Infertility Flashcards
What is infertility?
Inability to conceive despite regular unprotected intercourse
How many couples report infertility problems?
1 in 7
When should infertility be investigated?
Should be investigated after 1 year of trying to get pregnant
What percentage of couples will conceive within 24 months?
95%
What things are investigated in infertility?
Are there eggs
Are there sperm
Can they meet
What are the important aspects of the female partner’s history in infertility?
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
What are the important aspects of the physical examination of the female partner?
Weight
Height
BMI
Fat and hair distribution
Galactorrhoea
Abdominal examination
Pelvic examination
What causes hirsutism?
Testosterone excess
What hormones cause androgen excess?
Testosterone Androstenedione Dehydroepiandrosterone (DHA) Dehydroepiandrosterone sulphate (DHAS) 17-OH progesterone Sex hormone binding globulin
What is used in the clinical measurement of androgen excess?
Ferriman Gallwey score
What is acanthuses nigricans a sign of?
Polycystic ovarian syndrome
What might galactorrhea indicate?
Prolactinoma
What are the important features of the pelvic examination of the female partner/what are you looking for?
Masses Pelvic distortion Fixed retroversion Tenderness Fibroids - pressure symptoms, period problems, infertility
What are the important aspects of the male partner’s history?
Previous fertility Medical history Surgical history Occupational history Sexual history Previous investigations and treatments
What are the important aspects of the physical examination of the male partner?
Weight
Height
BMI
Fat and hair distribution
Abdominal and inguinal examination
Genital examination
What might you be looking for in the genital examination of the male partner of a couple reporting infertility?
Epididymitis - STDs, NSTD
Testicular size - Klinefelter’s syndrome
Vas deferens - cystic fibrosis mutations and congenital bilateral absence of the vas deferent
Testicular maldescent
Varicocoele
What do home ovulation kits measure, how does this compare to measurement in clinic?
Home ovulation kits measure LH surge, in clinic progesterone is measured as this has a longer peak (mid-luteal progesterone)
When should a couple be referred for investigation of infertility?
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
What are the baseline investigations of a couple reporting infertility?
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
What investigations are done at a fertility clinic?
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)
What are the features of polycystic ovary syndrome?
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
How many women have polycystic ovaries?
1 in 5
What are the treatment options for ovulatory disorders?
Treat underlying cause e.g. hormonal imbalance
Weight loss/gain
Achieve BMI > 18 and < 35
Ovulation induction
What must be working in order to induce ovulation?
Hypothalamic-pituitary axis
