Subfertility Flashcards by Alice Scholfield

What is the difference between primary and secondary infertility

Primary= unable to ever get pregnant/ carry a baby
Secondary= unable to get pregnant/ carry a baby having already had at least once succesful pregnancy

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What are the main causes of subfertility and in what proportion

Ovulatory disorders: 25%
Tubal damage: 20%
Uterine/ peritoneal disorders: 10%
Male factors 30%
Unexplained 25%

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In what % of cases are both male and female factors found

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What hormone surges at ovulation

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What dosage of folic acid is given during pregnancy

400mg

500mg if on any enzyme inducers

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What is an example of hypopituitary failure

Anorexia Nervosa

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What is an example of hypopituitary dysfunction

PCOS, hyperprolactinaemia

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What is type 3 ovarian failure

Premature ovarian failure if under 40

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What is the diagnosis criteria for PCOS

Clinical hyperandrogenaemia
Oligomenorrhoea
Polycystic ovaries on ultrasound

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What will blood tests show on somebody with PCOS

Raised LH
Normal FSH
Raised testosterone

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What metabolic disease is often linked to PCOS

Diabetes Mellitus

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Name 5 tubal and uterine causes of infertility

Pelvic inflammatory diseases
Previous tubal surgery (including surgery for ectopic pregnancy)
Endometriosis
Fibroids
Cervical mucus defect

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How often does infertility occur after pelvic inflammatory disease

10% after 1 episode

50% after 3 episodes

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Acute symptoms of pelvic inflammatory diseases

Pelvic pain
deep dyspareunia
Malaise
Fever
Purulent vaginal discharge

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What histological changes can be seen in endometriosis

Presence of tissue similar to endometrium outside the uterine cavity- most commonly in the pelvis

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What increased the risk of endometriosis

Age
FH
Frequent cycles

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Symptoms of endometriosis

Pain
Dysmenorrhoea
menorrhagia
dyspareunia

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Symptoms of fibroid

Heavy regular periods

What are fibroids

Benign tumours of smooth muscle of the myometrium

Main causes of male infertility (5)

Testicular (infection, cancer etc)
Azoospermia
Reversal of vasectomy
Premature/ retrograde ejaculation
Hypogonadism

What legal drugs are linked to infertility in women

NSAID
Chemotherapy
Neuroleptics
Spironolactone
Depo-provera

What legal drugs are linked to infertility in men

Sulfasalazine
Anabolic steroids
Chemo

What % of couples are pregnant within the year

What % of couples are within 2

How is ovulatory function assessed

Blood

Ovarian reserve testing- how would they respond to Gn stimulation in IVF

How is tubal function assessed

HSG | HyCoSy

How is uterine function assessed

Laparoscopy

How should you treat/ manage type 1 hypopituitary failure

Increase weight | Consider pulsatile GnRH or Gn with LH activity to induce ovulation

What is first line treatment of PCOS

Clomiphene for 6/12 max or metformin

Second line treatment for PCOS

Clomiphene and metformin | Laparoscopic ovarian drilling and Gn therapy

After how many years should IVF be offered

2 years

What is an intrauterine insemination

Sperm is separated in lab, removal of slower speed sperm before partner in inseminated

Who should intrauterine insemination be offered to

People who are unable to vaginal intercourse Requiring specific consideration (eg sperm wash for HIV) Same sex relationship

How many cycles of IUI should there be before offering IVF

Which day does insemination take place in IUI? How is insemination achieved

12-16 | Vaginal speculum and small catheter

What is IVF

Fertilisation of egg outside the body

Who should IVF be offered toq

Woman under 40 who have not conceived after 2 years or 12 cycles of IUI

How many cycles of IVF should be offered

When can a cycle of IVF be offered to a woman aged 40-42

- 2 years unprotected intercourse - 12 cycles AI - No previous IVF - No evidence of low ovarian reserve

What are the 6 stages of IVF

1) Suppressing month cycle via injections/ nasal spray for 2 weeks 2) Boosting egg supply via injection of gonadortrophins for 12 days 3) Checking on progress through vaginal ultrasound scans and blood tests. 34-38 hours before egg collection given hormone injection for egg maturation 4) Collection of eggs using ultrasound guidance 5) Fertilising the eggs and cultivated for 16-20 hours 6- Embryo transfer

What is ovarian hyperstimulation syndrome

Consequence of drugs used to stimulate ovarian function (gonadotrophin or clomifene)

Mild ovarian hyperstimulation syndrome symptoms

Lower abo discomfort/ distention | Nausea

Severe ovarian hyperstimulation syndrome symptoms

Abdo pain/ distention Ascites Pleural effusion VT

What is intracytoplasmic sperm injection (ICSI)

Embryologist selects a single sperm to be injected directly into an egg

When is ICSI indicated

- Severe deficits in semen quality - Azoospermia (obstructive or non obstructive) - Couples in whom IVF failed