Infertility Flashcards
Define health
A state of complete physical, mental and social well-being, not merely the absence of disease to infirmity
How many couples suffer from infertility?
1 in 6 couples
Semen abnormality is the cause of what percentage of male infertility?
85%
What does oligoasthenospermia mean?
Low count and low motiltiy
What 3 things could cause semen abnormality?
1- Testicular cancer
2- Drugs (such as alcohol and nicotine)
3- Variocele
What does azoospermia mean?
Semen contains no sperm
What type of azoospermia might chemotherapy cause?
Non-obstructive
Low testicular volume
Reduced secondary sexual characteristics
vas deferens present
^ LH,FSH (maybe v Testosterone)
What type of azoospermia does this represent?
Non-obstructive (Sperm production is not happening)
What congenital condition causes respiratory issues primarily but may also result in obstructive azoospermia?
Cystic fibrosis
Name two classes of drugs that may cause erectile dysfunction?
Beta-Blockers
Antidepressants
Why could thyroid disorders cause male infertility?
Decreases sexual function
Increases prolactin
What is the normal testicular volume in an adult?
12-25mls
What 5 things does Semen Analysis look for?
Volume Density Motility Progression Morphology
TRUE/FALSE
The first bit of ejaculate has the most sperm?
TRUE
Plasma FSH is raised in what?
Testicular failure
When would you do Testosterone and LH levels in infertility?
If suspect androgen deficiency
Treatment for infertility
General advice- Sex 2-3/week, No alcohol/smoking, Low BMI, avoid chemicals and testes from getting too hot
Treat specific cause
Fertility treatment- ICSI or DI
IF within 3 years how successful is reversal of vasectomy?
75%
What is included under the umbrella term of assisted conception treatment?
Any treatment in which involves gametes outside the body
What is the condition for ACT?
Has to have a reasonable expectation of live birth
One partner has no biological child
How many cycles are couples offered of ACT?
3 cycles
TRUE/FALSE
Sex selection of embryos is illegal
KINDA
It is illegal
but it is permitted if serious medical condition related to one gender
What are the 4 reasons to refuse treatment?
1- When its not legal
2- Issues with welfare of child
3- Reduced success rate
4-Increase risk harm
What is the age limit in order to meet the criteria for ACT on the NHS?
<40 at time of treatment
<41 at time of FET
How many cycles are paid for by the NHS if the women is aged 40-42
1 cycle
How long does the length of infertility and duration of relationship have to be in order to qualify for NHS funded treatement?
2 years
TRUE/FALSE
Smoking is not advised but you are able to access NHS funded fertility treatment even if you are smoking
FALSE
Both parents have to be non-smoking for 3 months
Breathylse before treatment
Single women seeking children are not currently funded on the NHS, why?
Not seen as infertility
Why is folic acid given to women who might conceive?
To reduce the risk of neural tube defects or anecepahalopathy
What are reasons for fertility preservation
Cancer
Transgender
Social reasons
What is the success rate of IVF?
35%
What would be indication for donor insemination?
Azzospermia/V low count
Failed ICSI
Genetic conditions
Infective conditions
What is the pregnancy rate per cycle with donor insemination/
15%
How many children is a sperm donor able to father?
up to 10 families of children
TRUE/FASLE
Sperm donors in Scotland are completely anonymous and have no legal parenthood over the child
Are not the legal parent of the child
However they are not anonymous- at 18 the child has a right to find them
What are the 3 situations that you would use ICSI?
Severe male factor infertility
Previous failed fertilisation with IVF
PIGD
Where would you get sperm from for a sperm aspiration in obstructive and non-obstructive azoospermia?
Epididymis - if obstructive
Testicular tissue- if non-obstructive
TRUE/FALSE
ICSI has a higher success rate than IVF
FALSE
They both have a rate of 35%
if someone has a BBV what can be done in order to reduce the risk of transmission?
Can do sperm washing and then intra-uterine insemination
After how many cycles of IUI do you move onto IVF?
6 CYCLES
TRUE/FALSE
In stimulated cycle gonadotrophin during early follicular phase result in synchronised growth of all follicles
TRUE
In IVF how many follicles become dominant?
15
What are the 5 stages of IVF
1-Downregulation 2-Ovarian stimulation 3-Oocyte collection 4-Fertilisation 5-Embryo transfer
What are the SE of down regulation as part of IVF?
Hot flushes/ Mood swings
Nasal Irritation
Headaches
(as pushed into artificial menopause)
What is injected in IVF to cause ovarian stimulation?
HCG (mimics LH)
How long should there be semen abstinence prior to IVF?
72h but not 1 week+
At what stage are embryos transferred?
Blastocyst stage - day 5
What can be used as luteal support?
Progesterone suppositries
What drug can be used in PCOS to induce gonadotrophin release and stimulate ovulation?
Clomifene citrate
What is a serious complication of IVF?
Ovarian Hyper-Stimulation syndrome (OHSS)
Mild symptoms of OHSS
Abdo bloating and pain
Ovarian size <8cm
Severe symptoms of OHSS
Clinical ascites Oligouria Hyponatraemia Hypo-osmolarity Hyperkalaemia Hypoproteinuria
TRUE/FALSE
There is increased risk of ectopic pregnancy with IVF
TRUE
Incidence increase 2-3x with IVF
After what age does fertility start to decline?
28
