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Repro > Infertility > Flashcards

Infertility Flashcards

1
Q

define infertility

A

inability for the couple to conceive after 12 months of regular intercourse without the use of contraception

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2
Q

what percentages of couple are able to conceive within a year if the woman is <40?

A

80%

them half of the 20% will conceive the next year

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3
Q

when should you refer a couple for infertility?

A 
in a year unless
> anxiety
> HIV/HEPB
> testicular problems
> period irregularity
> 45years<
> 35-45 years after 6 months
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4
Q

when assessing infertility what do you want from the female history?

A 
> previous contraception
> duration of infertility
> fertility in previous relationships
> previous pregnancy and complications
> sexual history
> menstrual timing
> previous investigations
> medical and surgical history
> psychological assessment
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5
Q

what should you look for when examining the female?

A 
> weight
> height
> fat and hair distribution
 - acanthosis nigrans
 - hirsutism
> galactorrhoea
> abdominal examination
> pelvic examination
 - masses
 - pelvic distortion
 - tenderness
 - vaginal septum
 - cervical abnormalities
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6
Q

what biochemical tests would you carry out if you thought hirsutism was a diagnosis?

A

> testosterone levels
progesterone levels
BIEAs (>700 CT adrenal)

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7
Q

what investigations would you carry out in a female when assessing infertility?

A 
> pelvic US
> tubal and interuterine abnormalities
 - hysterosalpingography
 - laparoscopy
> testing ovulation
 - serum progesterone midluteal phase 
> TSH
> chlamydia
> rubella immunity
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8
Q

if periods are regular describe what investigations would be carried out?

A

> serum progesterone mid luteal phase on day 21 to 28 cycle

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9
Q

if periods are irregular what investigations would be carried out?

A 
> serum progesterone mid luteal phase later in cycle then repeated weekly until next cycle
> day 1-5
 - TSH
 - testosterone
 - FSH
 - LH
 - prolactin
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10
Q

what information would you want from the male history?

A 
> developmental 
 - testicular descent
 - loss of body hair
> infection
 - mumps
 - STI
> surgical
 - varicocele
 - vasectomy
> previous fertility
> environment
 - alcohol
 - smoking
 - anabolic steroids
 - chemotherapy
 - radiation
 - recreational drugs
> sexual history
> chronic illness and medication
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11
Q

what would you examine in the male?

A 
> weight
> height
> fat and hair distribution
> abdo. exam
> inguinal exam
> genital exam
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12
Q

what would you exam in the male genital exam for infertility?

A

> epididymitis
varicocele
testicular size
vas-deferens

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13
Q

what may epididymitis indicate?

A

> chlamydia

> gonorrhoea

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14
Q

what are the effects of varicocele?

A

can lead to abnormal semen parameters

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15
Q

what is varicocele?

A

dilation of the pompiniform plexus of spermatic veins in scrotum

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16
Q

what is Klinefelter syndrome?

A 
> sex chromosome aneuploidy
> primary hypogonadism
 - testosterone deficiency
 - impaired spermatogenesis
> small testes
17
Q

what pathology in the vas deferens can affect fertility?

A

> congenital bilateral absence of vas deferens

> CF mutations

18
Q

what can cause infertility?

A

> ovulatory disorders
tubal factor and endometriosis
azoospermia
unexplained

19
Q

what causes group 1 ovulatory disorders?

A

hypothalamic ammenorhea

20
Q

what management is there for type 1 ovulatory disorders?

A

> increasing BMI if <19
GHRH
gonadotrophins with luteinising hormone activity

21
Q

what causes group 2 ovulatory disorder?

A

> hypothalamic pituitary failure
androgen excess
infrequent periods
polycystic ovaries

22
Q

what is group 3 ovulatory disorder?

A

ovarian failure

23
Q

how are ovulatory disorders managed?

A

> weight loss of gain so BMI is over 18 and under 35
treatment of the underlying cause
50-12mg of clomifene
gonadotrophin (FSH by injection)

24
Q

what monitoring is needed with clomifene?

A

follicular scanning in the first cycle

25
Q

what are the side effects if clomifene?

A

> vasomotor

> visual

26
Q

what can gonadotrophin management cause?

A

> multifollicular recruitment

27
Q

what tubal factors can cause infertility?

A

hydrosalpinges

28
Q

how are hydrosalpinges managed?

A

salpingectomy

29
Q

what investigations would you carry out in azoospermia?

A

> CF secretion
testosterone
FSH
prolactin

30
Q

what management is there for azoospermia?

A

surgical sperm retrieval
> testicular sperm extraction
> micro-epididymal sperm extraction

31
Q

what management can be offered in unexplained infertility?

A

IVF after 2 years of trying

32
Q

what infertility causes can be given IVF?

A

> tubal
male
ovulation
unexplained

33
Q

describe IVF

A

the oocyte is injected with single sperm and is incubated for 5 days

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