Management of Infertility Flashcards
what is the general lifestyle advice for fertility?
stop smoking achieve BMI 18.5-30 reduce/stop alcohol caffeine in moderation stop recreational drugs stop taking methodone
how can an overweight mother affect pregnancy?
increased rates of fertility problems
increased rate of miscarriage
reduced success with fertility treatment
how much weight loss can have improve pregnancy outcome?
5-10%
how can being overweight affect fertility in men?
9 kg weight increase can cause fertility problems
increased rates of erectile dysfunction
life cycle of sperm and egg?
sperm = 48 hrs egg = 24 hrs
primary care management of infertility?
full history and examination
advice
what vitamin supplements are used in pregnancy and why?
folic acid - 400micrograms daily before pregnancy and throughout first 12 weeks
- 5mg daily pre and early stages of pregnancy if any parent has neural tube defect, previous baby with neural tube defect, family history of neural tube defect or diabetes
10 micrograms of Vit D pere day for pregnancy and lactating women in groups at risk of vit D deficiency
what is rubella syndrome?
group of physical abnormalities in an infant as a result of maternal infection and subsequent fetal infection with rubella virus rash at birth low birth weight small head heart abnormalities visual problems bulging fontanelle
how can you tell if immune or non-immune to rubella?
rubella IgG antibodies 6U/L = non immune
what is done if the mother has chalmydia?
azithromycin 1mg stat
if macrolide allergic - doxycycline 100mg bd for 7 days
what is a good indicator of present ovulation?
regular menstruation
irregular cycles can indicate oligo/anovulation
what can cause group 1 ovulatory disorders?
hypothalamic disorder stress excessive exercise anorexia kallmans syndrome isolated gonadotrophin deficiency
what are the findings in group 1 ovulation disorders?
low FSH
low oestrogen levels
normal prolactin
negative progesterone challenge
which groups of ovulation disorders can be managed via ovulation induction?
groups 1 and 2
what are group 2 ovulation disorders? give some examples of features
hypothalamic pituitary dysfunction e.g PCOS normogonadotrophic normal oestrogen anovulation
what are group 3 ovulatory disorders and what are the findings?
ovarian failure
high gonadotrophins with low oestrogen
high or low prolactin can cause ovulatory disorders?
high
what are the 2 forms of reproductive surgery?
primary surgical treatment for infertility
surgery to enhance IVF outcome
which conditions can be managed by primary surgery for infertility?
pelvic adhesions
grade 1 and 2 endometriosis
chocolate cysts in ovary
tubal block
how is surgery to improve IVF success performed?
laparoscopy
hysteroscopy
- no place for laparotomy
how is tubal disease managed?
mild = tubal surgery
proximal tubal obstruction = salpingography + tubal catheterisation or hysteroscopic tubal cannulation
hydrosalpinges = salpingectomy (preferably before laparoscopy) before IVF
what is hydrosalpinx?
fluid build up in fallopian tubes causing obstruction
causes reduced pregnancy rates and increased miscarriage rates
how can hydrosalpinx be managed?
laparoscopic salpingectomy
hysteroscopy
…………
when is tubal occlusion used as management for hydrosalpinx and what is done?
if laparoscopy is contraindicated
hysteroscopic essure made of nickel is used to block the tubeal ostea and gets covered by tissue in a few weeks
how is endometriosis managed?
laparoscopic removal of endometriotic cyst
- helpful before fertility treatment
nice guidelines for endometriosis management?
minimal/mild = surgical ablation or resection of endometriosis + laparoscopic adhesiolysis
ovarian endometriosis = laparoscopic cystectomy
moderate/severe = surgical treatment
management of polyps?
myosure polypectomy
how can uterine septum be managed?
meteroplasty
how are women with amenorrhoea who are found to have intrauterine adhesions managed?
hysteroscopic adhesiolysis (improves chance of pregnancy)
what are fibroids?
benign lump in wall of uterus
low growing
can affect fertility
what are the 4 types of fibroid?
pedunculated (attached to the uterine wall via a stalk)
submucous (originate in uterine wall and bulge into uterine cavity)
intramural (inside wall)
subserous (outside uterus/outer wall of uterus, shouldn’t interfere with fertility so don’t need to remove it)
how is a fibroid inside the wall of the uterus managed?
if more than 5cm
submucosal = hysteroscopical treatment
intramural = if more than 5cm, laparoscopic myomectomy
subserosal = no treatment needed
what are the steps in IVF treatment?
pre-IVF work-up >stimulate ovaries > monitor cycle > ovulation induction > oocyte retrieval > preparation of sperms > in vitro fertilisation > embryo transfer > luteal support
at what point is the embryo implanted back into the uterus?
day 5 - blastocyst?
what is the initial predictor of IVF success?
age
>42 = basically no chance of success
