Infertility Flashcards
What is the WHO definition of infertility?
Failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse (in absence of known reason) in a couple who have never had a child.
What is primary infertility?
infertility in a couple who have never conceived.
What is secondary infertility?
couple previously conceived, although pregnancy may not have been successful e.g. miscarriage or ectopic
What are some factors with increase the chance of conception?
women <30 previous pregnancy <3 years trying to conceive intercourse occurring around ovulation woman's BMI 18.5-30 both partners non-smokers <2 cups coffee a day no recreational drug use
When are the physiological times when a female is infertile due to anovulation?
before puberty, pregnancy, lactation, menopause
what levels of FSH, LH and oestrogen would you see in an anorexic patient?
low FSH, LH and oestrogen
What levels of FSH, LH and oestrogen would you see in premature ovarian failure?
high FSH, high LH, low oestrogen
What are the symptoms of endometriosis?
dysmenorrhoea (classical before menstruation) dyspareunia menorrhagia (heavy) painful defaecation chronic pelvic pain infertility
What are some non-obstructive causes of male infertility?
47 XXY (Kleinfelter's) chemotherapy radiotherapy undescended testes idiopathic
What are the clinical features of non-obstructive male infertility?
low testicular volume
reduces secondary sexual characteristics
vas deferens present
what endocrine profile would you see in non-obstructive infertility?
high LH & FSH
low testosterone
What are some causes of obstructive male infertility?
congenital absence (cystic fibrosis), infecting, vasectomy
what are the clinical features of obstructive male infertility?
normal testicular volume, normal secondary sexual characteristics, vas deferent may be absent
What endocrine profile would you see in obstructive male infertility?
normal LH, FSH and testosterone
What investigations would you do to test a female patient’s fertility?
vulvo-vaginal swab (self-taken) or endocervical swab (if speculum examination) for chlamydia
smear if due
midluteal progesterone level
hysterosalpingogram (HSG) - tubal patency
Describe the midluteal progesterone level measurement.
Taken on day 21 of a 28-day cycle (or 7 days before expected period in prolonged cycles). If progesterone >30nmol/L then it is suggestive of ovulation.
When is a hysteroscopy performed?
only in cases where suspected or known endometrial pathology i.e. uterine septum, adhesions, polyp.
When would you perform a pelvic ultrasound?
when abnormality is felt on pelvic examination e.g. enlarged uterus/adnexal mass.
When required from other investigations, e.g. possible polyp seen at HSG
Which hormones/tests would you look for if a female patient had an anovulatory cycle or infrequent periods?
urine HCG prolactin TSH Testosterone and SHBG LH, FSH and oestrogen
What endocrine tests would you do if a male patient had abnormal semen analysis?
LH and FSH
testosterone
PRL
thyroid function
If a male patient had severely abnormal semen analysis/azoospermia, which tests would you do?
endocrine profile (as in abnormal semen)
chromosome analysis and Y chromosome micro deletions
screen for CF
testicular biopsy
What percentage of weight loss is recommended to overweight women who seek fertility advice?
5-10% weight loss
What is the typical folic acid recommendation?
400mcg daily before pregnancy and throughout the first 12 weeks
When would you recommend 5mg folic acid a day?
women who are planning a pregnancy / in early stages of pregnancy if they:
(or their partner) have a neural tube defect
have had a previous baby with a neural tube defect
(or their partner) have a FH of neural tube defects
have diabetes
