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MBCHB3: Reproduction, Development and Ageing > Lecture 6: Infertility > Flashcards

Lecture 6: Infertility Flashcards

1
Q

Define infertility:

A

Infertility is “a disease of reproductive system defined by the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse)

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2
Q

Define infertility:

A

Infertility is “a disease of reproductive system defined by the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse)

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3
Q

What was infertility associated with?

A

Increased risk associated with being underweight or very obese.

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4
Q

Does mens age impact their fertility?

A

There is a decrease in semen volume, sperm motility and sperm morphology with age.

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5
Q

Does mens age impact their fertility?

A

There is a decrease in semen volume, sperm motility and sperm morphology with age.

  • <30 vs 50+ there is a decrease in pregnancy
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6
Q

How is ovarian reserve assessed?

A
  • Family history, early menopause?
  • Antral follicle count
  • Anti-mullerian hormone test (blood test)
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7
Q

What factors affect gemete health in males?

A 
Age
Mediterranean diet
Smoking
Alcohol
Anti-oxidants
Weight
Frequent sex
Keep testes cool
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8
Q

What factors affect gemete health in males?

A 
Age
Mediterranean diet
Smoking
Alcohol
Anti-oxidants
Weight
Frequent sex
Keep testes cool
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9
Q

What are the common diagnosis for patients with sub/infertility?

A 
Anovulation
Endometriosis
Male factor infertility
PCOS
Recurrent miscarriage
Unexplained ~10%
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10
Q

What can cause anovulation?

A

Oligomenorrhea ->35 days without mensturation, can be exercised induced

Reduced body fat - adipose tissue important for producing oestrogens

PCOS

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11
Q

How do cholomiphene and letrozole act?

A

Cholomiphene: Blocks E2 action on pituitary, therefore, more FSH than usual

Letrozole: Similar effect on FSH by reducing the amount of estradiol made in the ovary.

[Extra FSH restores the menstural cycle]

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12
Q

How do cholomiphene and letrozole act?

A

Cholomiphene: Blocks E2 action on pituitary, therefore, more FSH than usual

Letrozole: Similar effect on FSH by reducing the amount of estradiol made in the ovary.

[Extra FSH restores the menstural cycle]

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13
Q

What are the treatments for PCOS:

A

Weight loss
Ovulation induction agent commonly letrozole
Metformin (evidence of insulin resistance)
IVF (Avoid OHSS)

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14
Q

How does PCOS impact mental health:

A

Higher rates of:

  • Depression
  • Anxiety
  • Poor body image and eating disorder
  • Psychosexual dysfunction

Regular check mental and emotional health

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15
Q

How does PCOS impact mental health:

A

Higher rates of:

  • Depression
  • Anxiety
  • Poor body image and eating disorder
  • Psychosexual dysfunction

Regular check mental and emotional health

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16
Q

What are some investigations for anovulation?

A
  • Progesterone (mid luteal)
  • FSH (early follicular)
  • LH (Early follicular)
  • Testosterone
  • Transvaginal US
  • BMI
  • Karyotyping
17
Q

What are some investigations for anovulation?

A
  • Progesterone (mid luteal)
  • FSH (early follicular)
  • LH (Early follicular)
  • Testosterone
  • Transvaginal US
  • BMI
  • Karyotyping
18
Q

Write some notes on endometriosis:

A

Presence of endometrial tissue outside the uterine cavity (ovaries, fallopian tubes)

Diagnosed by laproscopy

Symptoms may include painful periods but may be asymptomatic - symptoms can indicate the site

Interferes with fertilisation and implanatation

19
Q

What are the possible treatments for endometriosis?

A
  • Surgical removal (gold standard)
  • Lipiodol flushing
  • IUI using mild stimulation if endometriosis is mild and patent tubes
  • IVF - more risk
20
Q

What is examined in a semen analysis:

A 
Count - 15M/ml
Motility - 40% progressive
Volume 1.5mL plus
Total sperm ~39m
Morphology 4% or more
21
Q

What are some diagnostic tests for male infertility?

A

FSH, Testosterone, Chromosome, Endocrine imbalance

Physical exam: Varicoceles, abnormal swelling

Detailed history: mumps, trauma etc

Testicular biopsy

22
Q

Write some notes on unexplained infertility:

A

Female: Patients ovulating, patent fallopian tubes, no adhesions, no endometriosis

Males: normal semen parameters

Ovulation and sex for 12 months plus.

i.e everything algood, cant get pregnant

23
Q

What are some treatments for unexplained infertility?

A

Lifestyle changes
Expectant management - good chances
IUI treatment
IVF treatment

24
Q

What tests are required prior to a referral?

A
  • Semen analysis
  • Current smear
  • Ante-natal screening + current smear
  • HIV, Hep B, Hep C status
  • FSH and oestradiol level day 2-4 of cycle
  • Progesterone level 6-8 days before menses
25
Q

What tests are required prior to a referral?

A
  • Semen analysis
  • Current smear
  • Ante-natal screening + current smear
  • HIV, Hep B, Hep C status
  • FSH and oestradiol level day 2-4 of cycle
  • Progesterone level 6-8 days before menses
26
Q

What is the eligibility and cost of IVF in NZ?

A

Eligibility for up to two courses IVF determined by:

  • Failure after 12 months unprotected sex
  • BMI <35 first appt, <32 for treatment, <40 for man
  • Under 40 woman, under 55 man
  • N. prev children
  • Sterilisation history

Both non smokers for 3 months at least.

IVF 11-13k

27
Q

When is ICSI done?

A 
Poor sperm motility
Low sperm count
Morphologically abnormal sperm
Fert failure in prev. IVF for unknown reasons
Reterograde ejaculation
Immunological factors
28
Q

When is ICSI done?

A 
Poor sperm motility
Low sperm count
Morphologically abnormal sperm
Fert failure in prev. IVF for unknown reasons
Reterograde ejaculation
Immunological factors
29
Q

What pre-implantation testing is done?

A

Pre-implantation genetic testing (PGT) (day five embryo)

  • PGT-A (aneuploidy)
  • PGT -SR (test chromosomes for structural rearrangements)
  • PGT -M (Monogenetic disroders)

MBCHB3: Reproduction, Development and Ageing (24 decks)

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