Sub-fertility Flashcards
How common is sub fertility?
14% 1 in 7 couples
When does ovulation occur?
12-16 days before start of next period
What % of couple will concieve following 1 year & 2 year of regular unprotected intercourse?
1 year 84%
2 year 92%
When should someone be referred if not conceived with IUI?
After 6 cycles
Whe should someone be referred following regular unprotected sexual intercourse?
1 year of sexual intercourse or earlier if
>36 years or
known clinical cause of sub fertility
What % subfertilty caused by male and female factors?
Male 20-30%
Female 20-35%
Combine 25-40%
What % of sub fertility is no cause found?
10-20%
What is the most common cause of female infertility?
Ovulation dysfunction
21% of female infertility
How long to sperm survive in female reproductive tract?
7 days
What frequency of sexual intercourse optimises chance of becoming pregnant?
Sexual intercourse every 2-3 days
When trying to become pregnant how much alcohol can the woman/man have?
Woman - 1-2 units, 1-2 times per week
Man 3-4 units/day
A BMI of what cut off for men and women is associated with taking longer to conceive?
BMI 30
How can ovarian response to predicted gonadotrophin stimulation in IVF?
- Total astral follicle count on TVUS, Day 3 cycle
- <4 low responded
- >16 high responder - AMH
- <5.4 low responder
- >25 high responder - FSH
- >8.9 low response
- < 4 high response
Regular menus up to how many days are normally indicative of ovulation?
26-36 days
What blood test confirms ovulation?
Progesterone, 7 days before end of cycle.
Day 21 if 28 day cycle
WHO classification of ovulation disorders. What is group 1? What would be seen on blood?
Hypogonadotrophic hypogonadism
- Low LH/FSH
- Normal prolactin
- Low oestrogen
10% ovulation
WHO classification of ovulation disorders. What is group 2? What would be seen on blood?
Hypothalamic pituitary dysfunction
1) LH/FSH abnormality
2) Normal oestrogen
85% ovulation disorders
PCOS
WHO classification of ovulation disorders. What is group 3? What would be seen on blood?
Ovarian failure
- High gonadotrophins
- Hypogonadism, low oestrogen
4-5% ovulation disorders
What % of sub fertility is caused by tubal factors?
14%
What % of tubal obstruction detected at HSG will be confirmed at laparoscopy?
38%
What % of tubal patency detected at HSG will be confirmed at laparoscopy?
94%
Who should HSG not be offered to?
PID
Previous ectopic
Endometriosis
Need more reliable test - HyCoSy or Lap & Dye
What imaging and what infection screening should be performed when Ix sub fertility?
USS pelvis
Viral status (HIV, Hep B, Hep C, Rubella)
Chlamydia
For what infections can sperm washing be offered?
Hep C and HIV
When should sperm washing happen for HIV+ve male?
Not compliant with HAART
Plasma viral load >50
Confection with other infection
What prophylaxis if given to women undergoing HSG
Doxycycline ot azithromycin
In unexplained sub fertility, what is chance of spont pregnancy with each menstrual cycle?
2-4%
15% in 1 year, 35% 2 years
Unexplained fertility, most important predictor of successful conception>
Age of woman
1st line treatment for unexplained sub fertility?
Expectant management for 2 years
When to offer IVF in unexplained sub fertility
After 2 years
When to offer IUI as alternative to vaginal sexual intercourse?
Difficulty sexual intercourse - physical/psychosexual
Sperm washing
Same sex
If no pregnancy following 6 IUI what should happen?
Assess ovulation, tubal patency, semen analysis
If normal offer further 6 IUI
Low sperm count is found to be the cause of what % of sub fertility?
20%
Contributory in further 25%
What % of WHO criteria for sperm quartity will be a false +ve, following 1 & 2 test?
1 test 10% false +ve
2 test 2% false +ve
How long should a repeat sperm count be sent?
3 months
If azoospermia or severe oligozoospermia, when should the repeat sperm count be sent?
2-4 weeks
What % of men with poor sperm quality if no cause found?
30-50%
What is the normal values on sperm count:
Semen volume
> 1.5ml
What is the normal values on sperm count:
pH
> 7.2
What is the normal values on sperm count:
Spem concentration
> 15 million per ml
What is the normal values on sperm count:
Total number of sperm
> 39 million per ejaculate
What is the normal values on sperm count:
Total motility (progressive & non progressive)
> 40 motile
32 progressive motility
What is the normal values on sperm count:
Vitality
> 58%
What is the normal values on sperm count:
Sperm morphology
> 4%
List causes of hypothalamic hypogonadism causes of male subfertiliy
Congenital - Kallman
Acquire - pituitary lesion, hyperprolactinoma, anabolic steroids
Causes of non obstructive azoospermia (testicular), what is seen on Ix
Reduction in testicular size and elevated FSH
Most common cause of male infertility
Cryptorchidism
Torsion
Trauma
Orchitis
Chromosome disorders (Klinefelter’s syndrome, Y-chromosome microdeletions)
Systemic disease
Radiotherapy or chemotherapy
Idiopathic (66%)
→ offer cryopreservation
List causes of obstructive azoospermia, what seen on tests?
Normal testes size, normal FSH
- Congenital absence vans deference (CF)
- Varicocele
→ also consider anejacualtion or retrograde ejaculation
How does myotonic dystrophy effect male fertility?
Testicular atrophy, primary hypogonadism
- Oligo/azospermia
- Impaired secondary sexual characteristics
- Low testosterone, high FSH/LD
What is the medical treatment of male hypogonasotrophic hypogonadism?
FSH and hCG to stimulate spermatogenesis
What is the medical treatment of male anejacualtion?
Alpha-agonistic drugs
Parasympathetic drugs
What can be offered to men with obstructive azoospermia?
Surgical correction of obstruction
IVF/ICSI
Does surgical treatment of varicocele improve pregnancy rates?
No, do not offer
Which men are offered IVF/ICSI?
Azoospermia, oligosperma, unexplained infertility
Chances of successful prengnay with each cycle IVF?
15-20%
