PBL3-Infertility Flashcards
What could the couple do to optimise their chances of having a baby naturally?
Have regular unprotected sex, especially around the time of ovulation. Try and avoid being stressed and anxious about getting pregnant. For Kathy losing some weight could help and for Dev stopping smoking. Kathy should be taking folates to prevent the risk of neural tube defects.
What investigations would you do and why?
Would test both of their hormone levels to check that they are normal. Check Kathys FSH and LH on day 2 or 3 and then her progesterone on day 21 to see if she is ovulating.
FSH to LH ratio to see chances of having poly cystic ovarys.
Hystersalpingography would allow visualisation of Kathys tubes using contrast medium. This is because the chlamydia may have damaged her tubes.
Seminal analysis for Dev will be required to check for functioning sperm, also check FSH and testosterone. Tend to do sperm count first as if sperm is normal then FSH and testosterone is not a problem.
Examination of secondary sexual characteristics and ultrasound of scrotum to check vas deferens is intact may be required.
enlarged spermatic vein can cause large volume of semen with low sperm count.
Looking at the test results what conditions can you exclude as causes for infertility?
Kathy has FSH and LH at the upper limit of the normal range and normal progesterone so this rules out menopause.
She also has normal spill seen on HSG so no tubal obstruction and normal developing follicles are seen to be developing.
Dev has normal FSH and testosterone but has low sperm count at 5 million/ml when it should be 15 million/ml.
He also has low sperm motility (should be 32 million) and slightly low normal forms of sperm (greater than 4%).
This shows it is likely to be a problem with him.
What is the cause of the fertility issues?
Dev is oligozoospermic (low count), athenozoospermic (low motility) and teratozoospermic (low morphology).
Known as OATs. May be from the smoking but most of the time is from unknown reasons.
What are their treatment options?
IVF is possible as kathy is still ovulating, IUI is cheapest but not much different to normal sex. So may go straight for ICSI (intracytoplasmic sperm injection) and IVF. May have to use donor sperm if no luck with dev’s.
What are the couples chance of having a baby after treatment?
Depends on Sperm and egg quality but probably only around a 21% chance for ICSI.
Would they be eligible for NHS funding?
Kathy is just under the age and BMI criteria so qualifies however Dev is a smoker so does not qualify. However if they moved to south lake then only the woman needs to be a non-smoker.
