Reproductive medicine Flashcards
Causes of anovulaiton (what is the most common)
PCOS: Most common
Hypothalamic hypogonad
Hyperprolactinemia
Premature ovarian failure
PCOS criteria
Rotterdam criteria 2/3
- oligo-/or anovulation
- hyperandrogenism
- Polycystic overies
Why can PCOS cause endometrial hyperplasia?
High levels of oestrogen. Need to take progesterone to prevent cancer (always do PT first)
Diagnostic features of PCOS
Presence of risk factors Premature adrenarche FHx of PCOS Reproductive age Typically starts at time of puberty. However if oral contraceptives were began at young age, symtoms may be masked. Irregular menstruation 75% bleeding <21 days or >35 days. If regular may be anovulatory. As PCOS women age, cycle length may shorten. Infertility Hirsutism 60% hair in androgen dependant areas Acne Overweight/obesity Hypertension
Treatment of PCOS
want pregnancy: weight loss metformin clomifene Injectiable Gondaotrophins Laproscopic drilling IVF
if not wanting pregnancy
OCP
Reversible cause of premature ovarian failure
Hyperprolactnaemia
Treatable cause of ↓sperm count
hypogonadism (anabolic steroids- negative feedback, ↓ testosterone from testicles- sertoli cells ↓)
Test for male fertility
Volume: >2mL
pH: >7.2
sperm concentration: >20million per mL
Total sperm number: >40million per ejaculated
mobility: >50% grade a or b (that move forward)
morphology: >30% normal froms
Test for tubal factor
Hysterosalpingogram
Laproscopy & dye test
Difference between primary and secondary infertility
primary: never conceived, secondary, previously conceived
Aetiology
↑ Age Smoking Frequency of intercourse Alcohol Body weight (high >29 or low <19) Drugs: NSAIDS, chemotherapy Occupational hazards (exposure to radiation)
Ovulations problems
- Hypothalamic insufficiency, Pituitary (prolicatinaemia), PCOS, thyroids
Tubal blockage
- PID, other inflammatory (surgery or endometriosis)
Endometrial factors
Fibroids, polyps, adhesions, surgical resection
History for infertility.
Couple
- How long have they been trying to conceive
- Pregnancies together outcomes
- Pregnancies with previous partners
- Coital frequency, timing, problems.
Female:
- Cycle Hx
- Weight: change in weight, signs of PCOS
- Risk of tubal disease: STI, ectopic, surgery
- Hx Endometriosis
- Dhx
- Shx: smoking & alcohol & exercise
Male
- Occupation
- Testicular maldescent
- Trauma
- Infections: STI, MUMPs
- Surgery
- DHx: therapeutic & recreational
- Shx: smoking & alcohol & exercise
Basic investigations
Ovulation:
- Mid-luteal progesterone (7 days before expected peroid)
Day 2-4 hormone profile:
- FSH
- LH
- Prolactin
- TSH
- Testosterone
Pathology
- Rubella
- Cerival smear
- C & G swabs
- Viral serology (Hep B, C, HIV)
Tests for ovarian reserve:
- Easy FSH (can’t be on pill), ↑ if depleted follicle count
- AMH
- AFC
Check tubal patency (next slide)
Seminal fluid • Volume >1.5ml • Count > 15 million/ml • Motility > 40% • Morphology 4% +
What can be used to test for tubal patency?
- Hycosy (US with contrast)
- Hysterosalpingogram (HSG): X-ray with contrast
- Laparoscopy and dye: Gold standard
These test potency not funcitonal
Who would you refer early?
- Age 35+
- Low ovarian reserve
- Amenorrhoea/oligomennohoea
- Suspected tubal factor or male factor
