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Gwen - Reproductive Medicine (Obs, Gyn, Breast) > Infertility > Flashcards

Infertility Flashcards

1
Q

What is the definition of infertility?

A

No conception after one year of regular unprotected intercourse with no known cause

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2
Q

ARE EGGS AVAILABLE

ARE SPERM AVAILABLE

CAN THEY MEET

A

ARE EGGS AVAILABLE

ARE SPERM AVAILABLE

CAN THEY MEET

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3
Q

What are female causes of infertilifty?

A
  • Ovulatory dysfunction
  • Diminishing ovarian reserve
  • Tubal factors
  • Endometriosis
  • Uterine factor
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4
Q

What can cause anovulation in a woman?

A
  • Premature ovarian failure
  • Turner’s syndrome
  • Surgery/Chemo
  • PCOS
  • Excessive weight loss or exercise
  • Hypopituitarism
  • Kallman’s syndrome
  • Hyperprolactinaemia
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5
Q

What are problems in sperm production that can occur in a man?

A
  • Genetic
  • Failure of testes to descend
  • Infection
  • Torsion
  • Varicocele
  • Drugs
  • Radiation damage
  • Heat
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6
Q

What problems can occur with erection and ejaculation that can lead to problems with infertility?

A
  • Prostate surgery
  • Damage to nerves
  • Ejaculation problems
  • Timing of intercourse
  • Medication
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7
Q

What are causes of blockage of sperm transport which can cause infertility?

A
  • Vasectomy
  • Prostate problems
  • Absence of vas deferens
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8
Q

What are the main things you would want to establish in a couple that are having problems conceiving?

A
  • Are Eggs Available?
  • Is Ovulation happening?
  • Are sperm available?
  • Are the tubes ok?
  • Is the uterine cavity normal?
  • Are there any other factors?
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9
Q

How would you determine if eggs are available in a woman who is struggling to conceive?

A
  • Determine Age
  • Ovarian reserve - Blood test and scan
    • FSH - D1-5 of cycle - <10 iu/L
    • AMH - 5.0-25.0 pmol/L
  • Scan - Antral follicular count
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10
Q

What would you be assessing when scanning a woman to see if there were eggs present?

A

Antral follicular count

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11
Q

What should FSH be when measuring baseline hormonal profile at day 1-5 of the cycle?

A

< 10 iu/L

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12
Q

How would you confirm ovulation was occuring?

A
  • Mid-luteal phase progesterone levels
  • LH ovulation kits
  • Cervical mucus
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13
Q

How would you measure mid-luteal phase progesterone levels?

A

Measure 7 days before period is meant to start (day 21-28 of cycle)

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14
Q

What progesterone level indicate ovulation when mid-luteal phase progesterone levels are taken?

A

> 30 nmol/L

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15
Q

If there was no evident ovulation, what would you do?

A

Determine hormonal profile

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16
Q

What investigations would you consider doing to determine hormonal profile?

A

Taken D1-5 of menstrual cycle

  • FSH
  • LH
  • Testosterone
  • Prolactin
  • Thyroid Profile
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17
Q

If a woman had high FSH and LH, what might this suggest as to the cause of anovulation?

A
  • Hypergonadotrophic gonadism
  • Ovarian cause
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18
Q

What might a high prolactin indicate as a cause of infertility?

A

Prolactinoma

19
Q

What might a low FSH/LH indicate as a cause of infertility?

A

Hypogonadotrophic hypogonadism

  • Hypothalamic/pituitary cause
20
Q

What might normal FSH/LH indicate as a cause of infertility?

A

Normogonadotrophic normogonadism

  • Ovarian dysfunction
  • PCOS
21
Q

What is normozoospermia?

A

Normal ejaculate

22
Q

What is Oligozoospermia?

A

Reduced sperm count

23
Q

What is asthenozoospermia?

A

Reduced sperm motility

24
Q

What is teratozoospermia?

A

Reduced sperm morphology

25
Q

What is azoospermia?

A

No sperm in ejaculate

26
Q

What is aspermia?

A

No sperm

27
Q

How would you investigate if a mans sperm is the cause of infertility?

A

Computerised semen analysis

28
Q

What FSH levels mean in men?

A

If raised = testis problem

Normal FSH - blockage

Reduced FSH - pituitary problem

29
Q

How would you check if a womans “tubes” are ok?

A
  • Hysterpsalpingogram/HyCoSy - if no pelvic infection of gynae problem
  • Laparoscopic dye test - if pelvic infection or gynae problem
30
Q

If a woman was not ovulating due to PCOS, how would you manage them?

A
  • Weight loss/gain
  • Clomifine dictrate
  • Gonadotrophins
  • Consider metformin
  • Laproscopic ovarian drilling
31
Q

How does clomifene citrate work?

A

Anti-oestrogen - increases endogenous FSH via negative feedback to the pituitary. Therefore stimulates release of egg from ovary.

32
Q

When are gonadotrophins used in treating infertility in PCOS?

A

For clomifene resistant PCOS

33
Q

What is laparoscopic ovarian drilling?

A

Small holes are drilled into each ovary using needlepoint diathermy with the aim of reducing LH and restoring feedback mechanisms

34
Q

What interventions are used for tubal disease in an attempt to restore fertility?

A
  • Surgical - Tubal catheterisation
  • IVF
35
Q

What techniques can be used to manage infertility in endometriosis?

A
  • Ablation/resection of spots
  • Adhesiolysis
  • Cystectomy
36
Q

What are indications for IVF?

A
  • Tubal disease
  • Male factor subfertility
  • Endometriosis
  • Anovulation not responding to clomifene
  • Subfertility due to maternal age
  • Unexplained subfertility
37
Q

What are examples of sources of eggs used for IVF?

A
  • Own eggs
  • Donor eggs
38
Q

What does success of IVF depend on?

A
  • Age
  • Duration of subfertility
  • Previous pregnancy
  • Smoking
  • Low BMI
39
Q

What are the risks of IVF therapy?

A
  • Ovarian hyperstimulation syndrome
  • Multiple pregnancy
  • Medication side effects
40
Q

What criteria are used to determine if semen is normal?

A

WHO criteria 2009

  • Volume > 1.5 ml
  • Concentration > 15x106/ml
  • Progressive motility >32%
  • Total motility > 40%
  • Normal forms >4%
41
Q

What are causes of male infertility?

A
  • Anabolic steroid abuse
  • Alcohol abuse
  • Haemochromatosis
  • Drug-induced hyperprolactinaemia
  • Kleinfelter’s syndrome
  • Pituitary tumours
  • Hypothalamic tumours
  • Kallman’s syndrome
42
Q

What investigations might you consider doing in a man with infertility?

A
  • Bloods - LH, FSH, fasting glucose, iron studies, testosterone, LFTs
  • Other - Urinary steroid, tox screen for cannabis
43
Q

Define primary infertility

A

Unprotected sex >1 year + no history of pregnancy

44
Q

Define secondary infertility

A

Unprotected sex >1 uear + history of pregnancy

Gwen - Reproductive Medicine (Obs, Gyn, Breast) (49 decks)

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