Infertility Flashcards
what are the 3 types of ovulatory disorders?
hypothalamic-pituitary failure
hypothalamic-pituitary-ovarian dysfunction
ovarian failure
what condition is caused by hypothalamic pituitary ovarian dysfunction?
polycystic ovarian syndrome
what medication is given to stimulate ovulation in people with ovulatory disorders?
clomifene gonadotrophin (FSH injection)
what are the side effects of clomifene?
vasomotor
visual
what is the role of clomifene and how does it work?
stimulates ovulation by blocking the oestrogen receptor in the anterior pituitary therefore increasing release of LH and FSH
what are the main causes of infertility in females?
BMI (<19 or >25) PCOS congenital adrenal hyperplasia androgen secreting tumour acromegaly cushings hydrosalpinx tumours uterine septum cervical abnormalities fibroids pelvic distortion
what investigation i carried out to visualise the uterus, cervix and fallopian tubes?
hysterosalpingraphy
what is hydrosalpinx?
tubal occlusion
how is infertility by hydrosalpinx treated and can they get pregnancy after?
salpingectomy then gives IVF
a female patient comes to the clinic with irregular periods and infertility as she has been trying for a baby for 2 years.
what blood test would you carry out?
FSH, LH, prolactin, testosterone and TSH levels at day 1-5 of her cycle
a patient presents to the clinic with regular periods but cannot conceive after trying for 2 years.
what blood tests would you carry out?
progesterone levels at mid-luteal phase of cycle (day 21-25) to confirm ovulation
a low BMI causes what type of ovulation disorder and how would you manage/treat?
hypothalamic-pituitary disorder
advise on weight gain - BMI >19
give pulsatile administration of GnRH or GnRH with LH activity to stimulate ovulation
what are the main causes of infertility in males?
BMI epididymitis varicocele congenital bilateral absence of vas deferens / CF primary hypogonadism i.e. kleinfelters
how is sperm retrieved for IVF?
micro-epididymal sperm aspiration
testicular sperm extraction
if its a male problem which is preventing the couple from getting pregnant, what methods of fertility can be offered to overcome the problem ?
IVF
intra-uterine insemination
surgery - sperm retrieval
donor insemination
what questions would you ask in a fertility history of a male?
developmental: testicular decent , change in body hair
infections: STD’s (gonorrhoea, chlamydia), mumps
surgical: vasectomy, varicocele surgery
previous fertility
what STD’s are associated with infertility in males and females? how?
gonorrhoea and chlamydia
they can cause pelvic inflammatory disease in females and epididymitis in males
what is kleinfelters syndrome?
primary hypogonadism
karyotype with extra X chromosome i.e. XXY
cause of infertility in males
why does CF cause infertility in males?
bilateral absence of vas deferens
what are the causes of epididymitis and how does this cause infertility?
STD’s (gonorrhoea and chlamydia)
mumps
TB
causes seminiferous tubular necrosis and disrupts spermatogenesis
what is varicocele and how can it lead to infertility?
abnormal dilatation and distortion of pampiriform plexus of the scrotum
the enlarged veins can damage the sperm and lower sperm count
what investigations would you carry out if you suspected azoospermia?
history and examination
FSH, LH, testosterone, karyotype, PRL
CF screen
what is the presentation of polycystic ovarian syndrome?
hirsutism infertility irregular periods acne hypertension overweight/obese scalp hair loss
what investigations would you carry out if you suspected PCOS?
serum total and free testosterone serum TSH serum prolactin serum dehydroepiandrogen sulphate (DHEAS) pelvis USS
what are the signs of PCOS on USS?
> 20 follicles which typically encircle the periphery of the ovaries, 2-9mm in diameter
ovarian volume > 10ml
endometrial lining > 5-7cm
what criteria is used for diagnosing PCOS?
Rotterdam
what is involved in the Rotterdam criteria for PCOS?
2 or more of the following:
hyperandrogegism / hyperandrogenaemia
ano/oligo ovulation
polycystic ovaries on USS
what are the complications of PCOS?
infertility hypertension CVD type 2 diabetes psychosocial complications endometrial hyperplasia or cancer OSAS NAFLD
what is the first line treatment for PCOS if they want to get pregnant?
weight loss
+ metformin
clomifene (+dexamethasone)
what are the 2nd and 3rd line treatments for someone with PCOS if they want to get pregnant?
2nd line: gonadotrophin
3rd line: laparoscopic ovarian drilling , IVF
what treatment is given to reduce/reverse symptoms of hyperandrogegism in PCOS?
combined oral contraceptive pill
