Infertility Flashcards
How is infertility defined?
Inability to conceive after 12 months of regular intercourse with no use of contraception
Should people having fertility problems be seen alone or with their partner and why?
With their partner because decisions made will impact both patients
What are the chances of conception?
80% of the general population will conceive within one year and of those who do not conceive within one year half will do so in the second year
What are important factors to consider for infertility?
Are eggs available?
Are sperm available?
Can they meet?
Can embryo implant?
What questions should be asked of women who are concerned about infertility?
Duration of infertility Previous contraception Fertility in previous relationships Previous pregnancies and complications Menstrual history Medical and surgical history Sexual history Previous investigations Psychological assessment
What aspects should be examined in female patients?
Weight Height BMI Fat and hair distribution Galactorrhoea Abdo examination Pelvic examination
What is hirsutism?
Growth of body hair in women where it wouldn’t normally be expected to grow ie chest hair
What are common causes of hirsutism?
Androgen-secreting tumours
Ovarian hyperthecosis
What is acanthosis nigricans?
Dark discolouration in body folds and creases
What is acanthosis nigricans a sign of?
Androgen excess
What should be felt for in pelvic examination?
Masses Pelvic distortion Tenderness Vaginal septum Cervical abnormalities
What symptoms might a woman with fibroids experience?
Pressure symptoms
Period problems
Infertility
What are baseline investigations if a woman presents with infertility concerns?
Rubella immunity Chlamydia TSH Mid luteal progesterone if periods are regular Semen analysis of male partner
What investigations can be done at the fertility clinic?
Pelvic ultrasound Physical examination Testing for ovulation Semen analysis repeat if required Tubal patency test
How is ovulation assessed?
In women with regular periods - blood test to measure mid-luteal serum progesterone
Irregular periods should be offered a blood test to measure serum gonadotrophins
What is done to assess for structural abnormalities of the uterus and tubes?
Hysterosalpingography - HSG
What questions should be asked of male patients concerned about infertility?
Testicular descent Change in shaving frequency Loss of body hair History of mumps STDs Surgical history - varicocele repair or vasectomy Previous fertility Alcohol, smoking Chemotherapy Radiation Libido Frequency of intercourse Any chronic illness
What should be done on examination of a male patient?
Weight Height BMI Fat and hair distribution Abdominal and inguinal examination Genital examination - epididymis, testes, vas deferens, varicocele
What is a varicocele?
Dilatation of pampiniform plexus of the spermatic veins in the scrotum
What is klinefelter syndrome?
Primary hypogonadism caused by XXY chromosome - patients normally have very small testes
What are the three groups of ovulatory disorder?
Group I - hypothalamic pituitary failue
Group II - hypothalamic-pituitary-ovarian dysfunction
Group III - ovarian faiure
How can women with group I ovulatory disorders improve chance of regular ovulation?
Increasing body weight if they have a BMI<19
Moderate exercise if undertaking high levels of exercise
Offer pulsatile administration of gonadotrophin releasing hormone
What are signs and symptoms of PCOS?
Androgen excess
Infrequent periods
Polycystic ovaries
What are general methods to improve ovulatory disorders?
Treat underlying causes
Weight loss/gain to keep BMI between 18 and 35
Ovulation induction with clomifene or gonadotrophins
How should a women with hydrosalpinges be treated?
Surgery - salpingectomy
What is azoospermia?
Semen production with no sperm in it
What are investigations for azoospermia?
History and examination
FSH,LH,testosterone
Cystic fibrosis screen
What is the lowest normal level of semen volume in men?
1.5ml
What is the lowest normal sperm concentration?
15 million/ml
What is the lowest normal total sperm number?
39 million
What is the lowest normal percentage of morphologically normal sperm?
4%
How should women with unexplained fertility be managed?
Advise them to try for 2 years
Inform that clomifene as a stand-alone trearment doesn’t increase chances of pregnancy or live birth
Offer IVF after 2 years
What happens in IVF?
Eggs are harvested from the ovary
Eggs are fertilised in the lab with sperm
Embryos undergo cell divisions
Embryos transferred to womb
