Infertility Flashcards
Why does female age matter in fertility?
Egg count is determined at birth following which there is no new egg production
How does egg quality change over time?
Capacity to perform well in terms of nuclear and genetic material division declines with advancing age
Can we predict decline in fertility?
No
We can just advise to plan ahead
What are the main necessary components of successful conception?
Ovulation
Sperm production
Sperm to meet and fertilise the egg in patent and functioning fallopian tubes
Implantation
Does progesterone increase or decrease after ovulation?
Increase
Describe the hormonal control of spermatogenesis.
Hypothalamus releases GnRH
GnRH stimulates AP to release FSH
FSH acts on spermatogonia in seminiferous tubules
Spermatogenesis takes place
Describe the hormonal control of androgen release?
Hypothalamus releases GnRH
GnRH stimulates AP to release LH
LH acts on Leydig or interstitial cells of testes
Androgens released
What do androgens do?
Secondary male characteristics
Sustentacular cells of seminiferous tubules
What are some lifestyle factors associated with fertility?
Age BMI Smoking Alcohol Recreational drug use Stress
What are the 4 types of problems which may cause infertility in the male?
Problems producing hormones for sperm production
Blockage of sperm transport
Sperm production problems
Erection and ejaculation problems
What are some problems which could arise with erection and ejaculation?
Prostate surgery
Damaged nerves
Timing of intercourse
Medication
What are some problems which could impair sperm production?
Genetic Failure of testes to descend Infections Torsion Varicoele Drugs Radiation Sperm antibodies Heat
What are some causes of blockage of sperm transport?
Infection
Prostate problems
Absence of vas deferens
What are the main considerations for investigating infertility?
Are eggs available?
Are sperm available?
Can sperm and egg meet?
Any other factors?
How is incidence of ovulation investigated?
Basal Body Temperature Cervical mucus LH ovulation kits Ovulation calendars D21 serum progesterone
When is progesterone recorded for ovulation checking?
Day 21, assuming a 28-30 day cycle
What is HSG?
Hysterosalpingography Used to check fallopian tube patency Catheter through cervix Dye instilled X ray taken
What are some common other tests for couples with infertility problems?
Serum prolactin Thyroid fucntion Chlamydia screening Pelvic US Rubella immunity Cervical smear
What is first line advice for ovulation disorders?
Optimise body weight, healthy lifestyle, exercise
What are medications which can be used to induce ovulation?
Clomiphene
Gonadotrophins
What is a possible surgical management of ovulation disorders?
Laparoscopic ovarian drilling
What are some of the ways we could manage low sperm count (azoospermia)?
Gonadotrophins
Surgical sperm retrieval
Intrauterine insemination
Intracytoplasmic sperm injection (ICSI)
How can endometriosis be treated surgically?
Ablation or resection of spots
Ahesiolysis
Cystectomy for endometrioma
What are some possible surgical solutions for uterine problems?
Removal of polyp/fibroid
Adhesiolysis for synechiae
How is unresolved infertility managed?
IVF advised
What is the regulatory authority for IVF?
HFEA
Human fertilisation & embryology authority
Why may donor eggs be used for IVF?
Age
Poor quality
Ovarian failure
Genetic causes
Why may a sperm donor be used for IVF?
Single women Same sex relationship Azoospermia Genetic cause Infection (HIV, HepB, HepC)
What are the key steps in IVF?
Gonadotrophin induced superovulation Follicular monitoring Timing ovulation Egg collection Insemination Incubation Embryo transfer Progesterone support
What are the different techniques for IVF?
Sperm just mixed into dish with egg
ICSI - sperm injected into egg
Can embryos be stored?
Yes they can be frozen in nitrogen and stored for up to 10 years
What is OHSS?
Ovarian hyperstimulation
Over response of ovaries
Over production of follicles
Symptoms
Can multiple pregnancy be a risk of IVF?
Yes
Sometimes multiple embryos transferred
