Infertility Flashcards
how many couples are affected by infertility
1 in 6
how much of the population is infertile
8%
what might be causing the rising incidence of infertility
older women increase in chlamydia infections increase in obesity increasing male infertility increasing awareness of treatments change in expectations social changes - same sex couples
what is infertility
failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse in a couple who have never had a child
what separates primary and secondary infertility
primary- couple have never conceived
secondary- couple previously conceived (pregnancy may not have been successful- miscarriage or eptopic pregnancy)
what makes infertility prognosis worse
>30 long duration of infertility secondary infertility male infertility endometriosis tubal factor infertility
what increases your chance of conception
Woman aged under 30 years
• Previous pregnancy
• Less than three years trying to conceive
• Intercourse occurring around ovulation
• Woman’s body mass index (BMI) 18.5 – 30m/kg2
• Both partners non-smokers
• Caffeine intake less than two cups of coffee daily
• No use of recreational drugs
what are the physiological causes of anovulatory infertility
before puberty
pregnancy
lactation
menopause
what conditions can cause anovulatory infertility
hypothalmic- anorexia/ bulimia, excessive exercise
pituitary- hyperprolactinaemia tumours, sheehan syndrome
ovarian- PCOS, premature ovarian failure
systemic disorders- chronic renal failure
endocrine disorders- testosterone secreting tumours, congenital adrenal hyperplasia, thyroid
what drugs can cause anovulatory infertility
depo-provera, explanon, OCP
what are the clinical features of anorexia nervosa
low BMI hair loss increased lanugo low pulse and MP (hypothyroid) anaemia (vit deficiency)
what are the endocrine markers of anorexia
low FSH, LH and osteradiol
what is the commonest endocrine disorder in women
polycystic ovary syndrome
what can exacerbate PCOS
weight gain
what are the clinical features of PCOS
obesity, hirsuitism/ acne, cycle abnormalities, infertility
what are the endocrine markers of PCOS
high free androgens, high LH, impaired glucose tolerance
how do you diagnose PCOS
must have 2 of:
- chronic anovulation (no cycle)
- polycystic ovaries
- hyperandrogenism (clinical or biochemical)
what lifestyle change can help PCOS
weight loss
what is premature ovarian failure
loss of normal function of your ovaries before the age of 40
what can cause premature ovarian failure
idiopathic, genetic (turners, fragile X), chemotherapy, radiotherapy, oophorectomy (removal of the ovaries)
what are the clinical features of premature ovarian failure
hot flushes, night sweats, atrophic vaginitis
what are the endocrine markers of premature ovarian failure
high FSH, high LH, low oestradiol
what is wrong in turners
missing X
what are the infective causes of tubal disease
pelvic inflammatory disease: chlamydia, gonnorrhoea, anaerobes, syphilis, TB)
transperitoneal spread: appendicitis, intra-abdominal abscess
following procedure: IUCD insertion, hysteroscopy, HSG (hysterosalpingogram)
what are the forms of pelvic inflammatory disease
endotetrisis, salpingitis, oophoritis, parametritis, tubo-ovarian abcess, peritonitis
what are the non infective causes of tubal disease
endometriosis surgical (sterilisation, ectopic pregnancy) fibroids polyps congenital salpingitis isthmica nodosa
what is a hydrosalpinx
distally blocked fallopian tube filled with serous or clear fluid- becomes distended
what are the clinical features of a hydrosalpinx due to pelvic inflammatory disease
abdominal/pelvic pain febrile vaginal discharge dyspareunia cervial excitation menorrhagia dysmenorrhoea infertility ectopic pregnancy
what is endometriosis
presence of endometrial glands (what lines the uterus) outside the uterine cavity
what causes endometriosis
retrograde menstruation, altered immune function, abnormal cellular adhesion, molecules, genetics
what are the clinical features of endometriosis
dysmenorrhoea (classicaly before menstruation ), dysparenuia, mennorrhagia, painful defaecation, chronic pelvic pain, infertility, may be asymptomatic
what can happen to the position of the uterus in endometriosis
retorverted (tilted abnormally backwards) and can be fixed
what can be seen on scan of endometriosis
chocolate cysts on ovary
what types of cells are found proliferating in endometriosis
glandular epithelium
what can cause male infertility
unexplained, undescended testes , urogenital infection, sexual factors, systemic disease, varicocele (varicous veins on testes causing them to overheat), hypogonadism, immune system factors, other causes (drugs)
what are the types of pre testicular male infertility causes
endocrine and coital disorders
what are the endocrine causes of male infertility
hypogonadotrophic hypogonadism,
hypothyroidism,
hyperprolactinaemia,
diabetes
what are the coital disorders that can cause male infertility
erectile dysfunction,
ejaculatory failure
what are the types of testicular male infertility
genetic, congential, vascular, immunological
what are the genetic causes of male infertility
klinefelter syndrome (XXY), y chromosome deletion, immotile cilia syndrome
what are the congenital cause of male infertility
cyptorchidism,
infective,
activespermatogenic agents (heat, irradiation, drugs, chemotherapy)
what are the vascular causes of male infertility
torsion
varicocele
what are the types of post testicular causes of male infertility
obstructive: epididymal and vasal
what are the causes of epididymal obstructive male infertility
congenital, infective
what are the causes of vasal obstructive male infertility
genetic: cystic fibrosis
acquired: vasectomy, ejaculatory duct obstruction, accessory gland infection, immunological, idiopathic
what are drugs that cause may infertility by decreasing sperm count
alcohol, tobacco, marijuana, cocaine, testosterone supplements, chemotherapy, long term use of some antibiotics
what are drugs that cause may infertility by creating a hormone imbalance
marijuana, testosterone supplements, anabolic steroids
what are drugs that cause may infertility by decreasing sex drive
excessive alcohol, SSRI antidepressants
what are drugs that cause may infertility by causing erectile dysfunction
excessive alcohol, tobacco, cocaine
what are drugs that cause may infertility by decreasing the ability of sperm to fertilise the egg
CCB’s, tetracycline antibiotics
what are the clinical features of non obstructive male infertility
low testicular volume, reduce secondary sexual characteristics, vas deferens present
what are the endocrine features of non obstructive male infertility
high LH, FSH and low testosterone
what are the clinical features of obstructive male infertility
normal testicular volume, normal secondary sexual characteristics, vas deferens may be absent
what are the endocrine features of obstructive male infertility
normal LF, FSH and testosterone
how should you exam females to investigate infertility
BMI, general exam, assessing body hair distribution, galactorrhoea
pelvic exam, assessing for uterine and ovarian abnormalities/tenderness/mobility
swab for chlamydia,
smear if due,
bloods for rubella immunity,
progesterone levels,
test of tubal patency
how should you exam males to investigate infertility
BMI, general exam, genital exam: assess size/position of testes, penile abnormalities, presence vas deferns, presence varicoceles
semen analysis (twice over 6 weeks apart)
why should you check rubella immunity
as if women get it when pregnant can affect the baby - cant conceive for a month after being vaccinated as its a live attenuated vaccine
how do you test tubal patency
laparoscopy or hysterosalpingiogram
when is laparoscopy contraindicated to test tubal patency
obesity, previous pelvic surgery, crohns
when do you do laparoscopy
possible tubal/ pelvic disease
known previous pathology (ectopic pregnancy, ruptured appendix, endometriosis)
history suggestive of pathology (dysmenorrhoea, dysparunia),
previous abnormal HSG
when is a hysteroscopy
only performed in cases where suspected or known endometrial pathology (uterine septum adhesions, polyp)
when would a pelvic ultrasound be done
when abnormality or pelvic examination
when required for other investigations
what endocrine test are done if there is anovulatory cycle or infrequent periods
urine HCG prolactin TSH testosterone and SHBG LH FSH oestradiol
what is SHBG
sex hormone binding globulin
what endocrine test are done if hirsute
testosterone and SHBG
what tests are done in amenorrhoea
endocrine profile and chromosome analysis
what is hCG
Human chorionic gonadotropin is a hormone produced by the placenta after implantation
what are the semen parameters
volume, pH, concentration, motility, morphology, WBC
what tests are done is there is abnormal semen analysis
LH and FSH,
testosterone,
prolactin,
thyroid function
what tests are done if there is severely abnormal semen analysis/ azoospermic (no sperm)
endocrine profile (as in abnormal semen),
chromosome analysis and Y chromosome microdeletions,
screen for cystic fibrosis,
testicular biopsy
what test are done if there is an abnormal male genital exam
scrotal ultrasound
what causes the symptoms of menopause/ premature ovarian failure
decreased oestrogen level - hair thinning, atrophic vaginitis, hot flushes, mood swings
what are hormones like in premature ovarian failure
abnormally high FSH, LH will be raised
these are due to low oestrogen levels
what hormone test can indicate ovarian failure
level of FSH more than 30 units/litre on separate occasions (normal is 2-8 units/litre)
true or false- oestrogen protects from ischaemic heart disease
yes
what is the treatment for premature ovarian failure
HRT
prevents osteoporosis and coronary heart disease
symptomatic control
why is HRT usually combined
as progesterone protected the endomterium from getting endometrial cancer whos risk is increased by oestrogen
how are eggs donated
donor gets stimulation injections of gonadotrophins which cause the growth of follicles
donor eggs retrieved in theatres then ‘matched’ to recipients
transferred into recipients womb
