Infertility Flashcards
Causes of infertility
disease of repro tract after _1 year_ of trying
- Sperm problems (30%)
- Ovulation problems (25%)
- Tubal problems (15%)
- Uterine problems (10%)
- Unexplained (20%)
- 40% of infertile couples have a mix of male and female causes.
Risk factors for infertility? (5)
- smoking
- obesity
- occupational risks
- excessive alcohol consumption
- drug use.
Causes of infertility in women (6)
whats the most common cause?
the most common causes of infertility are
OVULATORY DISORDERS
Other causes and risk factors
- tubal
- uterine
- cervical factors
- use of certain drugs
- stress; and lifestyle factors (such as smoking, obesity, and alcohol consumption)
what r some abnormalities that may occur in the FT?
Hydrosalpinx
Endomt
what r some abnormalities that may occur in the endometrium
- Fibroids
- Polyps
- Intrauterine adhesions–> Ashermann’s, post surgery
- septum
Infertility Causes in men
- sperm count–> azospermia, oligospermia
- Infection–>orchitis
- Semen volume
- Varicocele
- Testicular T
- Genetic conditions–>Klinefelter’s syndrome
- CBAVD–> congenital bilateral abscence vas deferens (men who carry the gene for CF)
- Drugs–> steroids, elevates testerone levels, brain thinks body has enough testosterones, so LH & FSH r supressed–> no spermatogenesis occurs.
General Advice for infertiltiy (6)
- The woman should be taking 400mcg folic acid daily
- Aim for a healthy BMI
- Avoid smoking & exessive alcohol
- Reduce stress as this may negatively affect libido and the relationship
- Aim for intercourse every 2 – 3 days
- Avoid timing intercourse
Timed intercourse to coincide with ovulation is not necessary or recommended as it can lead to i_ncreased stress and pressure in the relationship._
Initial investigations in primary care (5)
- Body mass index (BMI)
–> LOW could indicate anovulation
–> HIGH could indicate PCOS
- Chlamydia screening
- Semen analysis
- Female hormonal testing (see below)
- Rubella immunity in the mother
initial investigations (hormone shit) for women? (5)
- Mid-luteal phase (day 21) serum progesterone in ALL women to confirm ovulation (or 7 days b4 the end of the cycle if not a 28-day cycle).
- Serum LH & FSH on day 2 to 5 –> in women w/ irregular menstrual cycles
- TFT’s –> suspect thyroid disease.
- Prolactin –> hyperprolactinaemia is a cx of anovulation (if symptoms of galactorrhea or amenorrhoea)
- Anti mullarian>> measure ovarian reserve
TGPT
Abnormalities of each blood test and what the could indicate (4)
- what is the most accurate marker to measure ovarian reserve?*
- high FSH? high LH? high proges? anti mullarian?*
- High FSH –> poor ovarian reserve (the number of follicles that the woman has left in her ovaries). The pituitary gland is producing extra FSH in an attempt to stimulate follicular development.
- High LH –> PCOS
- A rise in progesterone on day 21 indicates that ovulation has occurred, and the CL has formed and is secreting progesterone.
- Anti-Mullerian hormone can be measured at any time during the cycle & is the most accurate marker of ovarian reserve. It is released by the granulosa cells in the follicles
–> A FALL means the eggs are depleting.
–> A RISE indicates a good ovarian reserve.
what further investigations can be done in 2ndy care? (3)
- USS pelvis (transvaginal better) looks for PCOS or any structural abnormalities in the uterus
- HyCoSy–> utilizes USS
- if NO cormorbid conditions >> Hysterosalpingogram looks at patency of FT (no anesthetic required)
- if YES comorbid condition>> Laparoscopy + dye test looks at patency of FT, adhesions & endometriosis (anesthetic required)
comorbid conditions such as PID, endometriosis, or previous ectopic pregnancy
what investigations is done for men?
interpret Semen analysis
Semen analysis is used to examine the quantity and quality of the semen and sperm.
- Semen volume (more than 1.5ml)
- Semen pH (greater than 7.2)
- Concentration of sperm (more than 15 million per ml)
- Total # of sperm (more than 39 million per sample)
- Motility of sperm (more than 40% of sperm are mobile)
- Vitality of sperm (more than 58% of sperm are active)
- Percentage of normal sperm (more than 4%)
What are 3 main types of fertility management?
medical, surgical, and assisted conception.
managment in 3* care
if sperm count is reduced, or not swimming well–> ICSI
Management of Anovulation (6)
- Weight loss for overweight patients with PCOS can restore ovulation
- Clomifene may be used to stimulate ovulation
- Letrozole may be used instead of clomifene to stimulate ovulation (aromatase inhibitor + anti-oestrogen effects)
- Gonadotropins may be used to stimulate ovulation in women resistant to clomifene
- Ovarian drilling may be used in polycystic ovarian syndrome
- Metformin may be used when there is insulin insensitivity and obesity (usually associated with PCOS)
Clomifene is an anti-oestrogen (a serm. It is given on days 2 to 6 of the menstrual cycle. It stops the negative feedback of oestrogen on the hypothalamus, resulting in a greater release of GnRH and subsequently FSH and LH.
when is Clomifene given?
moa?
SE?
- is an anti-oestrogen (a SERM)
- It is given on days 2 - 6 of the menstrual cycle.
- It stops the negative feedback of estrogen on the hypothalamus, resulting in a greater release of GnRH and subsequently FSH and LH
SE . Hot flushes, N&V, abdo pain, headache, blurry vision
What is primary hypergonadotropic hypogonadism
Side-effects of ovulation induction
Ovulation hyperstimulation syndrome
can be life-threatening if not identified and managed promptly
ovarian enlargement with multiple cystic spaces form, and an increase in the permeability of capillaries leads to a fluid shift from the intravascular to the extra-vascular space, results in multiple life-threatening complix:
- Hypovolaemic shock
- Acute renal failure
- Venous or arterial thromboembolism
