 in 10

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9
Q

What are the causes of infertility?

A

Female or male problems (70%)
Combination (15%)
Unknown (15%)

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10
Q

What female factors contribute to infertility?

A 
Ovulation disorders
Tubal damage
Endometriosis
Uterine abnormalities
Implantation, growth and development problems
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11
Q

When is a hormonal blood test carried out for FSH and progesterone and what do the levels show?

A 
FSH = day 2-4. The plataeu shows ovarian reserve
Progesterone = day 21 for ovulation
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12
Q

What other tests may a female undergo?

A

Laproscopy with inflation to view the organs for signs of PCOS or endometriosis.
Hysterosalpingogram - uses a HSG dye spill to show that tubes are open

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13
Q

What may be the cause of amenorrhoea or oligomenorrhoea?

A
  • It is associated with stress, obesity, excessive exercise, anorexia and drugs.
  • Idiopathic ovarian failure - end organ insensitivity to gonadotrophins means low oestrogen and no follicle maturation.
  • PCOS - raised androgen levels
  • Anovulatory cycles
  • Failure of neuroendocrine maturity at puberty
  • Abbreviated luteal phase
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14
Q

Why may a cycle be anovulatory?

A

Normal hormone levels but failure for follicle to rupture due to poor quality of eggs.

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15
Q

What is an abbreviated luteal phase?

A

Reduced progesterone levels causing poor luteinisation during the formation of the corpus luteum.

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16
Q

What causes tubal damage and why does it reduce fertility?

A

Pelvic infection and STIs (TB, gonorrhoea, chlamydia).
Infection may be post-abortal or post-pregnancy sepsis.
Infection causes scarring and loss of cilia and adhesions form impairing oocyte and sperm transport.

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17
Q

What is endometriosis?

A

Endometrial tissue growth within ectopic sites causing pain, scarring and adhesions as the sites respond to the hormones of the menstrual cycle. Commonly occurs in oviduct, ovary or peritoneal cavity.

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18
Q

What is cervical incompetence?

A

Excess dilation

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19
Q

What happens if the ovary and uterine tube are separate?

A

The oocyte is lost into the peritoneal cavity. Sperm can also move out into the peritoneal cavity and cause ectopic implantation

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20
Q

What immunological factors may prevent implantation and development?

A

AI conditions

Immunological incompatibility of Rhesus group or ABO

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21
Q

How many pregnancies result in spontaneous miscarriage during the first trimester?

A

1 in 5

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22
Q

How many cycles of unprotected sex do not result in pregnancy?

A

4/5

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23
Q

How many conceptions reach birth?

A

1 in 5 - Only 20% reach blastocyst stage, the rest are abnormal or don’t implant

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24
Q

How is pregnancy detected?

A

Presence of hCG in bloo or urine at 18-30 days after initiation of last period.

25
Q

When is pregnancy clinically confirmed?

A

At 5 wks via USS and 7wks with presence of fetal heart beat.

26
Q

How many embryos become blastocysts in IVF?

A

20-40%

27
Q

10% of all clinical pregnancies are chromosomally abnormal. What do genetic abnormalities occurring in a clinical pregnancy lead to?

A

50% spontaneously abort
5% still birth
0.5% live birth

28
Q

Why do chromosomal abnormalities occur?

A

Due to meiosis problems

29
Q

What types of chromosomal abnormalities occur and what is the likelihood of reaching term?

A

Translocations
Error of ploidy e.g. triploidy and tetraploidy - fail to term
Errors of somy e.g. down’s syndrome - 3& to term
Sex chromosome trisomies progress to term

30
Q

What causes chromosomal abnormalities?

A

Ageing.
Most affected by female ageing as egg quality declines rapidly after 35yrs.
Males have a less dramatic decline.

31
Q

What male factors affect fertility?

A
  • Production, transport, transmission of spermatozoa
  • Sperm fusion
  • Fertilisation and the following events
32
Q

What will infertility investigations aim to identify?

A

Potentially correctable conditions
Irreversible conditions that will require assissted reproduction.
Life threatening conditions underlying infertility
Abnormal genetics affecting the offspring

33
Q

What is the process of investigations?

A

1) Reproductive Hx and screening using 2 x sperm analysis one month apart to allow spermogenesis to occur and a blood analysis
2) Examination - general, secondary characteristics, endocrine disease, gynaecomastia, abdo and genital exam, digital PR
3) Endocrine evaluation

34
Q

What type of infection commonly affects fertility?

A

Prostatic

35
Q

What may suggest an endocrine abnormality?

A

Low sperm count or self reported impaired sexual function

36
Q

What is a normal sample of sperm / normozoospermic?

A

> 15mill/ml
32% good motility
4% good quality/morphology

37
Q

What does zoospermia mean?

A

Sperm present in semen

38
Q

What is oligozoospermic?

A

<15mill/ml = reduced sperm count

39
Q

What is Asthenozoospermia?

A

<32% rapid and forward motility = Reduced motility

40
Q

What is teratozoospermia?

A

<4% normal morphology = Reduced morphology

41
Q

What is Azoospermia?

A

No sperm present

42
Q

What is OATS?

A

Oligoasthenoteratozoospermia - REduced count, motility and morphology

43
Q

What might be the cause of failure of sperm production?

A

Congential testicular deficiency e.g. Klinefelter
Maldescended tests / Cryptochidism (increased risk of testicular cancer and reduced spermatogenesis)
Acquired trauma or orcitits
Endocrine disorders

44
Q

What tests can be carried out for a male?

A 
Leukocytes = prostastitis
Sperm analysis ad viability test
Antisperm Igs
Karyotyping
AR test
45
Q

Why might there be failure of transmission?

A

Erectile dysfunction or ejaculatory dysfunction e.g. retrograde due to sphincter failure or defect in accessory sex gland

46
Q

What is the process of normal ejaculation?

A

Contraction of musculature in prostate, seminal vesicles, vas deferens moves seminal fluid and sperm into urethra. Under sympathetic control.
Contraction of urethral and pelvic floor musculature = ejaculation under parasympathetic control.

47
Q

What is the purpose of the vesicular urethral sphincter?

A

Closes bladder of neck to prevent retrograde ejaculation.

48
Q

What is retrograde ejaculation?

A

Occurs due to incompetence of urethral sphincter causing ejaculate to pass into the bladder due to the path of least resistance. The ejaculate volume is therefore low.

49
Q

What is retrograde ejaculation associated with?

A

DM, paraplegia, post bladder neck surgery

50
Q

How can retrograde ejaculation be tested for?

A

Test for presence of ejaculate in urine. It is tested if low volume or aspermia but not if hypogonadism is suspected.

51
Q

What are the causes of low sperm volume?

A

Retrograde
Lack of emission
Duct obstruction

52
Q

What may be the cause of failure of transport?

A

Post infection occlusion

Congential bilateral absence of vas deferens = azoospermia

53
Q

What tests should be carried out for men who have non-obstructive azoospermia?

A

Genetic testing e.g. Klinefelters, translocation, Y chromosome deletion

54
Q

What is CBAVD linked to?

A

CFTR gene.
A single homozyhous mutation in CFTR doesn’t present with CF but can cause improper development of vas deferens. Sperm is still produced but cannot ejaculate.
>95% of men with CF have CBAVD
85% of men with CBAVD only have one mutation
Partner must be checked for carrier of CF gene

55
Q

What problems may arise post fertilisation?

A

Centriole fusion, decondensation of chromosome, pronuclear fusion, activation of genes

56
Q

What does paternal smoking increase the risk of?

A

Childhood leukaemia

57
Q

What is unexplained fertility?

A

When there is no other explanation and all tests possible come back normal.

58
Q

What 3 types of assisted reproduction are there?

A

IUI - intrauterine insemination to bypass cervical mucus
IVF - To bypass uterotubal junction and fallopian transport
ICSI - To bypass natural penetration and fertilisation

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