PBL1 - Subfertility Flashcards
Primary sub fertility
No previous pregnancy
Secondary sub fertility
Previous pregnancy, whatever the outcome
Sub fertility incidence
15%
Female factors of subfertility (4)
Ovulation disorders
Tubal damage
Endometriosis
Cervical mucous hostility
Male factors for subfertility (1)
Disorders of sperm production or transport
Coital problems leading to subfertility:
Impotence
Dyspareunia (pain in sex)
Coital frequency of less than 3 times per week
Infertility - check men for …
Mumps orchitis
Physical examination of female look for (3)
Hirsutism
Pelvic tumour e.g. Fibroids, ovarian cysts
Genital abnormalities e.g. Rigid hymen, vaginal atresia
Physical examination of male look for (3)
Lack of virilisation
Small testicular size
Epididymal cysts
Varicoceles
Semen analysis: Volume ... .... million/ml density ... motility Repeat tests .... Times, after each months interval
Volume 2-5ml
>15 million/ml density
>40% motility
Repeat tests 3 times, after each months interval
Ovulation tests:
3
Biphasic basal body temperature chart
Luteal phase plasma progesterone level - >30nmol/ml
Pulsatile LH secretion - peaks 36 hours before ovulation
Ovum survives for
24 hours
Sperms remains fertile for
72 hours
Assess tubal patency and pelvic assessed by… (2)
Ultrasound
Hysterosalpinography (X-ray and dye)
Postcoital tests / Kremer tests check for …
Aspirated when?
Cervical hostility - happens mid cycle
Cervical mucus is aspirated 12 hours after intercourse and checked for sperm numbers and motility
Oligomennorrhea
Irregular periods
Most common cause of anovulatory infertility
PCOS
PCOS cause (2)
Insulin resistance, leads to hyperinsulinaemia
Stimulate androgen production by theca cells in ovary
Diagnostic criteria PCOS:
4
Infrequent / Absent ovulation
Hyperandrogenism (excessive hair, acne, raised LH and androgens)
Polycystic ovarian morphology on ultrasound - >12 follicles between 2-9mm in diameter, ovarian volume >10ml
PCOS treatment: (3)
Weight loss Ovulation induction by clomiphene Wedge resection (surgery) The pill Anti-androgens e.g. Cryproterone acetate Metformin
Induce ovulation with
Clomiphene
Anti-androgen -
Cyproterone acetate
Pelvic inflammatory disease - 2 main std’s
Chlamydia trachomatis
Neisseria gonorrhoeae
PID leads to …
Scarring of ovaries and oviducts
Leads to narrowing / complete closure - infertility
Before subfertility treatment check for
Rubella
Treatment of ovulation failure (2)
Oral clomiphene citrate
Human menopausal gonadotrophins - injected daily
Why must you monitor ovulatory treatment (2)
Reduce the risk of multiple pregnancy
Stop ovarian hyperstimulation syndrome
Pregnancy rates per cycle for women under 40 are
25-30%
Four cycles IVF success rates
60%
Male infertility treatments
Intrauterine insemination (IUI) Intracytoplasmic sperm injection (ICSI)
Use IVF / IUI / ICSI after …. Of subfertility
2 years
Subfertility
Defines as the inability to conceive for 12 months after regular unprotected regular intercourse
