Lecture 8 – Infertility Flashcards
What are the five main requirements for fertility?
Normal sperm Normal eggs Sperm must be able to traverse the female tract Sperm must be able to penetrate the egg Embryo must be able to implant
What is the definition of fertility?
The measure of the actual outcome of process e.g. number of children to an individual couple
What is the definition of fecundability?
The probability of concieving each month
What is the definition of fecundity?
The measure of the ability to concieve and produce a live birth.
What is the definition of infertility?
The inability to concieve or bring a pregnancy to term
What is subfertility?
A state of reduced fertility
What is the nice definition of infertility?
The inability to concieve after 2 years of regular unprotected intercourse.
What are the first and second most common reasons for women 20-40 to see their GP?
Most common is pregnancy, second most common is infertility.
What are the main female factors that cause infertility?
Ovulatory disorders Tubal damage Endometriosus Uterine abnormalities Problems with implantation, growth and development
What are the main ways that female factors are diagnosed?
Can be diagnosed on blood tests, by surgery (laproscopy) or by radiography (hysterosalpingogram)
Ovulation disorders form 40% of female factors, what can cause these?
Stress, anorexia nervosa, strenuous excercise and drug use. Can have failure of development of neuroendocrine system at puberty. Treating with placebo works alot for stress etc.
Idiopathic ovarian failure
Polycycstic ovary syndrome
Anovulatory cycles - unruptured follicles
What is idiopathic ovarian failure?
-Gonadotrophin secretion is normal but doesn’t produce normal cycle - oestrogen doesnt rise.
What are anovulatory cycles?
Lutenised unruptured follicle syndrome - normal endocrine - follicles form but do not rupture.
What can increase the chances of tubal obstruction?
Previous infections - scarring adhesions
STIs
Post-abortal sepsis
What is endometriosus?
Tissue growth that results in scarring and adhesions
What causes other than ovulation or tubal can be a female factor?
Implantation defects
Autoimmune e.g. lupus
Immunological e.g. Rhesus
Chromosomal abnormalitites
What are the main male disorders that can cause infertility?
Sperm production Sperm transport Sperm transmission Sperm function in female tract Sperm fertilisation
What would be the order of tests for male fertility?
History and examination
Semen analysis
Endocrine analysis
What should a normal semen volume be?
1.5ml
What should a normal number of sperm be?
39 million
What is normal sperm morphology percentage?
4%
What does normozoospermic mean?
Have greated than 15 million sperm/ml and have normal motility (>32% rapid forward motility) and morphology (>4%)
What is oligozoospermia?
<15million/ml
What is asthenozoospermia?
Low motility <32% rapid and medium forward motility
What is teratozoospermia?
Low morphology <4% normal morphology
What are the main causes for failure to produce normal sperm?
Congenital testicular deficiency (kleinfelters etc.)
Undescended testes - reduced spermatogenesis
Aquired - trauma
Endocrine
What is retrograde ejaculation?
Imcompetence of urethral sphincter which results in path of least resistance into bladder.
Associated with diabetes - post ejaculation urine analysis.
What are causes of failure of transportation of sperm?
Infections can cause blockages
Congenital bilateral absense of vas deferens (CBAVD) - linked to cycstic fibrosis
