Infertility Flashcards
Definition of infertility?
Inability of a couple to conceive after 12 months of regular intercourse without use of contraception
How many couples report infertility issues?
1 in 7
What are the chances of conception?
80% of couples in the general population will conceive within 1 year if: the woman is aged under 40 years and
they do not use contraception and have regular sexual intercourse
What are the main queries as to why they cannot concieve?
Are eggs available?
Are sperm available?
Can they meet?
Can embryo implant?
What questions should the woman be asked during the history?
- Duration of infertility
- Previous contraception
- Fertility in previous relationships
- Previous pregnancies and complications
- Menstrual history
- Medical and surgical history
- Sexual history
- Previous investigations
- • Psychological assessment
What should be examined of the female?
- Weight
- Height
- BMI (kg/m2)
- Fat and hair distribution
- Galactorrhoea
- Abdominal examination
- Pelvic examination
What baseline investigations should be carried out?
- Rubella Immunity
- Chlamydia
- TSH
- sub-clinical hypothyroidism can cause issues with implantation
- Testing for Ovulation
- Regular Period: Mid-luteal phase progesterone 7 days prior to expected period
- Irregular Period: Day 1-5 FSH, LH, PRL, TSH & testosterone
What investigations should be carried out at the fertility clinic?
- Pelvic US
- Physical Exams
- Tubal Patency Test
- Hysterosalpingo-Contrast-Sonography (HyCoSy)
- Laparoscopy
- Test for ovulation
- mid luteal phase progesterone
- Irregular periods require FSH & LH testing to assess
What male investigations should be carried out? And what are the normal reference values for said test?
- Computerised Semen Analysis
- Reference values15-200 million/ml
- <15 million is oligospermia
- <5 million is severe oligospermia
- 0 is azoospermia
- Total sperm count: <39 million= low
- Reference values15-200 million/ml
What are group 1 ovulatory disorders? + treatment?
- Hypo-gonatrophic hypo-gonadial anovulation
- Treatment: Optimise BMI and reduce exercise levels if very high
What are group 2 ovulatory disorders?
- Normo-gonadotrophic, normo-oestrogenic anovulation
- Polycystic Ovary Syndrome
How can we diagnose polycystic ovary syndrome?
Need 2 of the following:
- Androgen Excess
- Hirsutism
- Moderately raised Testosterone
- acanthosis nigricans
- Infrequent periods
- due to Anovulation
- US
What is the treatment for polycystic ovary syndrome?
- Optimise BMI (18-30)
- Clomifene (selective oestrogen receptor modulator, Inhibits oestrogen receptos in hypothalamus, preventing negative feedback, leading to up-regulation of gonadotrophin release, causing ovulation)
- Gonadotrophins
What is the required dose of Clomifene for Polycystic ovarian disease? + side effects?
- Start at 50mg per day
- Follicle scanning to monitor and adjust dose up to 150mg as necessary
- 6 cycles
- Ovarian hyperstimulation
- Multiple pregnancy
- Visual alterations
- Vasomotor “flushes”
What are the indications of use for gonadotrophins for polycystic ovarian disease?
- No ovulation on Clomifene
- Ovulated but still not pregnant after 6 cycles
- Up to 3-6 cycles