Sexual Health Flashcards
Normal conception rates
85% will conceive within a year of regular unprotected sex
- 1 in 7 struggle to conceive
Causes of infertility
- Sperm problems (30%)
- Ovulation problems (25%)
- Tubal problems (15%)
- Uterine problems (10%)
- Unexplained (20%)
40% of the time its a combination of male and female factors
General lifestyle advice for people trying to get preg
- Women take 400 mcg FOLATE daily
- HEALTHY BMI
- Avoid smoking + drinking too much
- REDUCE STRESS (_ve libido + relationship)
- Intercourse every 2-3 days
- avoid timing to coincide with ovulation as it just causes stress
Causes of male factor infertility
- Primary spermatogenic failure (congenital, aquired (trauma, systemic disease) or idiopathic)
-
Genetics
- KLEINFELTER’S
- KALLMANN (leads to hypogonadotropic hypogonadism)
- ANDROGEN INSENSITIVTY SYNDROME (XY but phenotype = female) -
Obstructive Azoospermia (bilat obstructed ducts)
- ABSENT VAS DEFERENS; Post infection; POST-OP - Varicocele
- Hypogonadism
- Other:
- Meds: chemo, anabolic steroids
- Psych factors causes ejaculation or erectile disorders
- Lifestyle: smoking, obesity, alcohol, drugs
1st line primary care Ix for potential male factor infertility
SEMEN ANALYSIS
- If abnormal -> REPEAT
- ideally after 3 monhts to allow spermatozoa cycle to complete
- earlier if severe deficiency - Refer to 2NDRY CARE if 2 ABNORMAL
- TEST CHLAMYDIA
What to check on examination for potential male factor infertility
- BMI
- Genital exam:
- Structural abnormalitie
- Testicular volume + consistency; varicocele; cryptoorchidism
- Hypogonadism
- Signs of anabolic steroid use
2ndry care Ix for male infertility
- Genetic test
- Sperm CULTURE
- Endocrine tests
- Image Urogenital tract (transrectal USS/MRI or VASOGRAPHY - contrast + xray in vas deferans)
- Testicular biopsy
Mx of male infertility
Lifestyle:
- Weight management
- Psych stress manage
- Advice -> smoking + alcohol cessation
Medical:
- Gonadotrophin drugs for hypogonadotropic hypogonadism
Surgical correction / sperm retrival offered for obstructive azoospermia
- Intra-uterine insemination
- Intracytoplasmic sperm injection
Donor insemination
Factors affecting semen quality + quantity
Hot baths
Tight underwear
Smoking
Alcohol
Raised BMI
Caffeine
Causes of female factor infertility
- Ovulation disorders (main)
1. Hypothalamic failure
2. Hypothalamic-pituitary ovarian (i.e. in PCOS)
3. Ovarian failure - Tubal:
- PID
- Endometriosis
- Sterilisation
- STI - Uterine / Peritoneal causes
- Endometriosis
- Previous surgery
- FIBROIDS
- Uterine anatomical anomalies
- Cervical issue - Other:
- Idiopathic
- GENETIC
- Immune issues / systemic illness
- MEDS (chemo / cytotoxic)
- LIFESTYLE (drugs + obesity)
Primary care Ix for female infertility
- Mid-luteal progesterone to assess ovulation (7 days before period is expected)
- Chlamydia + Rubella immunity screen
- HORMONES (consider):
- serum LH + FSH on days 2-5 of cycle (high: LH = PCOS; FSH = poor reserve)
- ANTI-MULLERIAN hormone (high = good ovarian reserve)
- TFTs if suggested
- PROLACTIN (too high can cause anovulation)
Refer to 2ndry care if no conception after 6 MONTHS in women > 36 YEARS
Secondary care Ix for female infertility
- USS PELVIS
- Hysterosalpingogram +/- tubal cannulation as required
- Prophyl Abx required if dilated tubes or Hx of pelvic infection due to infection risk
- STI screening before - Laproscopy + DYE test (see dye during laproscopy as opposed to imaging)
- DONE IF CO-MORBS -> can’t doe hysterosalpingogram
Mx of Anovulation
Oft due to PCOS so similar Tx
- Weight loss
- Clomifene (anti-oestrogen gien days 2-6 - stops -ve feedback)
- alt = Letrozole (aromatase inhib) - Gonadotropins
- Ovarian drilling (diathermy/laser therapy -> holes in ovaries - laproscopically)
- Metformin if insulin insensitivty + obesity
Mx of tubal cause of female infertility
- Tubal cannulation during hysterosalpingogram
- Laproscopy to remove adhesions/endomet
- IVF (intrauterine or intracytoplasmic - ICIS is more common)
Mx of uterine causes of female infertility
Surgery
Surrogacy
