Subfertility Flashcards
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
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%
In what % of cases are both male and female factors found
40
What hormone surges at ovulation
LH
What dosage of folic acid is given during pregnancy
400mg
500mg if on any enzyme inducers
What is an example of hypopituitary failure
Anorexia Nervosa
What is an example of hypopituitary dysfunction
PCOS, hyperprolactinaemia
What is type 3 ovarian failure
Premature ovarian failure if under 40
What is the diagnosis criteria for PCOS
- Clinical hyperandrogenaemia
- Oligomenorrhoea
- Polycystic ovaries on ultrasound
What will blood tests show on somebody with PCOS
Raised LH
Normal FSH
Raised testosterone
What metabolic disease is often linked to PCOS
Diabetes Mellitus
Name 5 tubal and uterine causes of infertility
- Pelvic inflammatory diseases
- Previous tubal surgery (including surgery for ectopic pregnancy)
- Endometriosis
- Fibroids
- Cervical mucus defect
How often does infertility occur after pelvic inflammatory disease
10% after 1 episode
50% after 3 episodes
Acute symptoms of pelvic inflammatory diseases
Pelvic pain deep dyspareunia Malaise Fever Purulent vaginal discharge
What histological changes can be seen in endometriosis
Presence of tissue similar to endometrium outside the uterine cavity- most commonly in the pelvis
What increased the risk of endometriosis
Age
FH
Frequent cycles
Symptoms of endometriosis
Pain
Dysmenorrhoea
menorrhagia
dyspareunia
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
50
80
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
12
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
3
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
