Lecture 10 and 11: infertility Flashcards
What is the definition of infertility?
- failure to conceive after 12 months of unprotected sex
- Affects 1:6 couples
Demographic statistics of infertility
NZ has a low fertility rate, potentially due to migration?
Who contributes the most to couple infertility?
- 30% men
- 30% women
- 20% both
- 10% unexplained, couple must be trying for at least 5 years before they can receive public funding
What are anti-sperm antibodies?
- For men→ sperm is separated from the immune system via blood-testis barrier. However, antibodies against sperm can develop due to testicular trauma. 90% of men will develop anti-sperm antibodies from a vasectomy.
- For women→ the female immune system should see sperm as a foriegn antigen. typically, women who have had a male sexual partner for a long period of term can eventually develop anti-sperm antibodies due to vaginal exposure. IgA antisperm antibodies prevent sperm from penetrating the cervical mucus, preventing it from entering the uterus and to the fallopian tube.
What is azoospermia?
lack of sperm in semen
What is asthenozoospermia?
What is asthenozoospermia?
What is teratozoospermia?
higher number of abnormal morphological sperm
aspermia is
no ejacualtion
Does mens age affect fertility?
- yes if its a donor population
- no if its a subfertile population
What are some common diagnoses for patients with sub/infertility?
anovulation endometriosis PCOS recurrent miscarriage unexplained
Anovulation
- absence of ovulation
- decrease occurence of periods, women go more than 35 days without having a period (AKA oligomenorrhoea)
- typically associated with women who have low body fat percentage. This is because adipose tissue is another main source of oestrogen (one third). That is why if a woman wants to increase her chances of getting pregnant and is an athlete/ has less tha 22% body fat, they are encourages to increase their fat percentage to produce enough oestrogen to support growing follicles.
endometriosis
- affects 10% of women
- It is basically the presence of endometiral tissue outside of the uterine caivity (often seen in fallopian tube or ovaries)
- diagnosed using laparoscopy
polycystic ovary syndrome
- quite a common subfertility (20% of women)
- diagnosed with ultrasound and if they’re are 12 of more small follicles. AMH testing also used in conjunction of diagnosis.
- Women with PCOS have elevated LH, testosterone and AMH (generally speaking)
- Signs and symptoms include irregular periods or no periods at all.
difficulty getting pregnant (because of irregular ovulation or failure to ovulate)
excessive hair growth (hirsutism) – usually on the face, chest, back or buttocks.
weight gain.
thinning hair and hair loss from the head.
oily skin or acne.
unexplained (in 10% of couples)
- the hardest to treat for because we dont really know whats causing it.
- they main things to check for is:
- are females ovulating? do they have patent fallopian tubes? do they have any adhesions? endometiosis?
- do males have the normal semen parameters?
- Are the couple having unprotected sex around ovulation for at least 12 months?
four diagnostic tests for infertiility in men
1) Semen analysis
WHO guidelines are stated below. these parameters should at least be: - Count → 15 million per mil - Motility → 40% progressive - Volume → 1.5 ml - Total number of sperm → 39 million in ejaculation - Live sperm → 58% - morphology → 4% must look normal Semen analysis is not 100% reliable evidence for infertility. Its a subjective method, it will depend on the sample on the day, who is analysing it, etc.
2) Hormone measurements
- FSH
- Testosterone
- LH
- Chromosome check
- Endocrine imbalance
3) Physical Exams
- increase varicoceles seen (big vein) = increase risk of infertility
- check for abnormal swelling
4) Detailed histories
- check for testicular trauma
- mumps: inflammatory response affecting testes. results in vascular occlusion and therefore ischemia and decrease sperm count.
- vasectomy
- previous surgeries
- hernia repair
