Repro: Infertility Flashcards
What percentage of couples having regular unprotected sex can expect to be pregnant in 1 year?
80%
What is ‘regular sex’?
2 or more times per week
How many couples have problems conceiving?
1 in 7 couples
What is primary and secondary infertility?
Primary: no previous pregnancy
Secondary: previous pregnancy, successful or not
List the initial tests you would perform in a couple experiencing fertility problems
BMI Galactorrhoea (milky nipple discharge) Pelvic examination for structural abnormalities
What male factors can cause infertility?
- idiopathic oligospermia (low sperm count, most common)
- varicocele
- hypothalmic/pituitary disfunction
- ductal obstruction eg scarring, post infection epididymitis
- failure to deliver sperm to the cervix eg hypospadias, impotence
What are the 3 classes of ovulatory disorders?
Gives examples of each
Group 1: hypothalmic pituitary failure eg significant weight loss, high prolactin
Group 2: hypothalmic pituitary ovarian dysfunction eg cushings, overproduction of adrenals
Group 3: ovarian failure eg turners, menoapuse, chemo
What is polycystic ovary syndrome?
Syndrome consists of polycystic ovaries and elevated androgens.
There is raised LH/FSH ratio, insulin resistanxe, amenorrhoea or oligomenorrhoea
What are the clinical features of PCOS?
- abnormal hair growth (hirsuitism)
- acne
- obesity
- male pattern baldness
- oligomenorrhoea
- mood swings, depression, anxiety
What can cause tubal damage in females?
- past pelvic infection eg chlamydia
- previous pregnancy
- pelvic surgery
- endometriosis
- mullerian developmental anomaly
What is endometriosis?
Presence of endometrial tissue outside the uterine cavity - most commonly in the pelvic cavity.
Causes painful periods and intercourse, chronic pelvic pain, infertility.
Which women would you refer for further investigations?
A women of reproductive age who hasn’t conceived after a year of unprotected intercourse, with no known cause of infertility.
A women of reproductive age using artificial insemination who has not conceived after 6 cycles, with no known cause of infertility.
What further investigation would you carry out on a female?
- measure FSH and LH
- measure progesterone on day 21
- prolactin, androgens
- cervical smear
- pelvic ultrasound scan
- test tubal patency
What further investigation would you carry out on a male?
- sperm analysis (count, motility, morphology)
- antisperm antibodies
- USS
- FSH, LH, testosterone
- cystic fibrosis
