L07: Fertility And Infertility Diagnosis And Causes Flashcards
What do you need to do to be fertile (to in males and females)
Produce sperm Produce egg Sperm should transverse female tract Sperm has to penetrate and fertilise the egg Implantation of embryo into uterus Normal pregnancy i.e no miscarriage
What is the definition of fertility
Measure of actual outcome of the reproductive process- number of children born
What is the definition of fecundability
Probability of pregnancy each month of an individual or population.
What is the definition of fecundity
Measure to conceive AND produce a live birth
What is the definition of infertility
Inability to conceive after a period of unprotected intercourse or inability to carry a pregnancy to term
What does NICE say the definition of infertility is
Failing to get pregnant after 2 years of regular unprotected sex
What is the definition of sub fertility
A state of reduced fertility
What causes increase the risk of infertility
Age
Smoking
Obesity
STI’s
Name and STI
Chlamydia
What are the groups of diseases that can cause fertility problem in females
Ovulatory disorder
Tubal damage
Endometriosis
Uterine abnormalities
What investigations can be carried out for a female patient presenting with fertility problems
LH/FSH ratio
Day 21 progesterone
Laparoscopy
Hysterosalpingogram (HSG)
What does looking at FSH/LH ratio help us to look at
Ovarian reserve
PCOS
What does day 21 progesterone help us to look at
If ovulation is occurring
What is laparoscopy
Key hole surgery that allows to view the uterus
What is hysterosalpingogram
Dye is inserted into the uterus and viewed with X-RAY
What does hysterosalpingoram allow to detect
Blockage of tubes
If there is no tubal blockage what happen to the dye
Spills into the pelvic cavity
What can ovulation disorders present as
Ammenorhhea
Secondary ammenorhhea
Oligomenorrhea
What are possible disorders that cause ovulation disorders
Idiopathic ovarian failure
PCOS
Luteinesed unruptured follicle syndrome
Abbreviated luteal phase
What does the idiopathic ovarian failure result in
Oestrogen levels do not rise and follicles to not mature this results in small follicles
What are the hormones like in PCOS
High FSH
High androgen
No oestrogen deficiency
What is the abbreviated luteal phase hormone Satus like
Decreased progesterone
What does decreased progesterone result in
Poor luteinisation
What are the disorders that can occur in the female tract
Tubal obstruction
Endometriosis
What can tubal obstruction occur as a result of
Infection
If the tube is blocked what becomes affected
The release of the egg
The transport of sperm to the egg
Due to loss of cilia and intraluminal cells and scarring that cause adhesion
What is endometriosis
When the endometrium of the uterus increases in ectopic sizes such as oviduct, ovary, peritoneal cavity
What are the maternal problems that can occur that affects fertility
Cervical incompetence
Implantation defects
Autoimmune
Immunological incompatible in terms of ABO or rhesus blood group loci
What increases the risk of tubal infection
STD, eg gonorrhoea, chlamydia, tuberculosis
What is the biochemical test for testing for pregnancy
HCG in blood or urine
At what day do we test for HCG after the last period
18-30 days
How do we test for clinical pregnancy
Ultrasound at week 5 as a foetal sac
If we do an ultrasound at week 7 what would be visible
Foetal heart
What is the main cause of spontaneous pregnancy loos
Chromosomal abnormalities
What are the 3 categories that result in chromosomal abnormality
Translocation
Errors of ploidy
Errors of chromosome number or somy
What is errors of ploidy
Deletion or duplication of a complete set of haploid chromosome i.e from diploid to tetraploid
What are the errors of chromosome or somy about
Loss or gain of a single chromosome
What does aneuploidy mean
Having one or more chromosome above or below the normal chromosome number
What happens to the risk of aneuploidy as maternal age increases
Risk increases
Why is there an increased risk of aneuploidy with increased age
Egg quality decreases as egg can become damaged
What can be the causes of male disorders for fertility
Production of sperm Transport of sperm Motility of sperm Sperm function in female tract Fertilisation and events after
What tests should be done for a male with fertility issues
Semen analysis
Blood test
If a male has a sperm production of less than 5 million per ml what is required
Endocrine evaluation
What does normozoospermic mean
Normal sperm with:
- more than 15 million spermatozoa
- more than 32% motility
- more than 4% normal morphology
What does oligozoospermic mean
Less than 15 million spermatozoa per ml
What does asthenozoospermic
Less than 32% of rapid and medium forward progressive motility
What does tetrazoospermic mean
Less than 4% of sperm with normal morphology
What does azoospermic mean
No sperm
Why can a patient be azoospermic
Congenital testicular deficiency e.g klinefelters syndrome XXY
Maldescent testis i.e cyrptorchidism
Acquired via trauma or mumps
Endocrine disorder
What are the congenital acquired testicular deficiency that lead to azoospermic
Klinefelters syndrome (XXY) Y chromosome deletion
What can be the acquired causes of azoospermic
Trauma
Orchitis (MUMPs)
Apart from the basic analysis of sperm what other tests can we do on semen
Leukocytes Sperm viability test Sperm vitality Antisperm antibodies CASA
At what leukocyte level indicates infection
More than 1 million per ml
What does sperm viability test look at
Even though the sperm is not moving, is it still alive
What are the causes for failure of transmission of sperm to the female tract
Erectile dysfunction
Ejacgulatory dysfunction
What are the 2 forms of ejaculatory dysfunction
Retrograde
Defects of accessory sex glands
Describe the normal process that occurs in normal ejaculation
1) prostate, seminal vesical and vas deferens contracts under the influence of SNS
2) seminal fluid and sperm enter the urethra
3) urethral and pelvic floor muscles contract and ejaculation occurs
4) vesicular urethral spinchter closes bladder neck
What is retrograde ejaculation
1) the urethral spinchter at the bladder neck does not close
2) ejculaton is into the bladder
3) so the sperm is low or nil
What are the associated conditions with retrograde ejaculation
Diabetes
Post traumatic paraplegia
Post bladder neck surgery
How is retrograde ejaculation confirmed
Semen in urine
What are the causes of total failure in transport of sperm
Infections
Congenital bilateral absences of vas deferens (CBAVD)
What is CBVAD linked to
Cystic fibrosis
What occurs in CVAD
Improper development of the vas deferens
It there is no obstruction in the male tract but patient is azoospermic or oligozoospermia what need to be tested
Genetic testing for chromosomal abnormality
What is the definition of unexplained infertility
- normal frequency of unprotected intercourse
- no obstruction or malformation of female/male tract
- normal follicle growth and ovulation and no signs of inflammatory reactions in female
- normal motile sperm and no signs of inflammatory reactions in males
What does high levels of FSH/LH indicate
Low ovary reserve as there is no negative feedback
What does low levels of LH/FSH indicate
Pituitary and hypothalamus pathology
In PCOS why is there higher levels of LH
LH stimulates theca cells to produce testosterone
Why are there normal levels of oestrogen in PCOS
1) there is normal levels of FSH
2) FSH acts on granulosa cells to produce aromatase which converts the testosterone into oestrogen
