Infertility Flashcards
80% of couples will conceive in one year IF
Women is under 40 y/o AND
They do not use contraception and have regular sexual intercourse
Biochemical measurements of hirsutism
Testosterone Androstenedione Dehydropiandrosterone (DHA) Dehydroepiandrosterone sulphate (DHAS) 17-OH-Progesterone Sex hormone binding globulin (SHBG)
Baseline investigations for female partner
Rubella immunity
Chlamydia has to be negative
TSH
If periods are regular = mid luteal progesterone (7 days prior to expected periods)
If periods are irregular = day 1-5 full hormonal profile (FSH, LH, PRL, TSH, testosterone)
Baseline investigations for male partner
Semen analysis
Testing for ovulation
Regular cycle = blood test to measure serum progesterone in mid luteal phase of their cycle (day 21 of 28)
Irregular prolonged cycle = blood test to measure serum progesterone - needs to be done later in the cycle and repeated weekly until next period
Irregular cycle = blood test to measure serum gonadotrophins (LH and FSH)
When to refer to infertility clinic
Trying for one year Unless there is a problem e.g. - Period irregularity - PMH - testicular problem Abnormal tests HIV/Hep B Anxiety
Treatment of ovulatory disorders
Treat underlying cause
Weight loss/gains = BMI > 18 and < 35
Ovulation induction
Ovulation induction drugs
Clomifene
Gonadotrophins
GnRH
First line drug for ovulation induction
Clomifene
Mode of action of clomifene
Oestrogen receptor modulation - binds to oestrogen receptors
Hypothalamus perceives hypoestrogenic state - pituitary increases release of gonadotrophins
Secondary site of action = direct effect on ovaries
So gives a positive trigger to release FSH and LH
How many times can clomifene be used?
Up to 6 times
Side effects of clomifene
Vasomotor
Visual
Treatment of male infertility
IVF/ICSI Intra uterine insemination Donor insemination Surgery - removal of vasectomy - surgical sperm revival
Investigations for azoospermia
History and exam
FSH, LH, testosterone, karyotype, PRL, CF screen
How IVF works
- Eggs harvested from ovaries
- Eggs fertilised in lab with sperm
- Embryos undergo a number of cell divisions
- Embryos transferred to the womb
Primary infertility meaning
If have had no children before
Irregular periods definition
Variation of 7 days or more from the other months
Side effects of any ovulation induction
Ovarian hyperstimulation
Multiple pregnancy
How to diagnose tubal block
Salpingogram
HyCoSY
Laparoscopy to confirm
Causes of tubal block
PID
If tubes are removed e.g. sterilisation
Endometriosis
Fibroids
IVF meaning
In vitro fertilisation (outside the body)
Azoospermia meaning
No sperm in the ejaculate
Causes of azoospermia
Absence of vas deferens Mumps Kleinfiers syndrome STIs Radiation Hypogonadism
Unexplained fertility meaning
Everything is fine but there is still no fertility
What is the overall success rate for IVF?
20 - 30 %
What ethical issues could surround IVF?
Unnatural Funding Religion Criteria Risks
What is IVF a moderate risk factor for?
Placental abnormalities
How long do patients need to be trying to conceive for to be referred on?
1 year
How many couples will be affected by infertility?
1 in 7
Causes of inferility
Male factor 30% Unexplained 20% Ovulation failure 20% Tubal damage 15% Other causes 15%
Key counselling points for conception
Folic acid
Aim for BMI 20 - 25
Advise regular sexual intercourse every 2 - 3 days
Smoking / drinking advise
For people with unexplained fertility, mild endometriosis or mild male factor infertility who are having regular unprotected sexual intercourse, what can be done?
Make sure they try for 2 years naturally
Common S/E of IVF
Ovarian hyper stimulation syndrome
