Infertility management Flashcards
Causes of female infertility
Ovarian defect:
- Primary ovarian insufficiency
- PCOS
Tubal defect:
- Asherman’s syndrome
- PID
Uterine abnormalities:
- Bicornate
- endometriosis
Environmental:
- Smoking
- 19 < BMI > 35
Other:
- Thyroid disease
- Hyperprolactinaemia
- Congenital adrenal hyperplasia
- Age
Causes of male infertility
Smoking Alcohol Drugs Previous testicular torsion Erectile dysfunction - psychological
Female investigations
BMI Bloods - FSH, LH, Free androgen index, prolactin, TFTs Pelvic USS Speculum and swabs - STIs Luteal phase progesterone - day 21 Tubal patency test Cervical screening
Male investigations
Sperm analysis - 2 separate occasions, 3 months apart
FSH/ LH/ Testosterone
USS of testicles
Testicular examination if history implies
Sperm factors
Volume - 1.5 ml pH - 7.2 Concentration - 15 million/ml Total - 39 million Motility - 40% Viable - 58%
Treatment of anovulation
1st line - Clomiphene citrate
2nd line - GnRH analogue
Dopamine agonist - hyperprolactinaemia
Weight optimisation
Egg donation - primary ovarian insufficiency
When is the embryo transferred
Morula cleavage stage - Day 3
Blastocyst stage - Day 5
Definition of infertility
Unable to conceive after having regular unprotected intercourse for a minimum of 1 year
Female History
Duration trying PMHx and surgery Sexual history Menstrual cycle Smoking and alcohol Nipple discharge
Female examination
BMI
Body hair - hirsutism
Acne
Secondary sexual characteristics
Male history
PMHx and past surgeries
Alcohol and smoking
Previous infections - TB and mumps
Sexual dysfunction
Male examination
Only if history implies
- scrotum - varicocele
- testicles - descended
- Prostate - chronic infection
Tubal patency test
Hysterosalpingography
Diagnostic laparoscopy and dye
Clomiphene mechanism of action
Stimulates the pituitary gland to secrete more FSH as blocks oestrogen receptors
When is intracytoplasmic sperm injection used
When vaginal sex not possible e.g. HIV or physical disability
