Management of Infertility Flashcards
what lifestyle changes can assist conception
healthy diet weight loss (5-10%)/ gain stop smoking reduce/ stop alcohol (4 units a week) moderate caffeine intake stop recreation drugs stop taking methodone
how can weight affect fertility
women- increased fertility problems and miscarriage rates,
decreased success with fertility treatments
men- increased DNA damage to sperm and erectile dysfunction
what advice should you give a couple trying to conceive
reassure- 84% conceive in year 1, 92% by year 2
advise sexual intercourse every 2-3 days
consider underlying psychosexual problems
consider preconception counselling
what is the lifetime of sperm
48 hours, increased by 3-5 days when gets nutrients from the cervix
what is the lifespan of an egg
24 hours
what vitamin supplements should you advise pre-conception
folic acid (reduces neural tube defects) - 400 micograms daily before pregnancy and throughout first 12 weeks (5 mg if history of neural tube defects or diabetes)
vit d - 10 micorgrams daily for pregnant or lactating women, or people in high risk population
how do you know if you have rubella immunity
rubella IgG antibodies
how long after rubella vaccinations before you can conceive
a month
what is characteristic of rubella syndrome (congenital rubella)
rash at birth, low birth weight, small head size, microcephaly, heart abnormalities (PDA), cataracts, bulging fontanelle
what treatment for women who are chlamydia positive
azithromycin 1 mg- if allergic doxyxcycline 100 mg for 7 days
what do irregular cycles usually indicate
oligomenorrhoea, anovulation
how many regular cycles are anovulatory
9%
what are the three types of ovulatory disorders
hypothalamic
hypoathalmic pituitary dysfunction
ovarian failure
what can cause hypothalamic ovulatory disorders
stress, excessive exercise, anorexia, kallmans syndrome, isolated gonadotrophin deficiency
what hormones are found in hypothalamic ovulatory disorders
low FSH, estrogen, normal prolactin, negative progesterone
what hormones are found in ovarian failure
high gonadotrophins with low estrogens
what else can cause an ovulatory disorder
hyperprolactinaemia
what causes type 1 ovulatory disorders (hypothalamic)
can be caused by any lesion affecting the pituitary or hypothalamus and affecting gonadotropin production
(hypogonadotrophiic hypogonadism)
what most commonly causes hypothalamic pituitary dysfunction ovulatory disorders (who type 2) (normogonadotrophic hypogonadism)
most commonly caused by PCOS
in what types of ovulatory disorders is induction of ovulation possible
type 1 (hypothalamic) type 2 (hypothalamic pituitary dysfunction)
what is the best way to achieve conception in type 3 ovulatory disorders (ovarian failure)
oocyte donation (usually have follicular depletion)
what are the reproductive surgeries for infertility treatment
primary for infertility: pelvic adhesions grade 1 and 2 endometriosis chocolate cyst in ovary tubal block
surgery to enhance IVF outcome:
laparoscopy
hyperoscopy
what is tubal surgery
creating patency in the tubes
what is a hydrosalpinx
blocked and distended fallopian tube
what surgery for proximal tubal obstruction
salpingography plus tubal catheterisation
or
hysteroscopic tubal cannulation (when contraindications for above)
what is the surgery for hydrosalpinges before IVF
salpingectomy (preferably laproscopy)
what are the types of fibroids
pedunculated, subserous, intramural, submucous
