Infertility Flashcards
How is infertility defined?
Failure to achieve pregnancy after 12 months of unprotected intercourse
List some common causes of female infertility. (6)
- Pregnancy, lactation
- Anorexia
- Hyperprolactinaemia
- Polycystic Ovarian Syndrome
- Premature Ovarian Failure (Early menopause)
- Tubal diseases (chlamydia, appendicitis, endometriosis)
What is Hypogonadotrophic hypogonadism?
Hypogonadism due to impaired secretion of LH and FSH
How is hypogonadotrophic hypogonadism managed?
- Pulsatile GnRH
2. Gonadotrophin (FSH+LH) injections
How is Polycystic Ovarian Syndrome managed?
Induce ovulation:
- Clomifene citrate
- Gonadotrophin therap (injections)
- Laparoscopic ovarian diathermy
What endocrine co-morbidity is common in PCOS patients?
Insulin resistance
What infertility investigations are carried out in the female?
- swab for chlamydia
- cerviacal smear
- rubella immunity
- midluteal progesterone level (ovulation?)
What is a Hydrosalpinx?
A blocked fallopian tube
_______ is measured to assess ovulation in a patient with regular menstrual cycles.
What needs to be measured if the cycles are irregular?
Progesterone
LH, FSH, Testosterone, TSH, PRL
What are the 3 Groups of ovulatory disorders?
Group I: hypothalamic
- low FSH and estrogen
- normal prolactin
Group II: hypothalamic pituitary dysfunction
- PCOS
- FSH and estrogen normal
Group III: ovarian failure
- high LH and FSH
- high oestrogen
What are the features of Polycystic Ovarian Syndrome?
symptoms:
-irregular menstruation, hirsutism, acne, subfertility, alopecia, obesity
biochemistry:
- high LH
- low progesterone
- raised Testosterone/FAI
What drugs are used in the treatment of PCOS?
- Clomifene citrate (anti-oestrogen)
- Tamoxifen (anti-oestrogen)
- Letrozole (aromatase inhibitor)
What is the treatment progression for PCOS?
- Clomifene citrate + Metformin
- Gonadotrophin: daily injections (FSH and LH)
- Laparoscopic ovarian diathermy
What chromosomal abnormality can cause male infertility?
Klinefelter’s syndrome
