Infertility Flashcards
What is the definition of subfertility?
When a couple have not conceived after a year of regular unprotected sex
What are the four different factors which can affect fertility?
- Ovulation
- Adequate sperm release
- Sperm meeting the egg - may be structural problems with fallopian tubes
- Fertilised egg must implant
What are the definitions of primary and secondary infertility?
Primary infertility = woman has never been able to conceive
Secondary infertility = woman has conceived in the past (even if it is miscarriage) but is now struggling
What causes bleeding in anovulatory cycles?
- Anovulatory cycles do not have ovulation and so there is no corpus luteum to secrete progesterone.
- This means there is thickening of the endometrium due to oestrogen but no secretory changes from progesterone.
- Endometrial thickening continues with oestrogen until it outgrows the blood supply leading to endometrial lining shedding off
How can you check for anovulation?
Check progesterone levels at mid-luteal phase when they should be very high.
Causes of infertility…
HYPOTHALAMUS :
Male and female: tumour, trauma, stress/ weight loss
PITUITARY:
Male and female: tumour
GONADS:
Male: Trauma, tumour, infection (mumps orchitis) , Klinefelters, steroids, chemoradiotherapy
Female: PCOS, Turner’s, premature ovarian failure, chemoradiotherapy ,
Uterus= endometriosis, fibroids
SEXUAL DYSFUNCTION:
- Erectile dysfunction
- Vaginsmus
Investigations for female infertility…
Ovulation kits to detect LH surge Mid-luteal progesterone levels Laparoscopic dye for tubal abnormalities Ovarian reserve testing triad: 1. FSH levels 2. AMH levels 3. USS TV of ovarian follicles
Management of female infertility…
- Hypothalamic problems - lifestyle changes e.g. reduce exercise, aim for normal BMI
- Hyperprolactinaemia - bromocriptine (dopamine agonist)
- Anovulatory cycles - use clomiphene (induce ovulation)
- Tubal disorders - IVF
Investigations for male infertility…
Sperm analysis - requires 3 days abstinence prior - if abnormal, repeat test 3 months later, then consider:
- FSH/LH levels for sperm production
- Inhibin levels (increased with too much sperm)
- CFTR (cystic fibrosis)
- Karyotyping - (XXY in Klinefelters)
- USS of male genital tract
Sperm analysis values…
- Normozoospermia = sperm that meets WHO criteria
- Oligozoospermia = low sperm count (<15ml/min)
- Asthenozoospermia = low sperm motility (<32% with rapid forward progression )
- Teratozoospermia = low sperm morphology ( <4% have normal morphology)
- Azoospermia = no sperm in ejaculate
Management of male infertility…
- hCG/ FSH to induce spermatogenesis
- Surgical intervention for structural abnormality
- Donor sperm
Indications for assisted conception …
- When all other methods have failed
- Unexplained subfertility
- Male factor infertility
- Endometriosis
- Tubal disorder
- Genetic disorder
What is the process of IVF?
- Stop natural menstrual cycle with daily GnRH agonist - continued all the way to egg collection
- Subcutaneous FSH and LG injections given to cause follicles to mature
- Once optimal number of mature follicles present - FSH and LH injections are stopped and replaced with one single large LH injection to induce final oocyte maturation
- Eggs collected 36 hours later via transvaginal US guided aspiration
- Eggs incubated with sperm in culture to allow fertilisation and growth into blastocyst
- Transfer takes place, allowing blastocyst to implant in uterus lining
- Progesterone pessaries used to maintain pregnancy until 12 weeks gestation
How does intrauterine insemination work?
Washed sperm are directly inserted into uterine cavity.
Correct timing is determined by using ovulation kit to work out time of ovulation.
When is intrauterine insemination indicated?
- Unexplained infertility
- Mild male factor infertility
- Cervical infertility
