Subfertility Flashcards
Subfertility?
Delayed conception after 12 months of regular unprotected sex
Causes of subfertility
Female (ovarian, uterine and tubal)
Male causes
Ovarian causes
PCOS
Hyperprolactinemia
Endocrine problem
Uterine causes
Intramural and submucosal fibroids
Ashermann syndrome
Polyp
Tubal disorders?
PID
Endometriosis
Hydrosalpinx
__________ fibroids dont cause subfertility
Subserosal
Male causes
Stress, ED, smoking, age, cancer, diabetes, mumps, epididymitis, previous surgery
SFA
Semen fluid analysis
Investigation
CBC
LFT
UCE
TFT
FSH
LH
Prolactin
AMH
AFC
HBA1C
Testosterone
TVUS
Hysterosalpingography
Male investigation
SFA (repeat it after 3 months)
Baseline
Karyotyping
Total Motile Count
Sperm count
Abstinence from intercourse for ______ before SFA
2-4 days
Treatment
Clomiphene citrate
Metformin
IVF
Adoption
Ovarian drilling
Intrauterine insemination
Fecundability
Likelihood of conceiving within one menstrual cycle
% of fecundability
18-20% in a young healthy couple
70% within 6 months
80% within 12 months
90% within 24 months
Single most important factor for subfertility
Female age
A person with subfertility also has symptoms of visual field defects
Prolactinoma
A person with subfertility also has symptoms of acne, hair growth
PCOS (hyperandrogenism)
If a person has regular cycle then we will investigate for
FSH
LH
AMH
If a person has irregular cycles then we will investigate for
TFT
Prolactin
Testosterone
Infection screening for subfertility
Chlamydia
HIV
Hep B and C
Progesterone is tested on the ______________ day to confirm ovulation
21th day of the cycle or mid-luteal phase
AMH is used to check _____________
ovarian reserve
__________ is the best biomarker of ovarian reserve
AMH
AFC >16 is _________ response
high
AFC <4 is ___________ response
low
Complication of using clomiphene citrate
Multiple pregnancies
Laparoscopic ovarian drilling is used only when there is _______________
no response to clomiphene citrate
Tx of hypothalamic disorder
injectable pulsatile gonadotrophins
Tx of hyperprolactinemia
Surgery
Dopamine agonist
What tests are used for tubal patency?
Hysterosalpingogram
Hysterocontrastsynography
Laparoscopy and Dye Insufflation
Hysterosalpingogram is performed during ____________
follicular phase
Exposed to Xrays
Hysterocontrastsynography uses _____________
ultrasound
_________________ is gold standard for tubal patency assessment
Laparoscopy
Explain the procedure of laparoscopy and dye insufflation
Pneumoperitoneum is created
Methylene blue is injected into uterine cavity.
Normal = When the dye distends the tube and spills out into the abdominal cavity
Abnormal = When the dye doesn’t enter either tube
Tx of adhesion
laparoscopic adhesiolysis
Tx of blocked tube
tubal surgery
Tx of endometriosis (surgical)
laparoscopic ablation
Tx of fibroid
Myomectomy
Hysteroscopy
Embolization
Oligozoospermia means
Sperm conc less than 15 million/ml or less than 39 million per ejaculate
Asthenozoospermia means
Sperm motility less than 32%
Teratozoospermia means
Sperm morphology less than 4%
Azoospermia mean
No sperms in ejaculate
Aspermia mean
no ejaculate
What is oligoasthenoteratozoospermia?
Low concentration
Low motility
Poor morphology
pH of semen
more than 7.2
Vitality of sperm
58%
What are the antispermatogenic drugs?
Alcohol
Anabolic steroid
What are antiandrogenic drugs?
Cimetidine
Spironolactone
What drugs cause ejaculatory dysfunction?
alpha and beta blockers
Antidepressants
Tx of Retrograde ejaculation
Sympathomimetics
Abnormal SFA then perform
FSH
LH
Testosterone
