Infertility Diseases Flashcards
what is infertility defined as
failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sex in a couple who have never had a child
what are the two types of infertility
primary = never conceived secondary = previously conceived but never carried ti term
what are the risk factors of infertility
obesity chlamydia infection old age smoking recreational drugs high caffeine intake
what are the common cause of infertility in FEMALES (5)
anorexia/bulimia endometriosis PCOS premature ovarian failure pelvic inflammatory disease
what hormone levels would you expect in anorexia/bulimia
low FSH
low LH
low oestrogen
what is endometriosis
presence of endometrial glands outside of the uterine cavity
what are the symptoms of endometriosis
dysmenorrhoea (classically before menstruation) = painful cramps dyspareunia = painful sex menorrhagia = heavy period painful defection chronic pelvic pain
what are the investigations of endometriosis
transvaginal US
what would you expect to see on US of endometriosis
“chocolate” cysts on ovaries
what are the symptoms of pelvic inflammatory disease
abdominal/pelvic pain vaginal discharge dyspareunia = painful sex cervical excitation menorrhagia & dysmenorrhoea ectopic pregnancy
what basic things should be done for a FEMALE presenting with infertility
test for chlamydia cervical smear bloods for rubella immunity midluteal progesterone level pelvic exam test tubal patency
what are the 2 methods of testing tubal patency
hysterosalpingogram
laparoscopy
when is a laparoscopy indicated
possible tubal/pelvic disease is suspected
previous pathology (e.g. ectopic pregnancy, ruptured appendix, endometriosis)
dysmenorrhoea
dyspareunia
previously abnormal hysterosalpingogram
when is a hysterosalpingogram indicated
no known risk factors of tubal/pelvic pathology
if laparoscopy is contraindicated
when would a laparoscopy be contraindicated
obesity
Crohn’s
previous surgery
when would you perform a hysteroscopy
suspected or known endometrial pathology e.g. uterine septum, adhesion, polyps
when would a pelvic US be preformed
if pelvic exam is abnormal
if further clarification is needed after a different test
what endocrine hormones are checked if hirsute
testosterone
SHBG
what endocrine hormones are checked if amenorrhoea
Urine HCG Prolactin TSH Testosterone and SHBG LH, FSH and oestradiol
what other test is indicated if amenorrhoea
chromosome analysis
what endocrine hormones are checked if they have an anovulatory cycle or infrequent periods
Urine HCG Prolactin TSH Testosterone and SHBG LH, FSH and oestradiol
what are the main causes of infertility in MALES
idiopathic (>60%)
drugs
non-obstructive
obstructive
give examples of non-obstructive causes of male infertility
47 XXY
chemo or radiotherapy
undescended testes
what hormone levels would you expect in a non-obstructive cause of male infertility
high LH
high FSH
low testosterone
what symptoms would make you suspect an non-obstructive cause of male infertility
low testicular volume
reduced secondary sexual characteristics
vas deferens present
give examples of obstructive causes of male infertility
CF
infection
vasectomy
what symptoms would make you suspect an obstructive cause of male infertility
normal testicular volume
normal secondary sexual characteristics
vas deferens may be absent
what endocrine hormone levels would you expect in an obstructive cause of male infertility
normal LH
normal FSH
normal testosterone
what investigations should you do for a MALE presenting with infertility
abdominal + testicular examination
semen analysis
what is the next step if male examination is abnormal
scrotal US
how is semen analysis done
twice, 6 wks apart
what is the next step if semen analysis is abnormal
measure: LH and FSH Testosterone Prolactin Thyroid function
what is the next step if semen analysis is severly abnormal/ azoospermic
LH and FSH Testosterone Prolactin Thyroid function chromosome analysis screen for CF testicular biopsy
what is the treatment for male infertility
intrauterine insemination = in mild disease
intracytoplasmic sperm injection
donor insemination
what is oligomenorrhea
cycles >35 days
what is amenorrhea
absent menstruation
what are the 2 types of amenorrhea
primary = never had a period secondary = had periods previously
what are the 3 types of ovulatory disorders, which is most common
group 1 = hypothalamic pituitary failure
group 2 = hypothalamic pituitary dysfunction (85%)
group 3 = ovarian failure
give an example of a group 2 ovulatory disorder
PCOS
what are the causes of hypothalamic pituitary failure (Group 1)
stress excessive exercise/ low BMI/ anorexia tumour head trauma drugs
what are the symptoms of hypothalamic pituitary failure (Group 1)
amenorrhea
ovulatory disorders
hypogonadism
what investigations are done in hypothalamic pituitary failure (Group 1), what would you expect to find
hormone levels = low FSH/ LH, normal prolactin
progesterone challenge test = negative
what is the treatment for hypothalamic pituitary failure (Group 1)
get BM >18.5
gonadotrophin injections daily
US monitoring
what is the treatment of hypogonadotropic hypogonadism
pulsatile GnRH
what are the symptoms of
Hypothalamic Pituitary Dysfunction (group 2)
normal oestrogen levels
oligo/amenorrhoea
PCOS
what are the symptoms of PCOS
Amenorrhoea (10-20%) Oligomenorrhoea (80-90%) Acne Hirsutism Central Obesity Insulin resistance (50-80%)
what are the investigations of PCOS
High free androgens (Testosterone)
high LH
glucose tolerance test
US ovaries
what would you expect to see on US in PCOS
polycystic ovaries:
12 or more 2-9mm follicles
Increased ovarian volume >10ml
Unilateral or bilateral
what is the treatment of PCOS
lifestyle change folic acid 5mg daily rubella immunity patency of tubes ovulation induction
what is the first line treatment in ovulation induction
clomifene citrate
what can be given instead of clomifene citrate
tamoxifen
letrozole
what increases sensitivity to clomifene citrate
metformin
what is the 2nd line treatment in ovulation induction
gonadotrophin therapy
what is the 3rd line treatment in ovulation
laparoscopic ovarian diathermy (drilling)
what are the risks of IVF treatment
ovarian hyperstimulation
multiple pregnancy
what is twin-twin transfusion syndrome
complication that arises in 10-15% of monochronicioc twins
what is the cause of twin-twin transfusion syndrome
unbalanced vascular communications within the placental bed
what is premature ovarian failure
menopause before 40
what are the causes of premature ovarian failure
turner syndrome (46X)
fragile X syndrome
autoimmune disease
radio or chemotherapy
what are the symptoms of premature ovarian failure
Hot flushes
night sweats
atrophic vaginitis
amenorrhoea
what hormone levels would expect in premature ovarian failure
high FSH (>30 in 2 samples)
high LH
low oestrogen
what is the treatment of premature ovarian failure
Hormone Replacement Therapy
Egg or Embryo donation (assisted conception treatment)
Ovary / egg / embryo cryopreservation prior to chemo
Counselling
Prevent osteoporosis
