Infertility Flashcards
How many couples report infertility problems?
1 in 7
About what percentage of couples generally conceive within a year if woman is under 40 and they dont use contraception?
80%
What should be asked in a female history in investigation for infertility?
- Duration of infertility
- Previous contraception
- Fertility in previous relationships
- Previous in pregnancies and complications
- Menstrual history
- Medical and surgical history
- Sexual history
- Previous investigations
- Psychological assessment
What should be looked at in a female examination in investigation for infertility?
- Weight
- Height
- BMI
- Fat and hair distribution
- Galactorrhoea
- Abdominal examination
- Pelvic examination
What may be some female signs of androgen excess?
- Hirsutism
- Acanthosis nigricans
What may be some causes of androgen excess in females?
- Nonclassic congenital adrenal hyperplasia (NCCAH)
- PCOS
- Androgen-secreting tumours (Ovarian/adrenal)
- Ovarian hyperthecosis
What can be used in measurement of androgen excess in women?
- Clinical measurement (Ferriman Gallwey Score)
- Biochemical measurement (Testosterone/DHEASetc)
What symptoms may fibroids present with?
- Pressure symptoms
- Period problems
- Infertility
What investigations would be used for female infertility?
-Rubella immunity,
-Chlamydia
-TSH
-If periods are regular: Mid luteal progesterone
( 7 days prior to expected period);
-If periods are irregular please do day 1-5 FSH, LH, PRL, TSH, testosterone
-Pelvic US
-Physical examination
-Ovulation testing
-Tubal pregnancy test
What investigation may be used as a reliable rest of tubal occlusion?
Hysterosalpingography (HSG)
What should be asked in a male history in investigation for infertility?
Developmental questions
-Testicular descent, change in shaving frequency, Loss of body hair
Infections
-Mumps, STDs
Surgical history
-Varicocele repair
Vasectomy
Previous fertility
Drugs/environmental - Alcohol, Smoking, Anabolic steroids, Chemotherapy, Radiation< Recreational drugs
Sexual history - Libido Frequency,
Chronic medical illness
What should be looked at in a male examination in investigation for infertility?
- Weight
- Height
- BMI
- Fat ans hair distribution (hypoandrogenism)
- Abdominal and inguinal examination
- Genital examination - Epididymis, Testes, Vas deferens, Varicocele.
List some of the causes of epididymitis?
STDs
TB
Mumps
What is a varicocele?
Dilatation of pampiniform plexus of spermatic veins
What condition may result in azoospermia?
Klinefelter Syndrome
When should referral be considered for infertility?
After 1 year of trying
Unless specific problems -Period irregularity, PMH, Testicular problems, Abnormal Tests HIV/Hep B Anxiety Age 35-45 (Offer after 6 months)
What are the three types of ovulatory disorder?
- Group I - Hypothalamatic pituitary failure (eg Hypothalamic amenorrhoea)
- Group II - Hypothalamic-pituitary-ovarian dysfunction (Mostly PCOS)
- Group III - Ovarian failure (POI)
What are signs of PCOS?
- Androgen excess (Hirsutism, ^Testosterone)
- Infrequent periods
- Polycystic ovaries on US
What is the mode of action of clomifene?
Selective estrogen receptor modulator - binds in Ant. Pit. -> ^FSH
When may gonadotrophins be used in female infertility?
- No ovulation with clomifene
- Ovulation but no pregnancy
What is done for unexplained infertility?
- Do not offer oral ovarian stimulation agents
- Advise to try to conceive for total of 2 years before IVF will be considered
- Offer IVF treatment
What happens during IVF?
Eggs harvested from ovary
Eggs fertilised in lab with sperm
Embryos undergo cell divisions
Transfer into womb
Roughly what percentage of births are due to IVF?
2%
