Repro 1 Flashcards
how can you define female infertility
12 months of unprotected sex and no baby
how can female causes on infertility be divided up
ovulating?
sperm?
pathway?
tests that can be done to assess ovulation
day 21 progesterone test
>30 is normla
other tests to assess infertility
sperm analysis
chlamydia. rubella. Hep B/C. HIV. ovarian reserve. pituitary hormones. testosterone
who is allowed to have IVF
<40 or 12 cycles of artificial insemination
40-42 12 cycles and no previous IVF, no evidence of low ovarian reserve and risks discussed
pelvic disease, anovulatory disease, genetic disease etc
what needs to happen before IVF treatment
alcohol <4 units per week. no smoking. weight BMI 19-29. folic acid 4g per day. smear. rubella. HIV. Hep B/C. chlamydia
IVF steps - just main ones 8
down regulation baseline scan ovarian stimulation action scan sperm sample oocyte collection embryologist transfer
what happens during down regulation what is given and why
SE of whatever is given
buserlin - synthetic GnRH agonist as nasal spray/injection
to reduce cancellation from ovulation and impose success rate and to allow precise timing of oocyte recover by using HCG trigger
headaches, hot flushes, mood swings, nasal irritation
what happens during ovarian stimulation
SE
GnRH and FSH plus or LH given as daily S/C injection for 10-14 days to allow follicular development
mild allergic reaction. OHSS
what happens during the action scan - what if theres a slow response
what should be assessed for
what if normal
if slow response (40-50%) repeat scan 72 h
if poor response to FSH - increase dose
assess for OHSS
plan date/time for HCG injection
what should be done for the sperm sample and what is assessed
abstinence for 72 hours
motility, progression, volume, density
what bad things can happen during oocyte collection
what is it described as
bleeding, pelvic infection, failure to obtain
like a smear
embryologist dos what
finds eggs and incubates at 37 degrees
when does transfer occur
at d5 when its a blastocysts
what is given to patient and done after transfer
progesterone supplements (cyclogest) for 2 weeks and a UPT
what are the symptoms of OHHS
abdominal pain. ascites. N/V. ARDS. thromboembolism/ tense ascites
what is the treatment of OHSS
analgesia/ anti emetic. paracentesis. fluid balance. LMWH. admit.
when should IUI be done
unexplained infertility. mild/mod endom. mild male factor infertility
what happens during IUI
in natural/stimulated cycle prepared semen inserted at time of ovulation to increase the number of sperm that reach the fallopian tubes
what is ICSI done
failed IVF. severe male factory infertility. pre implantation genetic disease
how is ICSI done
extract from epididymis if obstructive, testicular tissue if not. egg stripped (obtained via IVF). sperm immobilised and injected. incubate at 37 degrees
success created for IUI
ICSI
10% per cycle
30% per cycle
causes of male infertility (3)
idiopathic. obstructive. non-obstructive
obstructive causes
CF, vasectomy, infection
non obstructive causes
cryptochordism, mumps, orchiditis, chemo/radio, tumour, klinefelters, semen abnomarlities, systemic, endocrine
normal testicular volume in pre pubertal
pubertal
abnormal
1-3mls
12-25
<5
what is done on semen analysis
volume, density, morphology, progression
if semen analysis is positive why should it be done again nd when
3 months later: health, completeness of sample, period of abstinence, condition and time between transport, production and assessment, natural variation between samples
results of investigations done on obstructive
normal testicular volume and normal secondary sexual characteristics
normal LH/FSH/testosterone
VD may be missing
NO examination results
abnormal testicular volume (low) and decreased secondary sexual characteristics, VD present, increased FSH/LH, decreased testosterone
treatment of male infertility
frequent sex, alcohol <4 units per week, no smoking/caffiene, avoid tight baths, hot baths/saunas, avoid tight fitting pants, anti oxidants (vitc/zinc), IUI, ICSI, aspiration, donor insem
when is sperm aspiration done and success rates and what is done after
azoospermina
surgically
NO 50% and 95% in obstructive
ICSI
donor insemination success rate
15% per cycle
what is cryptochordism and how does it affect fertility
undescended testes
reduces sperm count but if unilateral still fertile
treatment for cryptochordism
orchidopexy in <1s to reduce risk of cancer
orchidotomy in adults
androgen insensitivity syndrome geentics
congenital insensitivity to androgens
AR
46XY
pathology of androgen insensitivity syndrome
androgen induction of wolffian duct does not occur but mullerian inhibition does
symptoms and signs of androgen insensitivity syndrome
born phenotypically female - absence of uterus and ovaries and short vagina primary amen lack of pubic hair breast development undescended testis
test for androgen insensitivity syndrome
buccal smear - chromosome analysis
treatment for androgen insensitivity syndrome
counselling - raise kid as girl
orchidectomy
oestrogen therapy
klinefelters syndrome geneticd
47XXY
clinical presentation of kilnefelterrs
tall, lack pf pubic hear, gynacamastia, infertility, decreased facial and body hair, small and firm testes, increased FSH and LH
ix for klinefelters
rx
chromosome analysis
testosterone therapy
tubal infertility causes
investigations
treatment
chlamydia. PID. anatomical
if history of PID - laparoscopy and dye hydrotubation
HSG.
if bilateral tubal dx- IVF
