Infertility Flashcards
What is infertility?
The inability of a couple to conceive after 12 months of regular intercourse without the use of contraception
What are the chances of conception?
80% of couples in the general populaiton will concieve within 1 year if :the woman is aged under 40 years and they have regular sex
What key information are you wanting to find out from the infertility consultation?
Are eggs available?
Are sperm available?
Can they meet?
Can an embryo implant?
What questions do you want to ask the woman abut female fertility
Duration of infertility? Previous contraception Fertility in previous relationships Previous pregnancies and complications Menstrual history Medical and surgical history Previous investigations Psychological assessment
What examinations do you carry out on the female?
Weight Height BMI Fat and hair distribution Galactorrhoea Abdominal examination Pelvic examination
What is androgen excess?
How do you measure androgen excess?
increased male hormones in woman leading to increased hair distribution and acanthosis nigricans
Ferriman gallwey score (hair distribution) through testosterone levels, DHEAS greater than 700mcg/dL Adrenal CT 17-OH progesterone
What is assesed for on pelvic examination?
Masses Pelvic distortion Tenderness Vaginal septum Cervical abnormalitis Fibroids (pressure symptoms, period problems, infertility)
What baseline investigation should be carried out at the fertility clinic?
Rubella immunity Chlamydia TFT Regular periods- mid luteal progesterone Irregular periods o FSH,LH,PRL,TSH,Testosterone Male partners semen analysis
What investigations should be carried out at the fertility clinic?
Pelvic ultrasound Physical examination testing for ovulation semen analysis repeat tubal patency test- typically HyCoSy
What history do you want from male patients?
Testicular descent Change in shavign frequency Loss of body hair Mumps? STD's Surgical varicocele repair Vasectomy Previous fertility Drugs (steroids, alcohol) Libido Frequency of intercourse Previous fertility assessment Chronic medical illness?
What male examinations should be undertaken?
BMI
Fat and hair distribution
Abdominal and inguinal examination
Genital examination (Epididymis, Testes, Vas deferens, Varicocele)
What is a varicoele?
How does it relate to infertility?
Dilation of the pampiformplexus of the spermatic veins in the scrotum. Most men with varicocele and presumptive ingertility have abnormal semen paramters including low sperm, concentration and abnormal
What is klenefelter syndrome?
One of the most common causes of primary hypogonadism with impaired spermatogenesis adn testosterone deficicncy. May occur in 1 out of 500 males.
It is characterised by XXY, small testes and azoospermia (spunk with no sperm)
When do you refer someone to the sexual fertility clinic?
Period irregularity Past medical probelms testicualr problems Abnormal tests (HIV/HEP B) Age <35 years after one year >35 years after 6 months
What are the different classes of ovulatory disorders?
Group I- hypothalmic pituitary failure
Group II- hypothalmic -pituitary-ovarian dysfunction
Group III- ovarian failure (POI)
What are some treatment and investigations for Group I ovulation disorders?
Anovulatory disorders (without ovulation)
Lifestyle advice: Increase weight (BMI<19)
Moderate exercise levels
GRH oR GH with LH to induce ovulation
What is Polycystic Ovary syndrome
Androgen Excess (hirsutism, high testosterone) Infrequent periods (anovulation) polycystic ovaries (on ultrasound)
How do you treat group 2 ovulatory disorders
treat underlying cause
Weight loss/gain
BMI>18 and BMI,35
Ovulation induction- clomifene and gondotrophins
Discuss clomifene therapy
Selective oestrogen receptor modualtor (stop oestrogen interacting with the pituitary)
Dose chice- 50mg-150mg days2-6
Monitoring through follicular scanning in the 1st cycle, 15% require a dose adjustment
Side effects include vasomotor and visual problems
When do you treat ovulatory disorders with gonadotrophins?
What is the treatment?
When there is ovulation but no pregnancy
No ovulation with clomifene
FSH is given by injection for 3-6 cycles
What is a hydrosalpinx?
A condition where the Fallopian tubes become blocked with fluid.
How do you treat woman withhydrosalpinges?
Surgery before in vitro fertilisation treatment. Woman with hydrosalpingesshould be offered a salpingectomy before IVF treatment as this improves the chance of a live birth
How do you treat infertility in those with endometriosis and fibroids?
Surgery v medical treatment
Reversal or sterilisation no longer availabel soconsider IVF
What treatment options can you offer males with infertility?
Urologist appoint if appropriate IVF/ICSI Intra uterine insemination reversal of vasectomy surgical sperm retrieval Donor insemination
