Investigation and treatment of infertility Flashcards
What sort of details are important for taking a history for a couple with fertility problems?
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
What sort of details are important for taking a history for a female with fertility problems?
Cycle
Weight/change in weight
Drugs
Risk of tubal disease (STI, ectopic, surgery)
What sort of details are important for taking a history for a male with fertility problems?
Occupation Testicular maldescent Trauma Infections (STI, mumps orchiditis) Surery Drugs (therapeutic, recreational)
What are the basic investigations used to investigate fertility problems
Ovulation
Semen fluid analysis
Pelis anatomy and tubal patency
Ovarian reserve
How can pelvic anatomy and fallopian tube patency be assessed?
Laparoscopy and dye = gold standard in tubal patency evaluation
Hysterosalpinogram (HSG)
Hystero contrast sonogram
What is AMH
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
What are the different types of anovulation
Group 1:
Hypothalamic pituitary failure (hypothalamic amenorrhoea or hypogonadotrophic hypogonadism)
Group 2:
Hypothalamic-pituitary-ovarian dysfunction (usually PCOS)
Group 3:
Ovarian failure
What is azoospermia?
Azoospermia is the medical condition of a man whose semen contains no sperm
What causes obstructive azoospermia?
Normal sized testes and FSH level
Post infection, post vesectomy, congenetial absence of vas deferens
What causes non-obstructive azoospermia?
Small testes, raised FSH
testicular failure
Clinically, how can you tell the difference between obstructive and non-obstrucive azoospermia?
Obstructive: normal sized testes and normal FSH
Non-obstructive: small testes and raised FSH
What is ICSI
Intracytoplasmic sperm injection
How can sperm be retrieved for ICSI?
PESA = percutaneous epidydymal sperm aspiration TESE = testicular sperm extraction