Infertility & Assisted Conception Flashcards
what are the 4 different types of defining gender
- Chromosomal sex: presence/absence of Y chromosome
- Gonadal sex: foetus with ovaries or testes
- Genital sex: male or female external genitalia
- Gender: female or male identity – perceived genital sex and rearing as female or male
how muchb of fertility are male factors causing
around a third
is male infertility increasing or decreasing
increasing
what is the most common cause of male infertility
idiopathic
what is normal testicular volume in adults and pre pubertal
12-15ml adult
1-3ml pre pubertal
what investigations are performed in male infertility
- semen analysis
- endocfrine profile
- chromosome analysis
- CF screening
- testicular biopsy/scrotal US
what is examined on semen analysis
volume, density, motility, progression and morphology
what 6 things can affect semen sample
- completeness of sample
- period of abstinence (>3 days)
- condition during transport (temperature)
- time between product and assessment
- natural variation between samples
- health of man 3 months before production
how many times is semen analysis performed
twice - 6 weeks later
describe the picture seen on examination w/ obstructive infertility
- Normal sperm production, mechanical blockage
- Normal testicular volume and secondary sexual characteristics
- The vas deferens may be absent
- Endocrine: normal LH, FSH and testosterone
describe the picture seen with non-obstructive male infertility
- Sperm production deficient/absent
- Low testicular volume and reduced secondary sexual characteristics
- Endocrine: high LH, FSH ± low testosterone
male infertility: how often do you advise sex
2-3 times a week
male infertility: alcohol, smoking and caffiene advice
alcohol <4 units a day
stop smoking - decreased semen quality and general health
no caffeine evidence
does BMI effect sperm
BMI <18.5/>30 is associated with decreased fertility and taking >1 year to get pregnant
also, insulin resistance PCOS etc
what are teh reversal rates for vasectomy
75% within 3 years, 55% 3-8years
what are teh success rates of IVF and ICSI
35%
how can pregnancy be achieved if man has azoospermia
donor sperm insemination
adoption etc
what investigations are done inthe female presenting with infertility
- lifestyle - drugs, alcohol, weight, smoking
- folic acid - 400mcg pre conception (5mg if obese/DM/epilepsy etc)
- check rubella immune
- cervical smears upt o date
- STI check
- screen for blood borne viruses eg hep and hiv
what investigation can be done in a female to investigate her fertility potential
antral follicle count - by transvaginal US
how can tubal patency be tested
hysterosalpinogram (X ray) and laparoscopy with dye
what is IUI
preapred semen inserted into uterine cavity around the time of ovulation
what are the main indications for IUI
- sexual problems, same sex relationships, discordant BBV or abandoned IVF
after how many years of unexplained infertility can you get IVF
>2years
at what stage is the embryo transfered into the uterus in IVF
blastocyst stage
