Investigation and treatment of infertility Flashcards

1
Q

What sort of details are important for taking a history for a couple with fertility problems?

A
How long together
How long have you been trying to conceive
Pregnancies together and outcomes
Pregnancies with previous partners
Smoking and alcohol
Coital frequency, timing and problems
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2
Q

What sort of details are important for taking a history for a female with fertility problems?

A

Cycle
Weight/change in weight
Drugs
Risk of tubal disease (STI, ectopic, surgery)

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3
Q

What sort of details are important for taking a history for a male with fertility problems?

A
Occupation
Testicular maldescent
Trauma
Infections (STI, mumps orchiditis)
Surery
Drugs (therapeutic, recreational)
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4
Q

What are the basic investigations used to investigate fertility problems

A

Ovulation
Semen fluid analysis
Pelis anatomy and tubal patency
Ovarian reserve

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5
Q

How can pelvic anatomy and fallopian tube patency be assessed?

A

Laparoscopy and dye = gold standard in tubal patency evaluation
Hysterosalpinogram (HSG)
Hystero contrast sonogram

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6
Q

What is AMH

A

Anti-mullerian hormone

Produced by granulosa cells, from the pre-antral and antral follicles
Can be measure anytime in the cycle and intercycle variability is low
Can be accuratly measured in women receiving hormonal contraception

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7
Q

What are the different types of anovulation

A

Group 1:
Hypothalamic pituitary failure (hypothalamic amenorrhoea or hypogonadotrophic hypogonadism)

Group 2:
Hypothalamic-pituitary-ovarian dysfunction (usually PCOS)

Group 3:
Ovarian failure

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8
Q

What is azoospermia?

A

Azoospermia is the medical condition of a man whose semen contains no sperm

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9
Q

What causes obstructive azoospermia?

A

Normal sized testes and FSH level

Post infection, post vesectomy, congenetial absence of vas deferens

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10
Q

What causes non-obstructive azoospermia?

A

Small testes, raised FSH

testicular failure

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11
Q

Clinically, how can you tell the difference between obstructive and non-obstrucive azoospermia?

A

Obstructive: normal sized testes and normal FSH

Non-obstructive: small testes and raised FSH

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12
Q

What is ICSI

A

Intracytoplasmic sperm injection

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13
Q

How can sperm be retrieved for ICSI?

A
PESA = percutaneous epidydymal sperm aspiration
TESE = testicular sperm extraction
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