Mangement of Infertility Flashcards
What lifestyle advice is given to couples who are trying to have a baby?
Stop smoking, achieve normal BMI, reduce/stop alcohol intake, moderate caffeine intake, stop recreational drugs and methodone
How does being overweight impact fertility in women?
Overweight women have a 2-5 fold increase in fertility problems = 2-3 fold increase in miscarriage rate, decreased success with fertility treatments
How does being overweight impact fertility in men?
Overweight men have a 2 fold increase in fertility problems = 3 fold increase in erectile dysfunction
How much weight loss is recommended to improve pregnancy outcomes?
Weight loss of 5-10% dramatically improves pregnancy and outcome rates
Why is reassurance a major part of management of infertility?
84% of couples conceive in first year and 92% will conceive by the second year
How often should sexual intercourse be recommended in couples struggling with infertility?
Every two to three days rather than timing intercourse with the menstrual cycle
What should be considered in patients struggling to get pregnant?
Consider underlying psychosexual problems and need for preconception counselling if pre-existing medical condition
How much folic acid is usually recommended for women to take?
400 micrograms before pregnancy and throughout the first twelve weeks
When should women be prescribed 5mg of folic acid?
If they or their partner have a neural tube defect, if they have had a previous baby with a neural tube defect, if there is a family history of neural tube defects on either side, if they are diabetic
How much vitamin D should be prescribed to patients?
10 micrograms daily for pregnant or lactating women or population groups at high risk of deficiency
What is regular menstruation strongly suggestive of?
Ovulation = irregular cycles usually indicate oligo/anovulation
How common are anovulatory cycles?
Up to 9% of regular cycles (duration 25-35 days) are thought to be anovulatory
What are the different classes of ovulatory disorders?
Hypothalamic (group 1), hypothalamic-pituitary dysfunction (group 2), ovarian failure (group 3), hyperprolactinaemia
What are features of hypothalamic (group 1) ovulatory disorders?
amenorrhoea (stress, excessive exercise, anorexia, Kallman’s syndrome, isolated gonadotrophin deficiency), low FH, oestrogen levels, normal prolactin, negative progesterone challenge
What are features of hypothalamic-pituitary (group 2) ovulatory disorders?
Normogonadotrophic, normoestrogenic, anovulation (usually PCOS)
What are some associations of ovarian failure (group 3) ovulatory disorders?
High gonadotrophins with low oestrogens, all variants of ovarian failure and resistant ovary
What is reproductive surgery used for?
Primary treatment for infertility or surgery to enhance IVF outcome
What are some examples of conditions treated with reproductive surgeries?
Infertility = pelvic adhesions, grade 1 and 2 endometriosis, chocolate cysts in ovary, tubal block
IVF enhancement = laparoscopy, hysteroscopy
Why is tubal surgery used to treat women with mild tubal disease?
Surgery is more effective than no treatment
How are proximal tubal obstructions in women treated?
Selective salpinography plus tubal catheterisation, hysteroscopic tubal cannulation = both improve chance of pregnancy
What should women with hydrosalpinges be offered?
Salpingectomy, preferably laparoscopically
How should submucosal fibroids be treated?
Hysteroscopically = improve conception rates
How should intramural fibroids be managed?
Should be individualised on a case to case basis
What type of fibroid is unlikely to have any major impact on fertility?
Subserosal fibroid
What type of treatment if not recommended for fibroids?
|Conservative management = should be routinely offered to women who wish to preserve or improve fertility
What is the IVF treatment cycle?
Pre-IVF work-up, ovulation stimulation, monitoring, ovulation induction, oocyte retrieval, preparation of sperm, in-vitro fertilisation, embryo transfer, luteal support
