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Reproductive System > Infertility > Flashcards

Infertility Flashcards

1
Q

What is infertility?

A

Inability to conceive despite regular unprotected intercourse

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2
Q

How many couples report infertility problems?

A

1 in 7

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3
Q

When should infertility be investigated?

A

Should be investigated after 1 year of trying to get pregnant

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4
Q

What percentage of couples will conceive within 24 months?

A

95%

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5
Q

What things are investigated in infertility?

A

Are there eggs
Are there sperm
Can they meet

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6
Q

What are the important aspects of the female partner’s history in infertility?

A 
Duration of infertility 
Previous contraception
Fertility in previous relationships 
Previous pregnancies and complications 
Menstrual history - most important features as this will tell you if there are eggs being released, also ask about pain
Medical and surgical history 
Sexual history 
Previous investigations
Psychological assessment
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7
Q

What are the important aspects of the physical examination of the female partner?

A

Weight
Height
BMI

Fat and hair distribution
Galactorrhoea
Abdominal examination
Pelvic examination

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8
Q

What causes hirsutism?

A

Testosterone excess

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9
Q

What hormones cause androgen excess?

A 
Testosterone
Androstenedione
Dehydroepiandrosterone (DHA) 
Dehydroepiandrosterone sulphate (DHAS) 
17-OH progesterone
Sex hormone binding globulin
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10
Q

What is used in the clinical measurement of androgen excess?

A

Ferriman Gallwey score

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11
Q

What is acanthuses nigricans a sign of?

A

Polycystic ovarian syndrome

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12
Q

What might galactorrhea indicate?

A

Prolactinoma

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13
Q

What are the important features of the pelvic examination of the female partner/what are you looking for?

A 
Masses
Pelvic distortion
Fixed retroversion
Tenderness
Fibroids - pressure symptoms, period problems, infertility
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14
Q

What are the important aspects of the male partner’s history?

A 
Previous fertility 
Medical history 
Surgical history 
Occupational history 
Sexual history 
Previous investigations and treatments
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15
Q

What are the important aspects of the physical examination of the male partner?

A

Weight
Height
BMI

Fat and hair distribution
Abdominal and inguinal examination
Genital examination

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16
Q

What might you be looking for in the genital examination of the male partner of a couple reporting infertility?

A

Epididymitis - STDs, NSTD
Testicular size - Klinefelter’s syndrome
Vas deferens - cystic fibrosis mutations and congenital bilateral absence of the vas deferent
Testicular maldescent
Varicocoele

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17
Q

What do home ovulation kits measure, how does this compare to measurement in clinic?

A

Home ovulation kits measure LH surge, in clinic progesterone is measured as this has a longer peak (mid-luteal progesterone)

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18
Q

When should a couple be referred for investigation of infertility?

A

1 year of trying (unless there’s a problem e.g. period irregularity, PMH, testicular problems)
Abnormal tests
HIV/Hep B
Anxiety

Age
< 35 years after 1 year
35-45 years after 6 months
> 45 years little can be offered

19
Q

What are the baseline investigations of a couple reporting infertility?

A

Female partner;

  • rubella immunity
  • chlamydia
  • TSH
  • if periods are regular measure mid-luteal progesterone
  • if periods are irregular do day 1-5 FSH, LH, prolactin, TSH and testosterone

Male partner;
- semen analysis

20
Q

What investigations are done at a fertility clinic?

A 
Pelvic ultrasound
Physical examination 
Further investigations
Semen analysis repeat if required
Tubal potency test - tested by x-ray, HyCoSy or laparoscopy

(HyCoSy = hysterosalpingo-contrast-sonography)

21
Q

What are the features of polycystic ovary syndrome?

A

Diagnosis of exclusion in infertility - only made when other diagnoses of hyperandrogegism have been ruled out

2 of the following 3 features must be present to have PCOS;

  • androgen excess (clinical e.g. hirsutism, biochemical e.g. testosterone)
  • infrequent periods (anovulation)
  • polycystic ovaries on ultrasound
22
Q

How many women have polycystic ovaries?

A

1 in 5

23
Q

What are the treatment options for ovulatory disorders?

A

Treat underlying cause e.g. hormonal imbalance
Weight loss/gain
Achieve BMI > 18 and < 35
Ovulation induction

24
Q

What must be working in order to induce ovulation?

A

Hypothalamic-pituitary axis

25
Q

How is ovulation induced?

A

Clomifene given if hypothalamic-pituitary axis is working, this stimulates GnRH -> FSH and LH -> oestrogen and progesterone
If the axis is not working, gonadotrophins are given to directly stimulate oestrogen and progesterone

26
Q

What is clomifene?

A

Selective oestrogen receptor modulator

27
Q

What is the dose of clomifene used for ovulation induction?

A

50-150mg days 2-6, progesterone priming if amenorrhoea

28
Q

How is clomifene use monitored?

A

Follicle scanning in first cycle - 15% require dose adjustment
Only prescribed by hospital (not GP) due to monitoring need

29
Q

What are the side effects of clomifene?

A

Vasomotor

Visual

30
Q

When are gonadotrophins used in ovulation induction?

A

No ovulation with clomifene

Ovulation but no pregnancy

31
Q

What causes side effects of gonadotrophins?

A

Multiple pregnancy and multi-follicular response causing ovarian hyperstimulation side effects

32
Q

How many cycles of gonadotrophins can be given?

A

3-6

33
Q

What are the treatment options for infertility due to a tubal factor or endometriosis?

A

Surgical vs medical treatment for endometriosis or fibroids
Reversal of sterilisation (no longer available on NHS)
IVF or tubal surgery

34
Q

What are the treatment options for an infertile male?

A 
Urologist appointment if appropriate 
IVF/ICSI
Intra-uterine insemination
Surgery - reversal of vasectomy (not available on NHS) or surgical sperm retrieval 
Donor insemination
35
Q

What are the causes of azoospermia?

A

Post-testicular

  • obstruction
  • iatrogenic
  • congenital
  • infective

Testicular

  • normo-gonadotrophic
  • hypo-monadism
  • hyper-gonadotrophic e.g. Klinefelter’s
36
Q

What is involved in the investigation of azoospermia?

A 
History 
Examination
FSH
LH
Testosterone
Karyotype
PRL
CF screen
37
Q

What are the modes of surgical sperm retrieval?

A

Micro-epididymal sperm aspiration

Testicular sperm extraction

38
Q

What are the treatment options for sexual problems causing infertility?

A

Psychosocial counselling

Artificial insemination - timed insemination at home or intra-uterine insemination at clinic

39
Q

What are important factors when investigating unexplained infertility?

A

Consider IVF option if problems have been ruled out
Age
Previous pregnancy
Duration of infertility

40
Q

What is involved in IVF treatment?

A 
Eggs harvested from ovary 
Eggs fertilised in the lab with sperm 
Embryos undergo a number of cell divisions 
Embryo transferred into the womb
Heavily regulated treatment
41
Q

How many cycles of IVF are done per year, and how many IVF births are there per year?

A

60,000 cycles

12,000 births (nearly 2% of total UK births)

42
Q

What is involved in intracytoplasmic sperm injection?

A

Injection of mature eggs with a single sperm

Incubation overnight

43
Q

Live birth rate following IVF decreases with what?

A

Increasing female age

Reproductive System (33 decks)

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