Lecture 6: Infertility Flashcards
Define infertility:
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)
Define infertility:
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)
What was infertility associated with?
Increased risk associated with being underweight or very obese.
Does mens age impact their fertility?
There is a decrease in semen volume, sperm motility and sperm morphology with age.
Does mens age impact their fertility?
There is a decrease in semen volume, sperm motility and sperm morphology with age.
- <30 vs 50+ there is a decrease in pregnancy
How is ovarian reserve assessed?
- Family history, early menopause?
- Antral follicle count
- Anti-mullerian hormone test (blood test)
What factors affect gemete health in males?
Age Mediterranean diet Smoking Alcohol Anti-oxidants Weight Frequent sex Keep testes cool
What factors affect gemete health in males?
Age Mediterranean diet Smoking Alcohol Anti-oxidants Weight Frequent sex Keep testes cool
What are the common diagnosis for patients with sub/infertility?
Anovulation Endometriosis Male factor infertility PCOS Recurrent miscarriage Unexplained ~10%
What can cause anovulation?
Oligomenorrhea ->35 days without mensturation, can be exercised induced
Reduced body fat - adipose tissue important for producing oestrogens
PCOS
How do cholomiphene and letrozole act?
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]
How do cholomiphene and letrozole act?
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]
What are the treatments for PCOS:
Weight loss
Ovulation induction agent commonly letrozole
Metformin (evidence of insulin resistance)
IVF (Avoid OHSS)
How does PCOS impact mental health:
Higher rates of:
- Depression
- Anxiety
- Poor body image and eating disorder
- Psychosexual dysfunction
Regular check mental and emotional health
How does PCOS impact mental health:
Higher rates of:
- Depression
- Anxiety
- Poor body image and eating disorder
- Psychosexual dysfunction
Regular check mental and emotional health
What are some investigations for anovulation?
- Progesterone (mid luteal)
- FSH (early follicular)
- LH (Early follicular)
- Testosterone
- Transvaginal US
- BMI
- Karyotyping
What are some investigations for anovulation?
- Progesterone (mid luteal)
- FSH (early follicular)
- LH (Early follicular)
- Testosterone
- Transvaginal US
- BMI
- Karyotyping
Write some notes on endometriosis:
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
What are the possible treatments for endometriosis?
- Surgical removal (gold standard)
- Lipiodol flushing
- IUI using mild stimulation if endometriosis is mild and patent tubes
- IVF - more risk
What is examined in a semen analysis:
Count - 15M/ml Motility - 40% progressive Volume 1.5mL plus Total sperm ~39m Morphology 4% or more
What are some diagnostic tests for male infertility?
FSH, Testosterone, Chromosome, Endocrine imbalance
Physical exam: Varicoceles, abnormal swelling
Detailed history: mumps, trauma etc
Testicular biopsy
Write some notes on unexplained infertility:
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
What are some treatments for unexplained infertility?
Lifestyle changes
Expectant management - good chances
IUI treatment
IVF treatment
What tests are required prior to a referral?
- 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
What tests are required prior to a referral?
- 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
What is the eligibility and cost of IVF in NZ?
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
When is ICSI done?
Poor sperm motility Low sperm count Morphologically abnormal sperm Fert failure in prev. IVF for unknown reasons Reterograde ejaculation Immunological factors
When is ICSI done?
Poor sperm motility Low sperm count Morphologically abnormal sperm Fert failure in prev. IVF for unknown reasons Reterograde ejaculation Immunological factors
What pre-implantation testing is done?
Pre-implantation genetic testing (PGT) (day five embryo)
- PGT-A (aneuploidy)
- PGT -SR (test chromosomes for structural rearrangements)
- PGT -M (Monogenetic disroders)
