Infertility Flashcards
Define infertility.
Approx how many couples are affected by infertility?
Failure to achieve pregnancy after 1 year of trying
1 in 7
What are the causes of infertility?
Unexplained
Woman:
- anovulation
- tubal blockage
- age
Man:
- problem with sperm
As the age of the woman increases, what happens to fertility?
Decreases
Also, more likely to have miscarriage or chromosomal abnormalities
For what reasons would you refer a woman early for infertility treatment?
Over 35 yrs
Menstrual disorder
Previous abdominal or pelvic surgery
Previous Pelvic Inflammatory Disease, STD
For what reasons would you refer a man early for infertility treatment?
Previous genital pathology
Previous STD
Systemic illness
Describe what pre-conception care you’d give a couple wanting to conceive.
Have intercourse at least 2-3x week
Folic acid
Ensure healthy:
- smear test
- management of existing conditions
They need to be immune to rubella
Ensure no harmful exposure: smoking, alcohol, environmental
Ensure healthy weight
What is the impact of obesity on fertility?
Why?
Takes longer to conceive
Impacts on both men and women
Because high BMI is linked with anovulation
How would you investigate a woman for infertility?
Check if ovulation is happening: day 21 progesterone
Ovarian reserve (FSH, antral follicle count)
Tubal patency:
- hysterosalpingography
- hysterosalpingo-contrast-sonography
Rubella immunity status
STI screen
How would you investigate a man for infertility?
Test semen quality:
- count
- motility
- morphology
Hypogonadism screen: FSH, LH, test, prolactin
Karyotype
Secondary sexual characteristics
You should repeat a test of sperm analysis if its abnormal.
True or false?
Why?
True
Because things like cold/flu, alcohol, smoking and others can reduce sperm quality. It may not necessarily be representative of their true sperm quality
How do you check if ovulation is happening?
Measure progesterone level in the mid-luteal cycle (day 21ish, after ovulation has occurred)
If it’s over 30 they’re ovulating
What is meant by ovarian reserve? How do you check it?
How many follicles are in the ovaries
Check FSH levels
Check anti-Mullerian hormone
Antral follicle count
How is tubal patency checked?
Hysterosalpingogram (XR)
Hysterosalpingo-contrast-sonography (USS)
Contrast is injected through a tube inserted through the vagina into the uterus.
If the dye gets trapped somewhere along the f. tubes there is a blockage
Treatment for male infertility?
What about if it’s a hormonal problem?
Mild: intrauterine insemination
Moderate: IVF
Severe: inject sperm into egg
Give gonadotropins
What is azoospermia?
What’s the treatment?
When there’s no sperm in the semen
Remove the sperm surgically from the testes, and insert into the uterus
