Subfertility Flashcards
How many people struggle to conceive naturally
1 in 7
85% will conceive after year unprotected sex
When should investigation and referral for subfertility be done
Without success for 12 months
6 mobths if woman if >35
Causes of subfertility
- Sperm problems (30%)
- Ovulation problems (25%)
- Tubal problems (15%)
- Uterine problems (10%)
- Unexplained (20%)
40% of infertile couples mix male and female causes
General advice for women trying to conceive
400mcg folic acid daily
Aim for healthy BMI
Avoid smoking and drinking excessive alcohol
Reduce stress at this may negatively affect libido and reslationsip
Aim for intercousre every 2-3 days
Avoid timing intercourse
What is not necessary for intercourse for subfertility
Dont have to time it - stress and pressure
Investgiations for subfertility initial
BMI
Chlamydia
Semen analysis
Female hormonal testing
Rubella immunity in mother
Female hormonal testing for fertility
Day 2-5 of cycle - Serum LH and FSH
Day 21 - serum progesterone on day 21 cycle (or 7 dyas before if not 28 dyas)
Anti-Mullerian hormone
Thyroid function tests
Prolactin - hyperprolactonaeima cause anovulation - symptoms galactorrhea or amenorrhea
What does high FSH suggest
Poor ovarian reserve (no. follicles women left in ovaries)
(pituitary gland producing extra FSH in attempt stimulate follicular development)
What does high FSH suggest
Poor ovarian reserve (no. follicles women left in ovaries)
(pituitary gland producing extra FSH in attempt stimulate follicular development)
What does high LH suggest
PCOS
What does a rise in progesterone on day 21 suggest
Ovulation has occured, corpus luteum formed and secreting progesterone
What does a high level of anti-mullerian hormone indicate
Ovarian reserve
(released by granulosa cells in follicles)
Further investigations for PCOS
US pelvis
Hysterosalpingogram
Laprascopy and dye test
What is hysterosalpingogram
Scan to assess shape of uterus nad patency of fallopain tubes, also therapeutic
What happens in a hysterosalpingogram
Small tube -> cervix. Contrast medium injected -> uterine cavity and fallopian tubes
X rays taken - contrast outlines uterus and tibes. If dye doesnt fill one of tubes, seen on x ray, suggests obstructuion
Can also tubal cannulation - xray guidance, open up tubes
What happens in a hysterosalpingogram
Small tube -> cervix. Contrast medium injected -> uterine cavity and fallopian tubes
X rays taken - contrast outlines uterus and tibes. If dye doesnt fill one of tubes, seen on x ray, suggests obstructuion
Can also tubal cannulation - xray guidance, open up tubes
What is given prophylactically with hysterosalpingotomy
Antibiotics - prophylactically
Screening for chlamydia and gonorrhea done before procesdure
What is laparascopy and dye test
Dye injected into uterus - should be seen -> fallopian tubes and spilling out end. Doesnt happen in tubal obstruction
Can also assess and treat endometriosis or pelvic adhesions
What is the management of anovulation
Weigth loss
Clomifene - stimulate ovulation
Letrozole - 2nd line
Gonadatropins
Ovarian drilling
Metformin - insulin senstivity and obesity
What is clomifene
Anti oestrogen - selective oestrogen receptor modulator. Stops negative feedback oestrogen to hypothaamus -> greater release of GnRH + therefore FSH and LH
When are gonadotrophins used
Stimulate ovulation in women resistant to clomifene
What are alternatives to clomifene
Letrozole - aromatase inhibitor, anti-oestrogen effects
Gonadotrophins
Management of tubal factors
Tubal cannulation in HSM
Laparascopy remove adhesions/endometriosis
IVF
Management of tubal factors
Tubal cannulation in HSM
Laparascopy remove adhesions/endometriosis
IVF
Management of uterin factors
Surgery - correct polyps, adhesions or structural abnormalities
When is surgical sperm retrieval used
Blockage along vas deferens preventing sperm reaching ejaculated seme
Needle and syring =e collect from epididymi=us through scrotum
Options for male infertility management
Surgical sperm retrieval
Surgical correction obstruction
Intra-uterine insemination
Intracytoplasmic sperm injection
Donor insemination
Options for male infertility management
Surgical sperm retrieval
Surgical correction obstruction
Intra-uterine insemination
Intracytoplasmic sperm injection
Donor insemination
What is intra-uterine insemination
Collect and spread high quality sperm, injecting them directly into uterus to give best chance of success
What is ICSI
Intracytoplasmic sperm injection
Sperm directly injected into cytoplasm of egg -> embryos, injected into uterus of woman
Significant motility issues, low sperm count etc
