Infertility Flashcards
What is the definition of infertility?
No conception after one year of regular unprotected intercourse with no known cause
ARE EGGS AVAILABLE
ARE SPERM AVAILABLE
CAN THEY MEET
ARE EGGS AVAILABLE
ARE SPERM AVAILABLE
CAN THEY MEET
What are female causes of infertilifty?
- Ovulatory dysfunction
- Diminishing ovarian reserve
- Tubal factors
- Endometriosis
- Uterine factor
What can cause anovulation in a woman?
- Premature ovarian failure
- Turner’s syndrome
- Surgery/Chemo
- PCOS
- Excessive weight loss or exercise
- Hypopituitarism
- Kallman’s syndrome
- Hyperprolactinaemia
What are problems in sperm production that can occur in a man?
- Genetic
- Failure of testes to descend
- Infection
- Torsion
- Varicocele
- Drugs
- Radiation damage
- Heat
What problems can occur with erection and ejaculation that can lead to problems with infertility?
- Prostate surgery
- Damage to nerves
- Ejaculation problems
- Timing of intercourse
- Medication
What are causes of blockage of sperm transport which can cause infertility?
- Vasectomy
- Prostate problems
- Absence of vas deferens
What are the main things you would want to establish in a couple that are having problems conceiving?
- Are Eggs Available?
- Is Ovulation happening?
- Are sperm available?
- Are the tubes ok?
- Is the uterine cavity normal?
- Are there any other factors?
How would you determine if eggs are available in a woman who is struggling to conceive?
- 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
What would you be assessing when scanning a woman to see if there were eggs present?
Antral follicular count
What should FSH be when measuring baseline hormonal profile at day 1-5 of the cycle?
< 10 iu/L
How would you confirm ovulation was occuring?
- Mid-luteal phase progesterone levels
- LH ovulation kits
- Cervical mucus
How would you measure mid-luteal phase progesterone levels?
Measure 7 days before period is meant to start (day 21-28 of cycle)
What progesterone level indicate ovulation when mid-luteal phase progesterone levels are taken?
> 30 nmol/L
If there was no evident ovulation, what would you do?
Determine hormonal profile
What investigations would you consider doing to determine hormonal profile?
Taken D1-5 of menstrual cycle
- FSH
- LH
- Testosterone
- Prolactin
- Thyroid Profile
If a woman had high FSH and LH, what might this suggest as to the cause of anovulation?
- Hypergonadotrophic gonadism
- Ovarian cause
What might a high prolactin indicate as a cause of infertility?
Prolactinoma
What might a low FSH/LH indicate as a cause of infertility?
Hypogonadotrophic hypogonadism
- Hypothalamic/pituitary cause
What might normal FSH/LH indicate as a cause of infertility?
Normogonadotrophic normogonadism
- Ovarian dysfunction
- PCOS
What is normozoospermia?
Normal ejaculate
What is Oligozoospermia?
Reduced sperm count
What is asthenozoospermia?
Reduced sperm motility
What is teratozoospermia?
Reduced sperm morphology
What is azoospermia?
No sperm in ejaculate
What is aspermia?
No sperm
How would you investigate if a mans sperm is the cause of infertility?
Computerised semen analysis
What FSH levels mean in men?
If raised = testis problem
Normal FSH - blockage
Reduced FSH - pituitary problem
How would you check if a womans “tubes” are ok?
- Hysterpsalpingogram/HyCoSy - if no pelvic infection of gynae problem
- Laparoscopic dye test - if pelvic infection or gynae problem
If a woman was not ovulating due to PCOS, how would you manage them?
- Weight loss/gain
- Clomifine dictrate
- Gonadotrophins
- Consider metformin
- Laproscopic ovarian drilling
How does clomifene citrate work?
Anti-oestrogen - increases endogenous FSH via negative feedback to the pituitary. Therefore stimulates release of egg from ovary.
When are gonadotrophins used in treating infertility in PCOS?
For clomifene resistant PCOS
What is laparoscopic ovarian drilling?
Small holes are drilled into each ovary using needlepoint diathermy with the aim of reducing LH and restoring feedback mechanisms
What interventions are used for tubal disease in an attempt to restore fertility?
- Surgical - Tubal catheterisation
- IVF
What techniques can be used to manage infertility in endometriosis?
- Ablation/resection of spots
- Adhesiolysis
- Cystectomy
What are indications for IVF?
- Tubal disease
- Male factor subfertility
- Endometriosis
- Anovulation not responding to clomifene
- Subfertility due to maternal age
- Unexplained subfertility
What are examples of sources of eggs used for IVF?
- Own eggs
- Donor eggs
What does success of IVF depend on?
- Age
- Duration of subfertility
- Previous pregnancy
- Smoking
- Low BMI
What are the risks of IVF therapy?
- Ovarian hyperstimulation syndrome
- Multiple pregnancy
- Medication side effects
What criteria are used to determine if semen is normal?
WHO criteria 2009
- Volume > 1.5 ml
- Concentration > 15x106/ml
- Progressive motility >32%
- Total motility > 40%
- Normal forms >4%
What are causes of male infertility?
- Anabolic steroid abuse
- Alcohol abuse
- Haemochromatosis
- Drug-induced hyperprolactinaemia
- Kleinfelter’s syndrome
- Pituitary tumours
- Hypothalamic tumours
- Kallman’s syndrome
What investigations might you consider doing in a man with infertility?
- Bloods - LH, FSH, fasting glucose, iron studies, testosterone, LFTs
- Other - Urinary steroid, tox screen for cannabis
Define primary infertility
Unprotected sex >1 year + no history of pregnancy
Define secondary infertility
Unprotected sex >1 uear + history of pregnancy
