Infertility Flashcards
What is the peak conception rate per cycle?
20%
How are conception rates affected by age?
Decline with age
What are the requirements for conception?
- Ovulation
- Sperm production
- Fertilisation
- Implantation
What is the hypothalamus-pituitary-gonadal axis?
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
What happens to estradiol and progesterone levels before and after ovulation?
Before:
•Estradiol - sharp decrease (but on decrease at start of ovulation)
•Progesterone - increase
After:
•Estradiol - slow decrease then sharp increase
•Progesterone - sharp increase
OVULATION
What happens to FSH and LH levels before and after ovulation?
Before:
•FSH - increase
•LH - sharp increase
However, both on decrease at start of ovulation
After:
•FSH - decrease
•LH - decrease
What hormone is released by the ovaries during fertilisation?
Estrogen
What hormones are released by the ovaries during tubal transport and implantation?
- Estrogen
* Progesterone
What does natural conception rely on?
•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
What does natural conception rely on?
•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
What are the lifestyle factors which affect fertility?
- Age
- BMI
- Smoking
- Alcohol
- Recreational drug use
- Stress
What are the lifestyle factors which affect fertility?
- Age
- BMI
- Smoking
- Alcohol
- Recreational drug use
- Stress
What is the WHO’s clinical definition of infertility?
- 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
What is the WHO’s epidemiological definition of infertility?
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)
What is the WHO’s demographic definition of infertility?
- 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
What percentage of women globally are affected by infertility based on the demographic definition?
10% (likely to be higher)
What proportion of couple are affected by infertility?
- 1 in 7 couples in the western world
* 1 in 4 couples in developing countries
When is it appropriate to refer a couple for infertility?
- No conception after one year of regular unprotected intercourse
- Referral earlier if:
- Age>35 years
- Known cause for infertility
What are the types of infertility?
- Primary/Secondary
* Cause
What are the female factors for infertility?
- Ovulatory dysfunction (35%)
- Diminishing ovarian reserve
- Endometriosis
- Uterine factor - issue with uterus
- Tubal factor - issue with fallopian tube
What are the male factors for infertility?
- Problems in producing hormones for sperm production
- Blockage of sperm transport
- Sperm production problems
- Erection and ejaculation problems
MALE INFERTILITY
What are the investigations used to see if eggs are available?
•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
What are ovulation tests used by couples?
- Natural methods - BBT (basal body temperature), cervical mucus
- LH ovulation kits (luteinizing hormone)
- Ovulation calendar
CERVICAL MUCUS
What is the ovulation test used by clinicians to investigate?
D21 serum progesterone
