Infertility Flashcards

1
Q

What is the definition of infertility?

How many couples suffer from this

A

Failure to achieve a pregnancy after 12 months or mor of regular unprotected sexual intercourse.

1/5 couples deal with this

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2
Q

Primary vs secondary infertility

A
  • Primary: not previously been pregnant and struggling now
  • Secondary: Struggling now but have had one or more previous pregnancies
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3
Q

What are the proportional causes of the infertility issues

A

Female Factors: 60%

  • Disorders of the fallopian tubes and/or endometriosis
  • Disorders of ovulation

Male Factors: 25%

  • seminal abonormalities

Both male and female: 15%

Unexplained: 20-30%

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4
Q

Female factors that make up for infertility account for ~60% of the aetiology. Of this disorders of the fallopian tube and ovulation are common. What specific types of issues can occur?

A

Ovulation Failure:

  • PCOS (85%)
  • hypothalamic amenorrhoea
  • ovarian failure

Tubal Disease:

  • PID
  • Peritonitis
  • Pelvic adhesions following bowel/pelvic surgery

Endometriosis:

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5
Q

After one episode of PID ___% of women are female and after three episodes ____%

A

After one episode of PID 10% of women are female and after three episodes 50%

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6
Q

anatomical and sperm reasons for an infertile male?

A

Anatomical:

  • Congenital/acquired disease of hypothalamus or pituitary
  • Cryptorchidism (undescended testes)
  • Genetic abnormalities (Klinefelters)
  • Surgery/trauma

Sperm:

  • Abnormal spermatogenesis (2° to mumps, orchitis, chromosomal abnormalities, chemical/radiation exposure)
  • oligospermia/azoospermia
  • abnormal morphology or motility
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7
Q

What is Fecundity? How is it measured

A

Capacity to concieve. Measured in a monthly probability of conception.

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8
Q

Average monthly chance of conceiving in normal fertile couples is ____

Average duration for fertile couple to conceive is ___

A

Average monthly chance of conceiving in normal fertile couples is 20%

Average duration for fertile couple to conceive is 3 months

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9
Q

What on examination of a women could indicate potential infertility?

A

General:

  • Increased BMI
  • Fat distribution central adiposity an indication of insulin resistance
  • Short stature, webbed neck Turner’s
  • Incomplete secondary sexual characteristics; hypogonadism
  • Hirutism . PCOS

Abdominal Exam:

  • scars, masses, tenderness

PV Exam:

  • Tenderness in adexae . PID
  • Palpable tender nodules . Endometriosis
  • Vaginal/cervical abnormalities . Mullerian Abnormality
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10
Q

What on examination of a man could indicate infertility?

A
  • General observations. Vital signs, BMI. Presence of secondary sexual characteristics (hair distribution, muscle mass, adiposity)
  • Gynaecomastia
  • Abdomen or inguinal: scars from previous surgery
  • External genital examination
    • Scars, penis (position of meatus),
  • Scrotum:
    • testicular size (Prader orchidometer), consistency, presence of masses, location
    • epididymis: induration, engorgement, cyst
    • spermatic cord: presence of varicocele
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11
Q

What investigations do you want to do on a female with suspected infertility?

A
  • Full antenatal blood screen
    • Rubella, syphilis, HIV
    • Assess immunity to varicella if not positive history
    • Hepatitis B antigen (HBsAg), hepatitis C antibodies, HIV status
  • STI swab for chlamydia and gonorrhoea
  • HbA1c
  • Cervical smear
  • AMH level
  • Day 2-4 of cycle: FSH level and oestrodiol levels
  • Hormones
    • Progesterone (mid luteal rise > 30mmol/L in 3 cycles, 6-8 days before period Ovulation >20nmol/l) If variable more then one measurement may be needed
    • Testosterone
    • LH (elevated days 2-5)
    • FSH • LH:FSH ratio (elevated in PCOS)
    • Thyroid (hypothyroidism)
    • Prolactin (produced by pituitary, increased levels interferes with ovarian function)
  • USS • View follicle development or change to secretory endometrium.
  • Laparoscopy/hysterosalpingogram • Assess tubal patency
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12
Q

What does the AMH level measure?

A

Ovarian reserve

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13
Q

What investigations could you do on a male with suspected infertiility?

A
  • Semen Analysis: if abnormal repeat 4-6 weeks later
  • Severe oligospermia/azoospermia
  • Hep B antigen (HBsAg), hepatitis C antibodies, HIV status
  • Scrotal ultrasonography
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14
Q

How/when should you collect a semen sample?

A

Best collected via masturbation following 3 days of abstinenece and taken to labtests within 1hour of collection

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15
Q

What are the indications for Scrotal USS

A

Indicated in patients with infertility + risk factors for testicular cancer

Also do a transrectal USS if obstructive azoospermia is suspected.

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16
Q
A