Management of an infertile couple Flashcards
What is infertility? what is the difference between primary and secondary infertility?
failure to concieve despite regular unprotected sexual intercourse over 12mths in absence of known reproductive pathology
- Primary: couple never concieved
- Secondary: couple have previously concieved
What are factors that influence infertility?
- female age <30yrs is good
- duration of fertility
- previous pregnancy
- cause of infertility
Is infertility common? why is the incidence increasing?
-common (15% couples)
Incidence increasing:
- older women
- chlamydia infection
- increase in obesity
- increasing awareness of treatment
- change in expectations
- increasing male factor infertility
What tests are done in females for infertility?
- endocervical swab for chlamydia
- cervical smear if due
- bloods for rubella immunity
- mudluteal progesterone test (if <30mnol/L anovulatory): if anovulatory do ovulation investigation
What tests are done in males for infertility?
-semen analysis twice, 6 weeks apart
If abnormal: endocrine profile
- LH/FSH
- testosterone
- PRL
- Thyroid
If severely abnormal/azoospermic:
- endocrine profile
- chromosome analysis
- screen for cystic fibrosis
- testicular biopsy
what are the three causes for female factor infertility?
- anovulation
- pelvic inflammatory disease: chlamydia
- PCOS
What is the treatment for chlamydia?
azithromycin 1g stat (if allergic to macrolide - doxycycline 100mg BD for a week)
Describe the sequelae of pelvic inflammatory disease?
Short term:
- tubo-ovarian abscess
- peritonitis
- fitz-hugh-curtis syndrome (liver capsule infection due to PID)
Long term:
- chronic pelvic pain
- infertility
- ectopic pregnancy
What are the obstructive causes of male factor infertility?
- vasectomy
- infection (chlamydia/gonorrhea)
- congenital absence of vas deferens e.g. cystic fibrosis
What are the non-obstructive causes of male factor infertility?
- undescended testes
- orchitis
- torsion
- trauma
- chromosomal (klinefelters)
- kartagener syndrome
- y chromosome microdepletions
- endocrine (hypog. hypog., hypothyroid, hyperPRL)
- testicular cancer
- varicele
- chemo/radio therapy
- erectile dysfunction
- immunological
Describe the treatment for male factor infertility?
Surgery - for obstructed vas deferens intrauterine insemination ICSI ICSI combined with surgical sperm aspiration from epididymis/testicle donor insemination
How is tubal disease investigated in females?
HSG: if no known risk factors, to look for pelvic/tubal pathology
Laparoscopy: PID, endometriosis/adhesions
-caution in obesity, previous pelvic surgery, crohns
Who is offered laparoscopy?
- possible tubal/pelvic disease (PID)
- known previous pathology e/g ectopic preg., ruptured appendix, endometriosis
- Hx suggestive of pathology: dysmenorrhea, dysparaunia
- previously abnormal HSG
What are the infective causes of tubal disease in females?
- PID
- transperitoneal spread e.g.appendicitis
- endometriosis
what are the non-infective causes of tubal disease in females?
- endometriosis
- surgical
- fibroids
- polyps
- congenital
- salpingitis ischmica nodosa (nodular thickening of narrow part of fallopian tube)
