Infertility Flashcards
Define infertility
Inability of a couple to conceive after 12 months of regular intercourse without use of contraception
How common is infertility?
1 in 7 couples report infertility problems
80% of couples in the general population will conceive within 1 year if…
The woman is <40y and they do not use contraception & have regular sexual intercourse
Of those who do not conceive in the first year, about a half will do so in the second year
After how long of trying with regular intercourse, not using protection do we investigate if the couple are struggling to conceive?
1 year
What are the main questions you should ask yourself if a couple are struggling to conceive?
Are eggs available?
Are sperm available?
Can they meet?
Can embryo implant?
What questions should you ask in the female infertility hx?
Duration of infertility Prev contraception Fertility in prev relationships Prev pregnancies and complications Menstrual hx Medical & surgical hx Sexual hx Prev investigations Psychological assessment
What should you examine a female for presenting with infertility?
Weight, height, BMI Fat and hair distribution (hirsutism may indicate PCOS, cushings, acromegaly) Galactorrhoea Abdominal examination Pelvic examination
What score can you use to assess androgen xs?
Ferriman Gallwey score
What biochemical tests can you do to measure suspected androgen xs?
Testosterone
DHEAS - if >700mcg/dL do CT of adrenals to check for androgen-secreting tumour
17-OH progesterone
Apart from hirsutism what is another sign of androgen xs?
Acanthosis nigricans
What are you feeling for in pelvic examination?
Masses Pelvic distortion Tenderness Vaginal septum Cervical abnormalities
What is the classic triad of fibroid symptoms?
Pressure symptoms
Period problems
Infertility
What are your baseline investigations for infertility?
Female -
Rubella immunity, chlamydia, TSH, if periods regular - midluteal progesterone (7 days prior to expected period)
If periods irreg do day 1-5 FSH, LH, PRL, TSH, testosterone
Male partner semen analysis
Why do you measure midluteal progesterone?
If they have ovulated their progesterone should be high as they would have made a corpus luteum
Why would you want to measure TSH in an infertile woman?
In hypothyroidism TSH release is increased so there is increased prolactin production and this inhibits GnRH, leading to lower oestrogen levels & no ovulation
What investigations can you do on an infertile lady?
Pelvic USS
Physical Rx
Testing for ovulation
Tubal patency test
How do you assess ovulation?
Ask about frequency & regularity of menstrual cycles
Those with regular monthly menstrual cycles are likely to be ovulating
Women should be offered a blood test to measure serum progesterone in the mid-luteal phase of their cycle (day 21-28) to confirm ovulation even if they have regular cycles
Woman with irregular cycles should be offered the same as above (may need to adjust timing & repeat weekly until the menstrual cycle starts) & should be offered LH and FSH measurement
Who should be offered test for tubal patency & uterine abnormalities?
Women who are not known to have cormorbs (e.g. PID, prev. ectopic, endometriosis) should be offered hysterosalphingography to screen for tubal occlusions
Can do HyCoSy (HSG with contrast) or laparoscopy
What should you ask in male hx of infertility?
Developmental - testicular descent, change in shaving frequency, loss of body hair
Infections - mumps, STIs
Surgical - variocele repair, vasectomy
Prev. fertility
Drugs, alcohol, smoking, anabolic steroids, chemo, radiation
Sexual hx - libido, freq. of intercourse
Any chronic illness
What is involved in male examination of infertility?
Wt, height, BMI
Fat and hair distribution (hypoandrogenism)
Abdominal & inguinal examination
Genital examination - epididymis, testes, vas deferens, varicocele
What may cause epididymitis?
STDs - chlamydia trachomatis, gonorrhoea
(causes ST necrosis & disrupts spermatogenesis)
TB and mumps can also cause
