Infertility Flashcards
What is the medical definition of infertile?
A couple unable to conceive after 12 months of regular intercourse without the use of contraception. 1 in 7 Couples have fertility issues. 80% of couples should conceive in the first year of trying.
What are the 4 main physiological barriers to fertility?
- Availability of Eggs - Availability of Sperm - Can gametes meet? - Can embryo implant?
Things to ask females who are worried that they are infertile (4)
- Previous contraception - Menstrual history - Sexual history - Previous pregnancies, complications and fertility in previous relationships.
What is the clinical measurement for androgen excess in females?
Ferriman Gallwey Score
What are the biochemical measurements that check for androgen excess in females?
- Testosterone - DHEAS >700mcg/dL (Follow up with Adrenal CT looking for androgen-secreting tumour) - 17-OH Progesterone
What is Acanthosis Nigricans?
A sign of androgen excess.
What things do we look for in the Pelvic Examination?
(5)
- Masses
- Pelvic Distortion
- Tenderness
- Vaginal Septum
- Cervical Abnormalities
What are the main 3 types of fibroids?
Submucous
Intramural
Subserosal
What findings are in concordance with fibroids?
- Pressure Symptoms
- Period Problems
- Infertility
What are the baseline investigations for females?
- Rubella Immunity
- Chlamydia
- TSH
- Mid-Luteal progesterone (7 days prior to period)
- Irregular Period investigations (day 1-5):
- FSH
- LH
- PRL (Prolactin)
- TSH
- Testosterone
What are the baseline investigations for males?
Semen Analysis
What investigations are carries out in a fertility clinic?
- Pelvic Ultrasound
- Physical examination
- Ovulation testing
- Semen analysis
- Tubal patency test`
What questions should be asked in an infertile male’s history?
-
Developmental
- Testicular Descent
- Change in shaving frequency
- Loss of Body hair
-
Infections
- Mumps
- STDs
-
Surgical
- Varicocele Repair
- Vasectomy
- Previous cases of infertility
What are the main causes of epididymitis?
-
STDs
- Chlamydia trachomatis
- Gonorrhoea
- Semineferous Tubular Necrosis (Disrupting spermatogenesis)
- TB & Mumps
What equipment do you use to identify size of testes / cyst / tumour?
Orchidometer
What is CBAVD?
Congenital
Bilateral
Absence of
Vas
Deferens
What is Group I ovulatory disorder?
Hypothalamic Pituitary Failure
(known as hypothalamic amenorrhoea / hypogonadotrophic hypogonadism)
What is Group II ovulatory disorder?
Hypothalamic-Pituitary-Ovarian dysfunction.
(Polycystic ovary syndrome)
What is Group III ovulatory disorder?
Ovarian Failure
(Primary Ovarian Insufficiency)
What can you offer Group I ovulatory disorder sufferers to induce ovulation?
- Pulsatile administration of GnRH
- GnH + LH
- BMI <19
- Moderate excercise levels
- Eat more
- Moderate excercise levels
What are the symptoms of Group I ovulatory disorders?
- Low body weight
- Stress/Excercise related amenorrhoea
- Craniopharyngioma (or other tumours that effect the hypothalamus)
- Kallmann’s Syndrome (Amenorrhoea with anosmia)
What is hydrosalpinges?
When the fallopian tube is blocked and fills with serous or clear fluid near the ovary. This may present as distention.
Why would we offer salpingectomy to women before in vitro fertilisation?
Laparoscopy salpingectomy for women with hydrosalpinges before IVF has been shown to improve the chance of a live birth.
What are the types of Azoospermia?
