Infertility Flashcards
Differential diagnoses of amenorrhoea
Pregnancy PCOS Premature Ovarian Failure Pelvic Inflammatory Disease Hyperprolactinaemia
Define primary infertility
never conceived before
Define secondary infertility
have previously conceived e.g. miscarriage, ectopic…
causes of infertility
tubal disease male factor infertility unexplained endometriosis ovulatory disease
Define subfertility
Failure to conceive despite regular unprotected sexual intercourse over 12 months in the absence of known reproductive pathology
factors influencing fertility
female age
duration of infertility
previous pregnancy
cause of infertility
infertility is common, true or false
true 15%
history taking
infertility history gynae and andrology sexual history SH PMH and surgery Obstetric history
examination
BMI, BP, urinalysis
general exam
pelvic exam and USS in female
urogenital exam in male
investigations for females
chlamydia and gonorrrhoea swab
cervical smear
blood for rubella immunity
midluteal progesterone level (7 days prior to last day of cycle)
progesterone >__nmol/L is suggestive of ovulation
30nmol/L
if progesterone is low and there is an anovulatory cycle,
FSH, oestrogen, LH
rubella immunity level
> 10 U/L IgG Ab
congenital rubella syndrome features
rash
microcephaly
PDA
cataracts
MMR booster vaccine
live vaccine
avoid conception for 4 weeks
Chlamydia can cause…?
PID tubal disease/block tubo-ovarian abscess peritonitis Fitz-Hugh-Curtis syndrome chronic pelvic pain infertility ectopic pregnancy ciliary damage in uterine tube
symptoms of chlamydia
asymptomatic vaginal discharge PCB spotting dysuria
consequence of PID
hydrosalpinx = damaged tube full of toxic fluid
asymptomatic but detected on imaging
regular menstruation is strongly suggestive of ovulation, true or false
true
commonest cause of anovulation
PCOS
Rotterdam criteria is for what
PCOS
Ovulation induction
Anti oestrogens:
clomifene citrate - taken in day 2-6 of cycle, can cause dual egg release
tamoxifen
Aromatase inhbitor:
letrozole - causes mono-ovulation, taken from day 2-6
2nd line ovulation induction
clomifene + metformin
gonadotrophin therapy injections (FSH + LH)
laparoscopic ovarian diathermy
causes of male infertility
multifactorial:
obstructive - vasectomy, infection, CF
non-obstructive - undescended testes, orchitis, torsion, chromosomal
idiopathic
management of male infertility
surgery for obstructed vas deferens
IUI
ICSI
donor sperm insemination
sperm retrieval
Percutaneous testicular sperm aspiration
MESA - microsurgical epidydimal sperm aspiration
tubal investigation
HSG
laparascopy
adhesiolysis
what is endometriosis
presence of endometrial glands and stroma outwith the uterine cavity
Turner’s syndrome chromosome analysis
45XO
ovarian dysgenesis - can’t get eggs
oocyte donation required
