Infertility, IVF and genetic testing Flashcards
what fraction of couples in the UK are affected by infertility?
1 in 6/ 1 in 7
around 3.5 million people
what are the types of infertility?
what percentage do each ocntribute
5
25% unexplained
25% ovulatory
20% tubal
30% male factor
10% uterine
what are the main causes of infertility for females?
- Problems with ovulation
- Tubal problems
- Uterine problems
- Age
what are the main causes of infertility for males?
- Poor sperm quality
- azoospermia
- sperm dysfunction
- ejaculation disorders
what two causes of infertility can apply to both sexes?
- unexplained
- immunological infertility
what is anovulation?
Anovulation happens when an egg (ovum) doesn’t release from your ovary during your menstrual cycle
what is oligoovulation?
a condition that causes irregular or infrequent periods.
because eggs don’t mature or get released like they should be
what are the primary causes of ovulation problems?
Surgical removal of ovary
Ovaries damaged by radiotherapy/ chemotherapy
Premature menopause (affects 1-2% <40years)
Congenital defect
Polycystic ovaries
what are the secondary causes of ovulation problems?
Severe stress
Recent large gain or loss of weight
Tumour
Excess prolactin
Disturbances in thyroid and adrenal gland
What are luteal phase defects?
Defect of progesterone secretion by corpus luteum or defective response of the endometrium to hormonal stimulation.
- Results in inadequate endometrium for embryo implantation
what happens in luteal phase defects?
3
- Poor follicle production
- Premature failure of corpus luteum
- Failure of uterine lining to respond to progesterone
- resulting in inadequate endometrium for embryo implantation
what is polycystic ovarian syndrome?
Most common cause of ovulation disorders in women of reproductive age.
Characterised by many minute follicles in the ovaries and an excess production of androgens. (cysts less than 1mm and rarely grow to maturity)
Associated with weight gain, excessive hair growth, irregular, infrequent or absent periods and infrequent or absent ovulation
what is the incidence of PCOS in those with oligomenorrhoea, amenorrhoea and anovulation?
90% women with oligomenorrhoea
30% women with amenorrhoea
70% women with anovulation
what is oligomenorrhoea?
irregular and inconsistent menstrual blood flow in a woman
what is amenorrhoea?
the absence of menstruation, often defined as missing one or more menstrual periods
what treatment options are there for people with polycystic ovarian syndrome?
Lose weight if over weight
Induce ovulation with clomiphene tablets
Controlled ovarian stimulation with FSH and hCG
Surgery
give two examples conditions causing ovulation problems?
- luteal phase defect
- polycystic ovarian syndrome
what are common tubal problems?
3 broad
- damaged fimbriae (prevent movement of oocyte into the fallopian tube)
- adhesions may distort the tube
- tubal blockage (prevents the sperm from reaching the oocyte or prevents the zygote fom moving to the uterus leading to increase incidence of ectopic pregnancy)
what are the causes of tubal problems?
- infection
- previous ectopic pregnancy
- congenital abnormality
- hydrosalpinx
- endometriosis
what is hydrosalpinx?
blocked, dialated, fluid filled fallopian tubes usually caused by previous pelvic infection
what is endometriosis?
what percentage of women of childbearing age does it affect?
Misplaced endometrial tissue outside the uterus
Commonly affects the ovaries and Fallopian tube, less commonly the bowel and bladder
If severe, may reduce fertility
Associated with mild, severe or chronic pain during menstruation and sexual intercourse may be painful
affects 10% of women of childbearing age
what is endometriosis?
what percentage of women of childbearing age does it affect?
Misplaced endometrial tissue outside the uterus
Commonly affects the ovaries and Fallopian tube, less commonly the bowel and bladder
If severe, may reduce fertility
Associated with mild, severe or chronic pain during menstruation and sexual intercourse may be painful
affects 10% of women of childbearing age
what treatment is available to those with endometriosis?
- Pain relief with NSAIDs - non steroidal anti-inflammatory drugs
- Prevent fluctuation in the woman’s hormone levels to remove the stimulation for growth of the endometriosis eg the oral contraceptive pill
what are the causes of uterine problems?
Fibroids – benign growths arising from smooth muscle of the uterus.
Uterine polyps – small growths of endometrial tissue dangling in the uterus may interfere with implantation
Uterine adhesions – may be consequence of infection or surgery may occlude uterine cavity
Congenital problems – absent uterus, hypoplastic uterus, double uterus, uterine septum etc