Infertilty/Subfertility Flashcards
Definition of subfertility?
Conception has not occurred after 1 year of regular unprotected intercourse
What are 2 types of of female anovulation causes? Categorise them.
Primary ovarian failure:
- Premature ovarian failure
- Genetic conditions i.e Turner’s Syndrome
- Autoimmune
- Chemotherapy/Previous surgery
Secondary ovarian failure:
- PCOS
- Excessive weight loss or exercise
- Hypopituitarism –> trauma, surgery, tumour
- Kallman’s syndrome
- Hyperprolactinaemia
You are a GP, couple has come in complaining of subfertility. What investigations do you do?
Hormone profile (Day 2 FSH, Day 21/28 progesterone) TFT Prolactin (if indicated) Vaginal swabs (to make sure no STIs) Cervical smear Rubella serology Semen analysis
What are 5 causes of infertility?
- Ovulation disorder
- Tubal factor
- -> PID/adhesions/endometriosis
- Male factor
- -> cystic fibrosis
- Unknown
- Lifestyle factors i.e smoking/obesity/alcohol
What is your initial advice to people concerned about their fertility?
A. Over 80% of couples in the general population will conceive within 1 year if:
1) the woman is aged under 40 years and
2) they do not use contraception and have regular sexual intercourse.
Of those who don’t conceive in the first year, about half will do so in the second year
B. Advise to stop smoking/lose weight
C. vaginal sexual intercourse every 2 to 3 days optimises the chance of pregnancy
As a GP, what questions would you ask the couple about fertility?
- Age.
- Duration of subfertility.
- Menstrual cycle regularity and LMP (pregnancy test?).
- Pelvic pain (dysmenorrhoea; dyspareunia).
- Cervical smear history.
- Previous pregnancies.
- History of ectopic pregnancy.
- Previous tubal or pelvic surgery.
- Previous or current STIs.
- Previous PID.
- Coital frequency.
- Any relevant medical or surgical history.
- Drug history (any prescription drugs that may be contraindicated in pregnancy and ask about recreational drug use).
- Smoking.
- Number of units alcohol/week.
- Folic acid.
2 investigations for tubal patency in female infertility?
Hysterosalpingogram
Hysterosalpingo-contrast-sonograph
Laparascopy + dye and dye test
5 reasons for male infertility?
Genetic: Klinefelter’s Syndrome, Cystic Fibrosis
Obstructive azoospermia: Epididymo-orchitis, previous testicular torsion/injury
Autoimmune: autoimmune orchitis
3 components of ovarian reserve testing?
FSH
AMH
Antral follicle count
In secondary care, what further investigations would you do to assess cause of male fertility?
Clinical examination:
- Secondary sexual characteristics
- Testicular size (orchidometer?)
Blood tests:
- FSH, LH, prolactin
- Karyotype (Klinefelter’s)
- Genetic testing (Cystic Fibrosis)
Imaging:
- USS/Vasogram
Testicular biopsy (if cryopresentation facilities present)
3 complications of IVF
Multiple pregnancy
Ectopic pregnancy
Miscarriage
Ovarian hyperstimulation syndrome
Definition of infertility?
Period of time people have been trying to conceive without success after which formal investigation is justified and possible treatment implemented
Give 5 components of semen analysis.
Semen volume pH Sperm concentration Total sperm number Total motility Vitality Sperm morphology
3 WHO categories of ovulation disorders?
Group I: hypothalamic pituitary failure (hypothalamic amenorrhoea or hypogonadotrophic hypogonadism).
Group II: hypothalamic-pituitary-ovarian dysfunction (predominately polycystic ovary syndrome).
Group III: ovarian failure.
3 pieces of advice for male infertility?
Wear loose boxers
Stop smoking
Moderate alcohol drinking
Get BMI in healthy range
