Infertility Flashcards
how many couple present with infertility
1 in 6 couples
why is infertility increasing in incidence (3)
increasing paternal age
chlamydia
more same sex couples
infertility definition
failure to achieve pregnancy after 12 months of regular unprotected sex in a couple who have never had a child
what is the difference between primary and secondary infertility
primary infertility - couple never conceived
secondary infertility - couple who have conceived but pregnancy unsuccessful (miscarriage or ectopic)
hypothalamic causes of hypogonadotropic hypogonadism = causing infertility (4)
anorexia/excessive exercise
kallmans syndrome
stress
drugs
pituitary causes of hypogonadotropic hypogonadism = causing infertility (3)
hyperprolactinaemia
sheehans syndrome (hypopituitarism cause by hypovolaemic shock after PPH)
pituitary tumours
ovarian causes of infertility (3)
PCOS
POF
endometriosis
tubal causes of infertility (3)
chlamydia - causes PID
hydrosalpinx - fluid dilatation of fallopian tubes
endometriosis - narrows tube
4 potential areas of problem causing infertility in women
hypothalamus
pituitary
ovaries
fallopian tubes
apart from drugs and idiopathic causes, where can the problem be in men with infertility (3)
pre testicular
testicular
post testicular (obstructive)
causes of pretesticular infertility (4)
pituitary problem = hyperprolactinaemia
kallmans syndrome
anorexia
steroid abuse
testicular causes of infertility (4)
kleinfelters syndrome (XXY) = testicular failure
varicocele
cryptorchidism (undescended testes)
chemo/radio
post testicular (obstructive) causes of infertility
ejaculatory gland obstruction
erectile dysfunction
vasectomy
absence of vas deferens (cystic fibrosis)
investigations for female infertility
chlamydia screen - endocervical swab
baseline hormone profile (menstruation cycles)
pelvic exam/US (for PCOS/abnormal growths)
tubal patency tests - hysterosalphingogram (HSG)
what is a hysteroslaphingogram (HSG)
contrast inserted into uterine cavity + xray takento look at patency of fallopian tube s(fluid should leak out into peritoneal cavity
investigations for male infertility
chlamydia screen - first pass urine sample testes size (compare to beads) semen analysis (sperm count)
normal size of testes
12-25ml
what is azoospermia
no sperm
what are you looking for in semen analysis
semen volume sperm concentration sperm morphology WBC sperm motility
how long must a male abstain for before a semen analysis
abstain from sex for 3 days
if semen analysis is abnormal what do you do
endocrine profile - LH, FHS, testosterone, prolactin, TFTs
what is oligoasthenospermia
low count and low mobility sperm
what is teratoosthenospermia
low count and abnormal form of sperm
first line treatment for infertility
how many people is this effective for
lifestyle advice!!
increase sexual intercourse - for 6 days before ovulation lose/gain weight (BMI 18.5-30) stop smoking reduce alcohol reduce coffee
effective for half of infertile people!
second line treatment (if lifestyle modification doesn’t work) for male infertility (3)
donor sperm
intrauterine sperm insemination
intracytoplasmic sperm injection
what can you give a male with infertility caused by hyperprolactinaemia
cabergoline
when would you used intrauterine sperm insemination/intracytoplasmic sperm injection
failed IVF
difference between intrauterine sperm insemination and intracytoplasmic sperm injection
IUSI - sperm inserted into uterus
ICSI - sperm injected straight into egg, then into uterus?
usually males can ejaculate their own sperm used for IUSI/ICSI, what are the alternatives if they cant (2)
surgical sperm aspiration
donor sperm
second line treatment (if lifestyle modification doesn’t work) for female infertility (4)
IVF
surrogacy - another female carries baby
egg donation
HRT
which hormone is used to assess ovarian reserve prior to IVF
anti Mullerian hormone (AMH)
IVF process (3)
semen and egg both collected
egg fertilization in lab
embryo implanted in uterus
when can you use HRT for infertility
if hypothalamic/pituitary problem (not if ovarian/tubal problem)
which hormones can be give in HRT for infertility
GnRH
LH and FSH
dependent on if problem is hypothalamic/pituitary
complications of HRT
ovarian hyperstimulation syndrome (OHSS) = swollen - ascites
what is a heterotopic pregnancy
when is there an increased risk for this
2 pregnancies - 1 in uterus 1 ectopic
IVF risk factor