Infertility and IVF Flashcards
Define infertility
Defined as an inability to conceive after 12 months regular intercourse without contraception
When does the LH surge occur?
36 hours before ovulation
When does progesterone peak?
A week following ovulation
What do ovulation predictor kits detect?
Detects LH surge (24-36h before ovulation)
How can it be confirmed is a woman is ovulating?
Confirmed by midluteal serum progesterone (>30nmol/L) - adjusted for cycle length
What initial investigations will be undertaken by GPs for infertility? (females)
- day 21 progesterone, establish ovulation
- TSH
- rubella immunity
- chlamydia screen
- ensure cervical smear up to date
If amenorrhoeic / cycle longer than 42 days - follicular phase bloods; LH, FSH, E2
- testosterone, SHBG, FAI
- prolactin
What is azoospermia?
No sperm in ejaculate
What is asthenozoospermia?
% progressive motile sperm below reference limit
What is oligozoospermia?
Total number / concentration of sperm below reference limit
What is teratozoospermia??
% morphologically normal sperm below reference limit
What is hydrosalpinx?
Fluid within the fallopian tube
What is the revised rotterdam diagnostic criteria (PCOS)?
- oligo/amenorrhoea
- polycystic ovaries (scan appearance); 12/more 2-9mm follicles, increased ovarian volume >10ml, unilateral / bilateral
- clinical and or biochemical signs of hyperandrogenism (acne, hirsutism)
How can ovulation be induced?
- clomifene citrate (1st line); 50-100-150mg tab, days 2-6, alternatively letrozole
- gonadotrophin injections; recombinant FSH, risk of multiple pregnancy and overstimulation
- laparoscopic ovarian diathermy; risk of ovarian destruction
What is the mode of action of clomifene citrate?
Anti-oestrogen properties to prevent feedback from follicles so that the pitutiary is stimulated to increase hormone release
Describe treatment of blocked fallopian tubes
- generally no treatment for tubal disease
- cannulation using guidewire or microcatheter for proximal tubal occlusion
