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Reproductive System > Infertility > Flashcards

Infertility Flashcards

1
Q

What is the peak conception rate per cycle?

A

20%

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2
Q

How are conception rates affected by age?

A

Decline with age

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3
Q

What are the requirements for conception?

A
  • Ovulation
  • Sperm production
  • Fertilisation
  • Implantation
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4
Q

What is the hypothalamus-pituitary-gonadal axis?

A

The hypothalamic-pituitary-gonadal (HPG) axis coordinates a tightly regulated feedback loop that consists of gonadotropin-releasing hormone (GnRH) produced by the hypothalamus; follicle-stimulating hormone (FSH) and luteinising hormone (LH) from the anterior pituitary; and the sex steroids estradiol, progesterone, and testosterone
HYPOTHALAMO-PITUITARY-GONADAL AXIS

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5
Q

What happens to estradiol and progesterone levels before and after ovulation?

A

Before:
•Estradiol - sharp decrease (but on decrease at start of ovulation)
•Progesterone - increase
After:
•Estradiol - slow decrease then sharp increase
•Progesterone - sharp increase

OVULATION

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6
Q

What happens to FSH and LH levels before and after ovulation?

A

Before:
•FSH - increase
•LH - sharp increase

However, both on decrease at start of ovulation

After:
•FSH - decrease
•LH - decrease

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7
Q

What hormone is released by the ovaries during fertilisation?

A

Estrogen

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8
Q

What hormones are released by the ovaries during tubal transport and implantation?

A
  • Estrogen

* Progesterone

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9
Q

What does natural conception rely on?

A 
•Functioning hormonal axis and gonads
•Ovarian reserve
•Regular ovulation 
•Normal sperm production
•Fertilization
-egg and sperm interaction
-patent fallopian tubes
•Normal uterine cavity for implantation
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10
Q

What does natural conception rely on?

A 
•Functioning hormonal axis and gonads
•Ovarian reserve
•Regular ovulation 
•Normal sperm production
•Fertilization
-egg and sperm interaction
-patent fallopian tubes
•Normal uterine cavity for implantation
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11
Q

What are the lifestyle factors which affect fertility?

A
  • Age
  • BMI
  • Smoking
  • Alcohol
  • Recreational drug use
  • Stress
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12
Q

What are the lifestyle factors which affect fertility?

A
  • Age
  • BMI
  • Smoking
  • Alcohol
  • Recreational drug use
  • Stress
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13
Q

What is the WHO’s clinical definition of infertility?

A
  • Inability to conceive over a 12 month period despite exposure to regular, unprotected intercourse
  • Represents a prognosis based approach and provides practical guidance on when to initiate investigations
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14
Q

What is the WHO’s epidemiological definition of infertility?

A

Lack of conception after 2 years in women of reproductive age (15-49 years) who are at a risk of becoming pregnant (sexually active, not using contraception)

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15
Q

What is the WHO’s demographic definition of infertility?

A
  • An inability of those of reproductive age (15-49 years) to become or remain pregnant within five years of exposure to pregnancy
  • An inability to become pregnant with a live birth, within 5 years of exposure based upon a consistent union status, lack of contraceptive use, non-lactating and maintaining a desire for a child
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16
Q

What percentage of women globally are affected by infertility based on the demographic definition?

A

10% (likely to be higher)

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17
Q

What proportion of couple are affected by infertility?

A
  • 1 in 7 couples in the western world

* 1 in 4 couples in developing countries

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18
Q

When is it appropriate to refer a couple for infertility?

A
  • No conception after one year of regular unprotected intercourse
  • Referral earlier if:
  • Age>35 years
  • Known cause for infertility
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19
Q

What are the types of infertility?

A
  • Primary/Secondary

* Cause

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20
Q

What are the female factors for infertility?

A
  • Ovulatory dysfunction (35%)
  • Diminishing ovarian reserve
  • Endometriosis
  • Uterine factor - issue with uterus
  • Tubal factor - issue with fallopian tube
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21
Q

What are the male factors for infertility?

A
  • Problems in producing hormones for sperm production
  • Blockage of sperm transport
  • Sperm production problems
  • Erection and ejaculation problems

MALE INFERTILITY

22
Q

What are the investigations used to see if eggs are available?

A

•Age
•Ovarian reserve test - blood test and scan
•Blood test
-FSH, D1-D5 of cycle (<10 iu/L) - good
-AMH (5.0-25.0pmol/L)
•UltrasoundScan - Antral follicular count

23
Q

What are ovulation tests used by couples?

A
  • Natural methods - BBT (basal body temperature), cervical mucus
  • LH ovulation kits (luteinizing hormone)
  • Ovulation calendar

CERVICAL MUCUS

24
Q

What is the ovulation test used by clinicians to investigate?

A

D21 serum progesterone

25
Q

What levels of progesterone give a diagnosis of ovulation?

A
  • Progesterone levels taken at appropriate time - day 21 only if 28/30 day cycle
  • Levels > 20nmol/l show satisfactory ovulation
26
Q

What are the requirements for the egg and sperm meeting?

A
  • Intercourse

* Patent fallopian tubes

27
Q

How is Fallopian tube patency checked?

A
  • If no pelvic infection or gynaecological problem in past - Hysterosalpingogram(HSG) (dye and x-ray)
  • If any of above- Laparoscopic dye test
28
Q

How else can the female reproductive organs be investigated?

A

Laparoscopy

29
Q

What are other fertility tests?

A
  • Serum prolactin - high prolactin/prolactinaemia
  • Thyroid function test
  • Chlamydia screening
  • Pelvic Ultrasound for uterine problems
  • Also check- Rubella immunity and cervical smear up to date
30
Q

How may ovulation disorders be managed non-pharmacologically?

A
  • Optimise body weight
  • Healthy lifestyle
  • Exercise
31
Q

How may ovulation disorders be managed pharmacologically (ovulation induction)?

A
  • Clomiphene citrate

* Gonadotrophins

32
Q

How may ovulation disorders be managed surgically?

A

Laparoscopic ovarian drilling

33
Q

How is a very low count or no sperm (azoospermia) managed?

A
  • Medical treatments - gonadotrophins
  • Surgical sperm retrieval - epididymis/testis
  • Donor sperm - intrauterine insemination
  • ICSI (intracytoplasmic sperm injection) - IVF
34
Q

How is a tubal problem managed?

A
  • Role of surgery limited to mild tubal disease

* IVF

35
Q

How is endometriosis managed?

A

Ablation or resection of spots
•Adhesiolysis
•Cystectomy for endometrioma

36
Q

How may a uterine disorder be managed?

A
  • Removal polyp/fibroid

* Adhesiolysis for synechiae

37
Q

How is unsolved infertility managed?

A

IVF

38
Q

What does the Human Fertilisation & Embryology Authority (HFEA) do?

A
  • Regulatory authority
  • Licensing
  • Inspections
  • Forms - registration, treatment, outcome
  • Register
39
Q

What do an egg and sperm form together?

A

An embryo

40
Q

How are a patients own eggs gathered for IVF?

A

Gonadotrophin induced superovulation

41
Q

Why might donor eggs be used?

A
  • Age (poor ovarian reserve)
  • Poor quality
  • Ovarian failure
  • Genetic cause
42
Q

How are a patients own sperm gathered for IVF?

A
  • Fresh sample on day of egg collection

* Frozen sample (thawed) from surgical retrieval or fertility preservation

43
Q

Why might donor sperm be used?

A
  • Single woman
  • Same sex relationship
  • Azoospermia
  • Genetic cause
  • Infection - HIV, Hep B, Hep C
44
Q

What are the key steps in IVF?

A
  • Controlled ovarian stimulation
  • Follicular monitoring
  • Timing ovulation
  • Egg collection
  • Lab fertilization - Insemination/ICSI
  • Incubation/embryo development
  • Embryo transfer
  • Progesterone support
45
Q

What is Intracytoplasmic Sperm Injection (ICSI)?

A

Injection of egg with single sperm

46
Q

How are the embryos transferred to the uterus?

A

Embryos pre-loaded in fine tube of embryo transfer catheter

47
Q

How long are the embryos incubated for?

A

3-5 days

48
Q

How are embryos freezes and stored?

A

Each embryo stored in labelled/colour coded “straw”

49
Q

What is the process after the embryo transfer?

A
  • Progesterone pessaries
  • Normal activity
  • Pregnancy test after 2 weeks
  • If positive - scan at 7 weeks
50
Q

What are the risks of IVF?

A
  • Ovarian hyperstimulation syndrome (OHSS)
  • Multiple pregnancy
  • Medication side effects
  • Procedure related
51
Q

What are the longterm effects of IVF?

A
  • Children born- no difference as per short term data.
  • Risk of ovarian cancer not confirmed
  • Absolute risk to women and children low
52
Q

What are some other reasons for using IVF?

A
  • Donor gametes
  • Fertility preservation - gamete/embryo cryopreservation
  • Ovarian tissue cryopreservation
  • Preimplantation genetic diagnosis
  • Assisted hatching
  • In vitro maturation
  • Surrogacy

Reproductive System (31 decks)

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