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)
