Infertility (+hormones) Flashcards
How many couples become pregnant within a year if they have no fertility issues?
80%
How many couples become pregnant within 2 years with no fertility problems?
90%
What age does cycle irregularities often begin in women?
45yrs
Which NATURAL female factors influence fertility most?
- female age
- ovarian reserve
which test is used to determine a women fertility?
There are none.
What are the 4 most important factors of conception?
- ovulation
- sperm production
- fertilisation
- implantation
Which hormone affects ovulation?
Lutenizing hormone
what is the hormone pattern in female ovulation?
LH surge causes ovulation
After ovulation, progesterone increases
What diagnostic test can tell you if a women has ovulated?
Measuring progesterone levels (they will have risen if ovulation has occurred) - it is released by the corpus luteum
When should progesterone levels be tested?
On day 21 (if it is a normal 28 day cycle)
What are the stages of the ovarian cycle?
- follicular stage
2. luteal phase
What are the stages of the menstrual stage?
- menstruation
- proliferative phase
- secretory phase
What does FSH hormone do in males?
Stimulates the Sertoli cells to allow spermatogenesis
What does LH hormone do in males?
Stimulates the Leydig cells to produce testosterone
What does testosterone do in males?
- Stimulates spermatogenesis in the Sertoli cells
2. Responsible for secondary characteristics
What is the site of fertilisation?
The Fallopian tube
What does LH do in the female?
- stimulates oestrogen and progesterone production by ovaries
- induction of ovulation
- production of ova
What does FSH do in females?
- stimulates development of eggs (ova)
What does oestrogen do in females?
https://courses.lumenlearning.com/wm-biology2/chapter/reproductive-hormones/
- endometrial regrowth
- calcium absorption
- secondary characteristics of puberty
- ovulation
- regulates menstrual cycle
. prepares body for pregnancy
What does progesterone do in the female?
- endometrial regrowth
- inhibition of FSH and LH
- regulation of menstrual cycle
- prepare the body for pregnancy
What is the clinical definition of infertility?
Inability to conceive over a 12 months period despite regular, unprotected intercourse
What does the clinical definition of infertility suggest?
Does not suggest infertility for sure
Should be used to suggest referral for investigations and management
When should you refer a couple for infertility testing and management?
- if no conception after a year of unprotected sex
2. earlier if >35 yrs or known cause for infertility
What is primary infertility?
When you have not conceived after 1yr of trying and have NEVER had a child.
What is secondary infertility?
When a couple haven’t conceived within 1yr of trying but HAVE had a child previously.
What is the most common cause of infertility in females?
- Ovulatory dysfunction
- tubal factor
- reducing ovarian reserve
- endometriosis
- uterine factors
What are common male infertility problems?
- cystic fibrosis
- low sperm count
- sperm - abnormal shape, not moving enough
- testicular problems
- ejaculation problems
How often is a cause of infertility not found?
1 in 4 have no cause found.
How often is a cause of infertility not found?
1 in 4 have no cause found.
When does the egg count in a female start to decline?
After 30yrs
steeply after 35yrs
Which tests can show ovarian reserve/egg availability?
- FSH test (day 1-5)
- AMH test (any day - anti-mullerian hormone)
- ultrasound (astral follicle counting)
Which tests can show if ovulation is happening?
- Basal body temperature (higher post ovulation)
- cervical mucous (maximum - thin and water - around ovulation)
- LH kids
- Ovulation calendar
- day 21 serum progesterone (>20 is suggestive of ovulatory cycle)
How can sperm availability be tested?
- semen analysis/sperm count
How can Fallopian tube patency be tested?
- Hysterosalpingogram
2. Laparoscopic dye test
Why is serum prolactin test done?
High levels of prolactin inhibit FSH which could cause infertility
How are ovulation disorders treated?
- lifestyle changes
- clomiphene citrate (acts like oestrogen)
- gonadotrophins
- laparoscopic ovarian drilling (for PCOS)
How is low sperm count treated?
- gonadotrophins
- surgical sperm retrieval
- donor sperm
- intracytoplasmic sperm injection
How are Fallopian tube problems treated?
- IVF (most common)
2. surgery (rare)
When is IVF given to couples with unexplained infertility?
After 2 years
What are the key steps of IVF?
- ovarian stimulation (using hormone injection)
- ovarian monitoring
- ovulation triggered (injection of HCG)
- 36hrs later - egg retrieval (sperm collected on this day if fresh is being used)
- Insemination (sperm and egg mixed into dish)
- ICSI (if low sperm count)
- incubation
- embryo development (maximum of 6 days)
- embryo transfer (using fine plastic catheter, via ultrasound)
What happens in IVF after embryo transfer?
- Pregnancy test after 2 weeks
- scan at 7 weeks (is positive pregnancy test)
- progesterone pessaries (to thicken womb and prepare for pregnancy)
What are the side effects of IVF?
- medication side effects
- multiple pregnancy (usually only 1 embryo is implanted)
- procedure related injury
- Ovarian hyperstimulation syndrome (due to hormones)
How successful is ICSI and insemination at fertilising the egg?
Both have a 60-70% success rate.
