Lecture 5: Infertility Flashcards
Define infertility
- Inability to conceive after 1y of unprotected intercourse of reasonable frequency in women < 35y
- Inability after 6m for women > 35y
Primary = no prior para. Secondary = multips
What conditions tend to result in infertility?
- Oligo/amenorrhea
- Uterine/tubal/peritoneal disease
- Stage 3/4 endometriosis
- Known/suspected male infertility (varicocele)
What is the MCC of infertility?
Ovulatory issues
Male is 2nd highest, so evaluate both partners!
What is conization?
Cone biopsy of cervix, which can affect cervical anatomy and decrease mucus quality
What typically can cause recurrent pregnancy loss?
- Monosomy X (Turner syndrome) for spontaneous miscarriage
- APS
- Uterine abnormalities
What is the MCC of premature ovarian failure < 40y?
Turners
Monosomy X, aka gonadal dysgenesis
What is mittelschmerz?
Midcycle pelvic pain associated with ovulation
What are molimina symptoms?
- Breast tenderness
- Acne
- Food cravings
- Mood changes
How does basal body temperature change with ovulation?
Basal temp increase by 0.4-0.8F is strongly predictive of ovulation
How do ovulation predictor kits work?
Measuring urinary LH, since LH surge precipitates ovulation
Why is FSH good to check ovarian reserve?
- The less eggs you have, the less inhibin you secrete.
- The less inhibin, the more FSH
- FSH > 10 IU/L is associated with diminished ovarian reserve
What does increased antimullerian hormone mean for follicle count?
More follicles
What is the initial treatment for anovulatory infertile women?
Clomiphene citrate (clomid)
What does letrozole do?
Aromatase inhibitor, which inhibits the production of estrogen and increases FSH
What is ovarian hyperstimulation syndrome?
Excessive exogenous gonadotropin therapy resulting in ovarian enlargement
Supportive tx
Describe intrauterine insemination (IUI)
- wash/concentrate sperm
- Insert catheter into endometrial cavity and inject sperm
Describe in vitro fertilization (IVF)
- Direct injection of mature oocytes into endometrial cavity via sonographic evidence.
What is a hyserosalpingogram used to image? (HSG)
Uterine cavity and tubal imaging via radio-opaque dye
What is chromopertubation?
Injection of methylene blue thru cervical canal during laparoscopy to evaluate tubal patency
Tx for tubal occlusion
- Tubal cannulation
- Tubal reconstruction
- Tubal resection followed by IVF
Tx for endometriosis
- Surgical treatment
- IVF
- GnRH
Tx for pelvic adhesions
- Surgical removal
- IVF
How do fibroids affect infertility?
- Obstruction of tubes or distortion of uterus
What is Asherman’s syndrome?
- Intrauterine adhesions
- Hx of D&C
Dx and Tx of Asherman’s syndrome
- Dx: HSG or hysteroscopy
- Tx: Hysteroscopic lysis of adhesions
Why is an endometrial biopsy performed?
Thought to be more informative than just a serum progesterone level.
No longer routine
What does high estrogen do to cervical mucus?
Thin and slippery
It wants the sperm to go up
How long does it take sperm to mature?
90d, so anything 3 months prior could be the culprit for male infertility
Sperm matures best at slightly below body temp
How is semen analysis performed?
- Dont jack off for 2-3 days
- Sterile cup collection
How do you treat antisperm antibodies?
Corticosteroids
You will see agglutination on semen analysis
Tx of oligospermia
IUI
If you cant make enough, then we concentrate it and inject it
Causes of azoospermia
- Congenital absence of vas deferens (CF)
- Severe infection
- Vasectomy
Tx with donor or epididymal aspiration
What is asthenospermia and causes and tx?
- Decreased sperm motility
- Prolonged abstinence
- Antisperm antibodies
- Infection
- Varicocele
- Tx with intracytoplastic sperm injection or IUI
What is teratospermia and Tx?
- Abnormal morphology
- Tx with IVF
What might low FSH & low testosterone suggest in a male? Tx?
- Kallmann syndrome: anosmia + hypogonadotropic hypogonadism
- Idiopathic hypogonadotropic hypogonadism
- Tx with gonadotropins!
What might elevated FSH with low testosterone suggest?
Testicular failure resulting in oligospermia.
Testicles get stimulated but they aint working
What are the genetic causes of poor semen analysis?
- Klinefelter syndrome (XXY)
- Microdeletion of Y chromosome
- CF
