Infertility Flashcards
Causes of infertility in men and women
Give some examples of what could cause a failure of sperm production in men
Kleinfelters syndrome (low testosterone > reduced spermatogenesis) Cryptorchidism (born with undescended tetes > reduced spermatogenesis)
Male infertility could be causes by a failure in the transport of sperm. Give some examples of how this could happen
Occlusion of vas deferens or epididymis after an infection
Congenital bilateral absence of the vas deferens (CBAVD)
What is congenital bilateral absence of the vas deferens (CBAVD)
- mutation in the CTFR gene on chromosome 7 > improper development of vas deferens
- 85% of men with CBAVD are CF carriers
- > 95% of men with CF have CBAVD
What could be some causes of the failure of transmission of sperm in men
ED
Ejaculatory dysfunction - retrograde ejaculation, defects in accessory glands
What would prompt you to investigate retrograde ejaculation in a man
low/nil ejaculate volume
Investigate via post-ejaculatory urine analysis
A mans semen analysis turns up an abnormal result, what do you do next and why
repeat it more than a month later to look at a different cycle of spermatogenesis
What are some clinical test which can be carried out on semen
leucocyte concentration to see if there’s an infection in a gland (>1million/ml is bad) - the one to remember
look for antisperm antibodies
HOS test - sperm viability
EN test - sperm vitality
fecundability =
probability of conceiving each month - the monthly chance of pregnancy
fecundity =
measure of the ability to conceive AND produce a live birth
Ovulation disorders account for 40% of infertility cases in women. They include idiopathic ovarian failure - what is this and what are its symptoms?
Follicles stop responding to gonadatropins (FSH & LH); secretion is normal but insufficient to support a normal cycle (before age 40)
Therefore oestrogen level fail to rise and follicles fail to mature (lots of small under developed follicles)
- absence of ovulation > infertility and amenorrhoea/oligomenorrhoea
- lack of ovarian hormones > hot flashes, night sweats, vaginal dryness
Ovulation disorders account for 40% of infertility cases in women. They include polycystic ovarian syndrome (PCOS) - what is this and what are its symptoms?
PCOS has 3 main features:
ammenorrhoea, excess androgen, and polycystic ovaries (lots of harmless underdeveloped follicles which can’t release an egg)
1 in 5 women UK have it; more than half asymptomatic. Symptoms would include ammenorrhoea, excess hair (due to androgen), dull aching abdominal pain, painful sex, feeling of pressure in lower abdomen
Ovulation disorders account for 40% of infertility cases in women. They include luteinised unruptured follicle syndrome - what is this?
LUF - the follicle has not ruptured and an egg hasn’t been released, however the follicle has been luteinized by LH. This is an anovulatory cycle (no egg released)
Ovulation disorders account for 40% of infertility cases in women. They include an abbreviated luteal phase - what is this?
A shortened luteal phase (from day of ovulation to menstrual bleeding) of less than 9 days (usually 11-17).
This means decreased progesterone which is needed to put endometrium into secretory state receptive to a blastocyst.
What would cause a tubal obstruction in a woman
loss of cilia and scarring secondary to infection meaning impaired sperm and oocyte transport, possible adhesions - STI, post-abortal/pregnancy sepsis.
Ovulation disorders account for 40% of infertility cases in women. They include endometriosis - what is this?
endometrial tissue grows in ectopic sites - fallopian tubes, ovaries, uterine ligaments, peritoneum, etc causing bleeding and inflammation at that site.
Symptoms depend on site of tissue implantation and involve pain. If the site is on a repro organ > pelvic pain, painful menstruation, sex, bleeding.
What are absent cycles in women associated with?
Absent cycles meaning primary and secondary amenorrhoea, oligomenorrhoea, anovulatory cycles,
Associated with stress, obesity, strenuous exercise, anorexia nervosa and drug use
- Placebo treatment ->30% will get pregnant showing its stress
Maternal problems account for 40-50% of infertility cases in women. Give some examples of these problems.
Cervical incompetence - cervix dilates & effaces before pregnancy at term
Autoimmune eg lupus
Implantation defects eg ectopic pregnancies
Immunological incompatibility - ABO/rhesus blood group loci
What is clinical pregnancy considered to be
5 week ultrasound
7 week fetal heartbeat
In which trimester do 15-25% of clinical pregnancies usually fail
1st trimester
Why does female fertility decline?
due to egg quality
Why does male fertility decline?
more to do with age-related factors such as hypertension and diabetes
From what ages does female fertility sharply decline
35
What day of a womans menstrual cycle do we measure LH and FSH in fertility testing (blood test)
2-4
Besides LH, FSH, and progesterone what other hormones is looked at in a womans blood test to measure her fertility
AMH - secreted by follicles; more AMH more follicles (indicates egg count/ovarian function)
