Infertility Flashcards
How is infertility defined?
Inability of a couple to conceive after 12 months of regular intercourse without use of contraception
Causes of infertility in women
PCOS Over/underactive thyroid Premature ovarian failure Scarring from surgery Fibroids Cervical mucus problems Endometriosis Pelvic inflammatory disease Sterilisation
Causes of infertility in men
A lack of sperm Sperm that aren't moving properly Abnormal sperm Testicular problems (eg cancer, infection etc) Sterilisation Ejaculation disorders Hypogonadism
Investigations at fertility clinic
Pelvic Ultrasound Physical examination Testing for ovulation Tubal patency test Semen analysis repeat if required
What should blood tests from women who are undergoing investigations for infertility be measuring? (regular cycle)
Serum progesterone in the mid luteal phase of their cycle to confirm ovulation
When is the mid-luteal phase of the menstrual cycle?
Day 21-28
What should be measured by blood test in women with irregular menstrual cycles?
Serum gonadotrophins (FSH and LH)
What is hysterosalpingography (HSG) used to screen for?
Tubal occlusion
What could increased body fat, decreased muscle mass and loss of pubic, axillary and facial hair in men suggest?
Androgen deficiency
What is one of the most common causes of primary hypogonadism with impaired spermatogenesis?
Klinefelter syndrome - characterised by sex chromosome aneuploidy
Often have very small testes and almost always have azoospermia
What is azoospermia?
When the semen contains no sperm
What are the three groups of ovulation disorders?
Group I
Group II
Group III
POI
Primary ovarian insufficiency
Group I ovulation disorders
Hypothalamic pituitary failure (hypothalamic amenorrhoea or hypogonadotrophic hypogonadism)
Group II ovulation disorders
Hypothalamic-pituitary-ovarian dysfunction (predominately polycystic ovary syndrome)
Group III ovulation disorders
Ovarian failure (POI)
Group I ovulation disorders treatment
Increasing body weight if BMI of less than19 and/or
moderating their exercise levels if undertake high levels of exercise
Pulsatile administration of gonadotrophin-releasing hormone or gonadotrophins with luteinising hormone activity to induce ovulation
What are the signs/symptoms of polycystic ovary syndrome?
Androgen excess (hirsutism/excess testosterone) Infrequent periods (anovulation) Polycystic ovaries (USS)
What is clomiphene?
Selective oestrogen receptor modulator - works similarly to oestrogen to stimulate ovulation in women who produce eggs but do not ovulate
What is endometriosis?
Where endometrium starts to grow in other places, such as ovaries and fallopian tubes
Causes of azoospermia
Testicular
Post testicular
Testicular causes of azoospermia
Normogonadotrophic
Hypogonadism
Hypergonadotrophic
Post testicular causes of azoospermia
Iatrogenic
Congenital
Infective
What is intracytoplasmic sperm injection?
Injection of mature eggs with single sperm
Incubation overnight
