Subfertility Flashcards
Define infertility
a disease of the reproductive system defined by the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse
Define primary infertility
When a woman is unable to ever bear a child, either due to the inability to become pregnant or the inability to carry a pregnancy to a live birth she would be classified as having primary infertility. Includes miscarriages, ectopics, abortions and stillborns.
Define secondary infertility
When a woman is unable to bear a child, either due to the inability to become pregnant or the inability to carry a pregnancy to a live birth following either a previous pregnancy or a previous ability to carry a pregnancy to a live birth
What are the causes of subfertility in females?
Ovulatory disorders, tubal damage, uterine disorders, unexplained
What are the three main types of ovulatory disorders?
Hypopituitary failure
Hypopituitary dysfunction
Ovarian failure
What causes hypopituitary failure?
Anorexia nervosa, preventing ovulation
What may cause hypopituitary dysfunction?
Polycystic ovary syndrome or hyperprolactinaemia
What is polycystic ovary syndrome?
Where a woman has 10 or more follicles on each ovary found on ultrasound
What will blood tests for polycystic ovary syndrome show?
Elevated LH, normal FSH and raised testosterone
What are the signs and symptoms of polycystic ovary syndrome?
Hyperandrogenaemia (male-pattern hair loss, acne, infertility), oligomenorrhoea, central obesity, acanthuses nigerians
Why does polycystic ovary syndrome put a woman at greater risk of developing diabetes?
There are associated metabolic abnormalities with PCOS such as abnormal serum lipid concentrations and insulin resistance which convey a greater risk
What is pelvic inflammatory disease?
An infection of the upper female reproductive tract (uterus, fallopian tubes and ovaries) caused by bacteria that spread from the vagina and cervix
How may pelvic inflammatory disease present?
May be asymptomatic, otherwise may be purulent vaginal discharge, pelvic pain, fever, pain with sex or irregular menstruation
How is pelvic inflammatory disease treated?
Antibiotics
Which bacteria are most likely to cause pelvic inflammatory disease?
Infections by Neisseria gonorrhoeae or Chlamydia trachomatis are present in 75 to 90 percent of cases
Which disorders may cause tubal damage that affects fertility?
Pelvic inflammatory disease, endometriosis, previous tubal surgery, fibroids and cervical mucus defect
What is endometriosis?
Where tissue that is histologically similar to the endometrium is found outside the uterine cavity and myometrium, most commonly in the pelvis
What can protect against endometriosis?
Pregnancy and COCP
What are the symptoms/signs of endometriosis?
Pain, dysmenorrhoea, menorrhagia or difficulty urinating
What would be found on examination in endometriosis?
Pelvic tenderness/mass and a fixed uterus
How is endometriosis treated?
NSAIDs, COCP, danazol or GnRH agonists
What are fibroids?
Uterine leiomyomas, they are benign tumours of the smooth muscle of the myometrium
How are fibroids treated?
Tran acid, COCP, LARCs and surgery
What are the signs of fibroids?
Heavy, regular periods
What are the male causes of subfertility?
Testicular (infection, undescended, trauma), azoospermia, reversal of vasectomy, ejaculatory dysfunction (retrograde or premature) or hypogonadism
Which drugs may lead to sub fertility in women?
Long term NSAIDs, chemotherapy, neuroleptics, spironolactone, depo-provera
Which drugs may lead to sub fertility in men?
Sulfasalazine, anabolic steroids, chemotherapy
What hormones do the ovaries produce?
Oestrogen (oestrodiol), progesterone, activin and inhibit
What tests may be conducted to assess female tubal function?
HSG and HyCoSy
How may infertility due to hypopituitary failure be treated?
Increase weight and consider pulsatile GnRH or Gn with LH to induce ovulation
How may subfertility due to polycystic ovary syndrome be treated?
Consider clomiphene and/or metformin
How may infertility due to hyperprolactinaemia be treated?
Consider bromocriptine
What is ovarian hyper stimulation syndrome?
Condition that occurs due to drug used to stimulate ovarian function (gonadotrophin or clomifene) and it can cause lower abdominal pain, distention, ascites, pleural effusion or venous thrombosis
How may infertility due to ovarian failure be treated?
Consider donor eggs or adoption
When is IVF offered to couples?
After 2 years of trying with no success
What is intrauterine insemination (IUI)?
A sample of sperm is separated the lab and slower sperm is removed and best sperm are selected. These are then inserted via vaginal speculum and a small catheter into the womb. This is done at the time of ovulation (usually day 12-16 of a woman’s menstrual cycle)
Who may require intrauterine insemination for conception?
Those unable to have vaginal intercourse, sperm-wash for HIV positive men or same-sex relationships (with donor)
What is IVF?
Where there is fertilisation of an egg in a dish which is then grown and implanted when it is an embryo into the womb
Outline the process of IVF.
> Suppress natural hormone cycle
Boost egg supply with gonadotrophins to increase the number of eggs produced
34-38 hours before eggs are due to collection, hormone injection to aid maturation
Collection of eggs with USS guidance
Eggs fertilised with prepared sperm
Incubated for 6 days and best quality are chosen for implantation (one or two)
Who is IVF offered to?
o Women under 40 who have not conceived after 2 years of unprotected intercourse or 12 cycles of artificial insemination (6 IUI).
What is intracytoplasmic sperm injection (ICSI)?
Single spear is selected to be injected directly into an egg
Who may have intracytoplasmic sperm injection (ICSI)?
If there are severe defects in sperm quality, azoospermia or IVF treatment failed
