Infertility Flashcards
How common is Infertility
1 in 7 couples report infertility problems
When would one begin investigating claims of infertility
- After 1 year of a couple trying to get pregnant with no success(<35yrs, 6months if 35-45yrs)
- Period irregularity
- PMH
- Testicular problems
- HIV/Hep B
- Anxiety
Female infertility Hx
- Duration of infertility
- Previous contraception
- Fertility in previous relationships
- Previous pregnancies + complications
- Menstrual Hx
- Medical + surgical Hx
- Sexual Hx
- Previous investigations
- Psych assessment
Female infertility Hx
- Weight and height
- BMI (kg/m2)
- Fat and hair distribution
- Galactorrhoea (milky secretion from nipple, not normal milk)
- Abdo exam
- Pelvic exam`
What is Acanthosis Nigricans and what is it a sign of with relevance to infertility
- Dark, thickened, velvety skin in body folds and creases
- Typically in armpits, groin and back of the neck
- Usually appears slowly
- Polycystic Ovary Syndrome (PCOS)
What causes Polycystic Ovary Syndrome (POCS)
Caused by elevated androgens (male hormones) in women
Signs and Symptoms of Polycystic Ovary Syndrome (PCOS)
- Acanthosis Nigricans
- Difficulty getting pregnant
- Irregular/no/heavy periods
- Hirsutism (excess body and facial hair)
- Pelvic pain
- Acne
Treatment for PCOS
- Oral contraceptives
- Metformin
- When associated with obesity weight loss is recommended
Cause of Galactorrhoea
A prolactinoma
Main points of pelvic exam
- Masses
- Pelvic distortion
- Fixed retroversion
- Tenderness
What are fibroids
- Non-cancerous growths that develop in or around the uterus
- Made up of muscle and fibrous tissue and vary in size
- Many women are asymptomatic
What can fibroids cause
- Pressure symptoms
- Period problems
- Infertility
Male infertility Hx
- Previous fertility
- Medical and surgical Hx
- Occupational Hx
- Sexual Hx
- Previous investigations and treatments
Male infertility exam
-BMI
-Fat and hair distribution (hypoandrogenism)
-Ado and inguinal exam
-Genital exam
Testes
Epididymis
Vas deferens
Varicocele
Penis
3 causes of epididymitis
- Chlamydia Trachomatis
- Gonorrhoea
- NSTD
What is Klinefelter’s Syndrome and what can it cause
- 47 XXY
- Causes small testicles and reduced libido
- Infertility
- Osteoporosis
What investigations would you carry out for female infertility
-Rubella immunity
-Chlamydia
-TSH
-Mid luteal progesterone, 7 days prior to expected period (if periods are regular)
-If periods are irregular day 1-5;
FSH
LH
PRL
TSH
Testosterone
-Pelvic ultrasound
-Tubal patency test
What investigations would you carry out for male infertility
Semen analysis
1 feature of a Hx + exam that would suggest Polycystic Ovary Syndrome (PCOS)
- Hirsutism
- Anovulation (infrequent periods)
How to induce ovulation
- Clomifene
- Gonadotrophins
- Gonadotropin-releasing hormone (GnRH)
What is Azoospermia
When semen contains no sperm
What do PR, CF Screen, FSH, LH stand for
- PRL = Prolactin
- CF Screen = Cystic fibrosis screen
- FSH = Follicle-stimulating hormone
- LH = Luteinizing hormone
Treatment for Azoospermia
-Surgical retrieval of sperm
Micro-epididymal sperm aspiration
Testicular sperm extraction
Number of births due to IVF
12,000 (2% of total UK births)
