Repro - Infertility + contraception Flashcards
what is the definition of male infertility
infertility resulting from failure of the sperm to normally fertilise the egg
what are the types of male infertility
idiopathic = most common
obstructive = CF, infection, vasectomy
non-obstructive
give examples of genetic conditions which cause male infertility
Klinefelter’s syndrome
microdeletions of Y chromosome
Robertsonian translocation
what are the symptoms of obstructive male infertility
normal testicular volume
normal secondary characteristics
vans deferens may be absent
what are the symptoms of non-obstructive male infertility
low testicular volume
reduced secondary sexual characteristics
abnormal endocrine = high LH, FSH +/- low testosterone
what investigations should be if male infertility if suspected
genital exam semen analysis endocrine profile chromosome analysis CF screening if indicated: - testicular biopsy - scrotal scan
what factors affect semen analysis
Completeness of sample – “any difficulties producing sample”
Period of abstinence e.g. less than 3 days
Condition during transport e.g. cold
Time between production and assessment e.g. deteriorates if after 1 hour
Natural variations between samples
Health of man 3 months before production
how many times should semen analysis be preformed
1st time then repeat 6 weeks later
what is the treatment of male infertility
treat specific cause = reverse vasectomy
anejculation conditions = psychosexual treatment
intracytoplasmic sperm injection
surgical sperm aspiration = azoospermia
donor insemination
what general advice should be given if male infertility is suspected
Decrease alcohol (<4 units daily) Stop smoking Lose weight (BMI <30) Regular intercourse avoiding toxic lubricants Avoid prolonged heat/chemical exposure
what is assisted conception treatment
any treatment which involves gametes outside the body
what are the indications for assisted conception treatment
Single
Same sex couple
Fertility preservation = Transgender, Cancer, Social reasons
Avoid transmission of blood born viruses between patients
Inherited disorder
Surrogacy when uterus abnormal/absent
what should be done before assisted conception treatment is started
lifestyle factors
folic acid = 3 months pre conception until 12 weeks
screen for disease = smear, bloods
assess ovarian reserve
assisted conception treatment can cause ovarian hyper-stimulation syndrome, what are the symptoms of this?
Mild = abdominal bloating/pain. Ovarian size <8cm
Moderate = abdominal bloating/pain, nausea +/- vomiting, ascites on U/S, ovarian size: 8-12cm
Severe = clinical ascites, oliguria, High K, low albumin and Na, ovarian size >12cm
Critical: thromboembolism, ARDS
how can ovarian hyper-stimulation be prevented
only low doses of HCG administered
Monitor = fluids, TED stockings, fragmin
Analgesia
what are the types of assisted conception
donor insemination intra-uterine insemination IVF ICSI fertility preservation surrogacy
what is intrauterine insemination
Prepared semen is inserted into the uterine cavity around time of ovulation
what is the indications for intrauterine insemination
sexual problems
same sex relationships
abandoned IVF
discordant blood virus
what are the indications for IVF
unexplained fertility
pelvic disease
anovulatory infertility after failed ovulation induction
failed 6 cycles of intrauterine insemination
what steps are involved in IVF
down regulation = reduced cancellation from ovaries
ovarian stimulation = FSH +/- LH to cause follicular development
Oocyte and sperm recovery
fertilisation
embryo transfer
what are the indications for Intra Cytoplasmic Sperm Injection (ICSI)
previous failed IVF
preimplantation genetic diagnosis
severe male infertility
what is the treatment of azoospermia
surgical sperm aspiration then ICSI
where is the sperm extracted from in ICSI
obstructive infertility = epididymis
non-obstructive = testicular tissue
what is an IUD, what is it also known as
aka copper coil
non-hormonal and long-lasting method of contraception
