Infertility Flashcards
What is infertility?
The inability of a couple to conceive after 12months of regular intercourse without the use of contraception.
What must be covered in a female history during an infertility consultation?
Duration of infertility Previous contraception Fertility in previous relationships Previous pregnancies/complications Menstrual history Medical and surgical history Sexual history Previous investigations Psychological assessment
What should be involved in a female examination when investigating infertility?
Weight Height BMI Fat and Hair distribution Galactorrhoea Abdominal examination Pelvic examination
What is a more serious cause of hirsutism?
Androgen secreting tumours - ovarian or adrenal.
If Dehydroepiandrosterone sulphate is greater than 700mcg/dL then adrenal CT is recommended to look for tumours.
They are rare especially in premenopausal women however when found most are already malignant.
What is a sign if androgen excess?
Acanthosis nigricans -
darkening of under arms, dark line on back of neck.
What are you looking for during a pelvic examination?
Masses e.g uterine fibroids, enlarged Fallopian tubes etc Pelvic distortion Tenderness Vaginal septum Cervical abnormalities
What are some signs of fibroids?
Pressure symptoms
Period problems
Infertility
What are some baseline investigations for testing the female partner’s fertility?
Rubella immunity
Chlamydia
TSH
If periods are regular - mid luteal progesterone (7days prior to expected period).
If irregular periods then do a day 1-5 FSH, LH, PRL, TSH , Testosterone
What are some baseline investigations when testing the male partner’s fertility?
Semen analysis
What is Hysterosalpingography?
Radiological procedure to examine the shape of the uterine cavity. It uses a dye to look at the womb and Fallopian tubes.
Good for screening for tubal occlusion.
What is Hysterosalpingo-contrast-sonography? (HyCoSy)
Ultrasound procedure of the female reproductive system. Used to diagnose structural defects. Fluid is inserted into Fallopian tubes to provide a contrast medium.
What is involved in a male fertility examination?
Weight Height BMI Fat and Hair distribution Abdominal and inguinal examination Genital examination of epididymis, testes, vas deferent and varicocele if present.
What are some conditions that cause epididymitis?
Chlamydia trachoma’s
Gonorrhoea
Tuberculosis
Mumps
Causes seminiferous tubular necrosis and disrupts spermatogenesis.
What is a Varicocele?
Dilation of the pampiniform plexus of the spermatic veins in the scrotum.
How may a varicocele affect male fertility?
Normally have abnormal semen parameters, including low sperm concentration.
Should not be offered surgery for varicoceles as fertility treatment as it does not improve pregnancy outcomes.
Why is a varicocele more common in the left testicle?
On right side the internal spermatic vein drains directly into IVC. On left side the left internal spermatic vein drains at a right angle into horizontal left renal vein. The left adrenal vein also does this. This results in further retrograde flow in the left internal spermatic vein causing dilatation and tortuosity of the pampiniform plexus.
What is Klinefelter syndrome?
Sex chromosome aneuploidy with an extra X (XXY) chromosome being the most frequent. It is one of the most common causes of primary hypogonadism with impaired spermatogenesis and testosterone deficiency.
Often present with very small testes and azoospermia (semen contains no sperm).
What are the lower laboratory reference values for semen?
Semen volume - 1.5ml Sperm conc. - 15million/ml Total sperm number - 39 million Progressive motility - 32% Total motility - 40% Morphologically Normal - 4%
When do you refer someone for fertility treatment?
After 1 year of trying if <35years
After 6months if 35-45yrs
After >45yrs little can be offered.
If a problem is found.
What are the different groups of ovulatory disorders?
Group I- hypothalamic pituitary failure (hypothalamic amenorrhoea or hypogonadotrophic hypogonadism)
Group II - Hypothalamic-pituitary ovarian dysfunction (polycystic ovary syndrome)
Group III - ovarian failure (premature ovarian insufficiency).
What advice can you give women with Group I disorders so they can improve their fertility?
Increasing or decreasing their body weight to a healthy size.
Moderating their exercise if they are undertaking high levels.
Pulsatile administration of gonadotropin-releasing hormone or gonadotrophin with LH activity to induce ovulation.
What is Polycystic Ovary Syndrome?
Set of symptoms due to elevated androgens in females, results in multiple cysts developing in the ovaries.
What are the symptoms of PCOS?
Irregular or no menstrual periods. Heavy periods Acne Pelvic pain Excess body and facial hair Polycystic ovaries on Ultrasound.
What are some medications that help induce ovulation?
Gonadotrophins
Clomifene - binds to oestrogen receptors to block the so more FSH will be released.
Gonadotrophic releasing hormone.
What are hydrosalpinges?
Fallopian tube becomes blocked and fill with a serous fluid near the ovary. Tube may become distended overtime.
How are hydrosalpinges treated?
Salpingectomy preferably by laproscopy.
What is the access criteria for NHS IVF treatment in Scotland?
Both partners must not have children.
BMI <30
Both must be non smokers
Both must not have had any sterilisation procedures.
When are artificially fertilised embryos inserted into the womb?
The best is picked on day 5.
If there is only one good one put it back asap (day 2). If there is a few but not that great then put back day 3.
Why is there an increase in IVF treatment?
More single women
More same sex couples
More older women
More obese patients
