Preventing & Treating Female Infertility Flashcards
is infertility a disease of male or female reproductive system or both
both
when should heterosexual women seek evaluation for female infertility
advise infertility evaluation if:
- no conception after 12 months of unprotected intercourse or donor insemination
- consider earlier evaluation for those aged 35yrs and older: if no conception within 6 months
- advise immediate infertility assessment for those ages 40 and older
when seeking evaluation for female infertility, what are 3 reasons why earlier evaluation is considered for women aged 35yrs and older (at 6 months of no conception)
- due to expected decrease fertility with age
- rising occurrence of conditions affecting fertility
- increased likelihood of miscarriage
why is there an increased likelihood of miscarriage with older age
- due to decrease in oocyte quality with rising age
in what circumstances should women also seek evaluation for female infertility
females with:
- oligomenorrhoea (infrequent menstrual periods - less frequent)
- amenorrhoea (absent menstrual periods)
- known or suspected tubal, uterine (including stage III or IV endometriosis), or peritoneal disease
- male partners with known or suspected male factor infertility
what is infertility caused by in 85% of infertile couples globally
- identifiable alterations in expected physiology or underlying disease
top 3 most common causes of infertility
- ovulatory dysfunction
- male factor infertility
- tubal disease
what is cause of infertility in remaining 15% of infertile couples
unexplained infertility
list 2 common infertility treatments
- ovulation induction
- ovarian stimulation
[treatments for female infertility] describe ovulation induction
- pharmacological stimulation of ovulation
-eg/ Clomiphene citrate, Letrozole
[treatments for female infertility] describe ovarian stimulation
- stimulate multiple ovarian follicles and oocytes to mature <- thru FSH and LH
- followed by ovulatory trigger - hCG
list & describe 2 fertilisation options following common fertility treatments
- intrauterine insemination (IUI) during ovulation
- in vitro fertilisation (IVF) or intracytoplasmic sperm injection (ICSI) - requires retrieval of oocytes from ovary via ultrasound-guided needle
list causes of ovulatory dysfunction / anovulation
- thyroid dysfunction or hyperprolactinemia
- polycystic ovary syndrome (PCOS)
- hypothalamic amenorrhoea
[ovulatory dysfunction / anovulation] diagnosis of thyroid dysfunction or hyperprolactinemia
- diagnosis involves looking at serum markers for thyroid stimulating hormone (TSH) or prolactin
[ovulatory dysfunction / anovulation] treatment of abnormal TSH or prolactin ie/ thyroid dysfunction or hyperprolactinemia
- correction of specific defect can result in resumption of ovulation
[ovulatory dysfunction / anovulation] diagnosis of polycystic ovary syndrome (PCOS)
- looking at free and total testosterone levels in serum; looking at DHEAS (androgen derivative); looking at 17-OHP (progesterone derivative); transvaginal US (to find presence of multiple small ovarian follicles)
[ovulatory dysfunction / anovulation] treatment of polycystic ovary syndrome (PCOS)
- ovulation induction
- w timed intercourse or intrauterine insemination (IUI)
- if obese, 15% loss of body weight can stimulate resumption of ovulation on its own
- if above unsuccessful, in vitro fertilisation (IVF) should be considered
[ovulatory dysfunction / anovulation] diagnosis of hypothalamic amenorrhoea
- looking at serum levels of FSH, LH, oestradiol
[ovulatory dysfunction / anovulation] treatment of hypothalamic amenorrhoea
treatment depends on if:
- hypogonadotropic hypogonadism - pulsatile GnRH therapy / gonadotrophin therapy
- hypergonadotropic hypogonadism - donor oocytes
diagnosis of endometriosis
risk factors:
- early menarche
- short menstrual cycles
- heavy menstrual periods
- nulliparity (never had birth)
- family history of endometriosis
diagnosed by transvaginal ultrasound
what can a delay in diagnosis of endometriosis lead to
is delay of diagnosis often for these patients
- chronic pelvic pain
- fatigue
- anxiety and depression
-> negatively impacting quality of life
these patients often have delay in diagnosis
treatment options for endometriosis are based on what 2 factors
- severity of symptoms
- if patient seeking to become pregnant
treatment of endometriosis involves:
- pain management
- laparoscopic surgery sometimes
- for fertility: ovulation induction w intrauterine insemination (IUI); if unsuccessful, consider IVF (in vitro fertilisation)
outline what is involved in treatment of endometriosis for pain management
- non-steroidal anti-inflammatory drugs (NSAIDs)
- analgesics
- GnRH-analogies
- contraceptive (birth control) methods
what is laparoscopic surgery used for in endometriosis
- to remove endometriosis lesions, adhesions, scar tissues
how are structural factors of tubal disorders, including blocked oviducts, diagnosed
- hysterosalpingography (HSG) procedure inject dye at cervix
- determine if passes thru reproductive tract & exits oviducts
how are structural factors of tubal disorders, including blocked oviducts, treated
- for bilateral blockage - surgical repair or ovarian stimulation [where oocytes removed from ovary] and IVF used
- unilateral blockage - patients can usually still become pregnant without treatment
how are structural factors of uterine factors including septate uterus, fibroids, polyps (congenital and benign uterine disorders) diagnosed
- transvaginal ultrasound, 3D ultrasound, magnetic resonance imaging (MRI)
how are structural factors of uterine factors including septate uterus, fibroids, polyps (congenital and benign uterine disorders) treated
- surgery to correct uterine cavity defects
causes of diminished ovarian reserve (have low number of follicles and oocytes)
- advanced age
- previous ovarian surgery (eg/ from cancer treatment)
- family history of premature menopause
- cancer treatment
- fragile X premutation
diagnosis of diminished ovarian reserve
- serum markers including anti-mullerian hormone (AMH), FSH, oestradiol
- ultrasound examination (look for number of antral ovarian follicles (growing follicles in ovary))
how is diminished ovarian reserve prevented
- fertility preservation (freezing oocyte / embryo) earlier in life or prior to gonadotoxic therapies
- starting reproduction earlier to realise number of desired children
how is diminished ovarian reserve treated
- ovarian stimulated w intrauterine insemination (IUI) or IVF (in vitro fertilisation) <- these success rates decr with advancing age
- for those w very diminished ovarian reserve - oocyte donation may be only option
treatment option for unexplained infertility
- suggested 3-4 cycles of ovarian stimulation w intrauterine insemination (IUI)
- if these treatments not lead to pregnancy, consider IVF
[lifestyle factors for fertility - exercise] what may disrupt menstrual cycles and ovulation resulting in infertility
- extreme exercise or low body weight
[lifestyle factors for fertility] a balanced lifestyle that supports reproductive health and optimal fertility involves what
- nutrient-rich diet (incl incr folic acid, dairy intake, fruits, veges, wholegrains, seafood)
- regular moderate exercise
- overall well-being
- maintaining healthy body weight
what lifestyle factor is negatively associated with successful live births post-IVF & what advice is given
- female obesity (BMI >30)
- advised for obese women to seriously consider postponing conception to prioritise weight loss
what should patients seeking to get pregnant aim for with tobacco, recreational drugs, and alcohol
- avoid tobacco
- avoid recreational drugs
- consume no more than 2 alcoholic drinks per day
- if pregnant, consume no alcohol
what should patients seeking to get pregnant avoid environmentally due to toxins
- avoid environmental pollutants and toxins - such as pesticides, heavy metals, workplace exposures
- some plastics and cosmetic products contain chemicals that can negatively impact fertility - should be minimised or avoided
what factors are success rates influenced by in fertility treatments
- age
- diagnosis
what are physical ways couples can maximise conception chances
- regular intercourse
- esp during 3-day interval ending on ovulation day <- targets most fertile window of menstrual cycle
