Infertility Tutorial Flashcards
30F - BMI 19 kg/m2, amenorrhoea for 6/12, runs daily to help with stress at work, training for London Marathon.
Oestradiol <70pmol/L (undetectable)
LH 0.5 U/L (2 – 14)
FSH 0.8 U/L (1.5 – 10)
Prolactin 300mU/L (100 – 500)
What is the diagnosis?
Female athlete triad - excess exercise, low BMI, stress: leads to low GnRH
Which consequently leads to low LH / FSH = low oestrogen levels
There are limited body resources that can be distributed
Underweight = depleted resources = sacrifices fertility (as fertility is not key for personal survival)
Linked to leptin, a hormone contained within body fat, one of the signals to the brain to maintain HPG function
Sudden decreased adipose tissue = drop in lectin levels = HPG axis shuts down
What treatment would you suggest to improve fertility?
Reduce exercise regimen
Gain weight
30F, BMI 30kg/m2, has gained weight over last 3 years. Oligomenorrhoea for 1 year. Acne and hirsutism particularly problematic over the last year too
Oestradiol 150pmol/L (50-800)
LH 6 U/L (2 – 14)
FSH 3 U/L (1.5 – 10)
Testosterone 3 nmol/L (<1.8)
What is the diagnosis?
PCOS - high BMI, high testosterone levels, oligomenorrheoa, acne and hirsutism
Clinical and biochemical signs of hyperandrogenism
Insulin resistance = common, so may have high insulin (not measured in this case study)
What treatment would you suggest to aid fertility?
Weightloss - helps restore insulin sensitivity
Metformin - diabetic medication for insulin resistance
OCP = decreases oligomenorrhoea / regulates menses
Aromatase inhibitors - reduce oestrogen that then increases LH and FSH = increase fertility (ovulation)
SERM = selective oestrogen modulator - only binds to certain oestrogen reeptors i.e. in the hypothalamus = stops oestrogen having a negative feedback mechanism on the hypothalamus
Anti-androgen gel - depends on patient and their hyperandrogenism
40F - BMI 24kg/m2; amenorrhoea for 6/12; previously regular periods; no acne, hirsutism or galactorrhoea.
Oestradiol <70pmol/L (undetectable)
LH 30 U/L (2 – 14)
FSH 24 U/L (1.5 – 10)
Prolactin 300mU/L (100 – 500)
What is the diagnosis?
Secondary amenorrhoea, normal BMI
POI = high LH, FSH and low oestrodial
What treatment would you suggest to improve fertility?
IVF or egg donation - as there is no ovulation
Assisted fertilisation
Anti-Mullerian Hormone (AMH) = marker for egg reserve
30 yearold, BMI 24kg/m2. Amenorrhoea for 6/12. Previously regular periods. Galactorrhoea. Recent visual disturbance.
Oestradiol <70pmol/L (undetectable)
LH 0.5 U/L (2 – 14)
FSH 0.5 U/L (1.5 – 10)
Prolactin 30, 000mU/L (100 – 500)
What is the diagnosis?
Prolactinoma - v. high prolactin levels
Comppression of the optic chiasm = visual disturbance
High prolactin = shuts down HPG axis
What treatment would you suggest to aid fertility?
Dopamine angonist - can help shrink the tumour
Surgery = remove tumour as it is causing visual disturbance - trans-sphenoidal hypophysectomy
30F, BMI 24kg/m2. Regular periods.
Oestradiol 150pmol/L (50-800)
LH 3 U/L (2 – 14)
FSH 3 U/L (1.5 – 10)
Prolactin 300mU/L (100 – 500)
What is the diagnosis?
Healthy biochemically
Therefore, might be:
Male factor infertility
Anatomical abnormalities (not physiological)
Stress
What treatment would you suggest to aid fertility?
Keep trying for another 12 months - regular sex
Male factor infertility - investigate partner’s sperm count
Anatomical abnormalities (not physiological) - do an examination and/or ultrasound scan and/or uterus MRI
Stress - evaluate current life situation
