Subfertility Flashcards
catogries of subfertility their treatments and investigations
Causes
- Sperm issues/male factors –> intrauterine insemination (IUI), IVF
- Ovulatory dysfunction (anovulation) –> medical induction of ovulation (controlled ovarian hyperstimulation)
- Tubal damage –> IVF
- Endometriosis/poor endometrial quality –> medically controlled ovarian hyperstimualtion + IUI
- Coital issues (impotence) –> medical/surgical
- Unexplained –> timed intercourse, lifestyle changes, controlled ovarian hyperstimulation, IUI, IVF
Investigations
- Full Hx
- Semen analysis
- FSH levels
- Chlamydia
- USS
- If known to have co-morbidties e.g. PID can be offered HSG (hysterosalpingography x-ray) to screen for tubal occlusion
Principles of ovulation induction, artificial reproduction, gamete donation, reproductive surgery
Ovulation induction - Stimulation of ovulation by medication
Artificial reproduction - does what it says on the tin, examples include artificial insemination, IVF
Gamete donation - donation of egg or sperm to be used by someone else
Reproductive surgery - Surgical field examples include vasectomy, IVF
causes of infertility and what category they fall into
Ovulatory dysfunction (anovulation)
- Menopause
- Polycystic ovarian syndrome
- Hyperprolactinaemia
- Anorexia nervosa
- Hypogonadotrophic hypogonadism
- Congenital adrenal hyperplasia
- Hypothyriodism
- Cushings
Tubal damage
- Pelvic surgery
- Fibriods
Endometriosis/poor endometrial quality
- Endometriosis
- PID
Unexplained
Polycystic ovarian syndrome : definition, cause, diagnosis, DD, how it impact on fertility and treatment
Def: Elevated androgens (testosterone) in woman
Cause: Not known thought to be genetic and environmental. Obesity and lack of exercise are risk factors
DD: hypothyroidism, congenital adrenal hyperplasia , cushings, prolactinoma, androgen secreting tumour
Diagnosis: no ovulation, high androgen levels, and ovarian cysts (sx not cause)
Treatment and fertility: no cure for PCOS and causes anovluation,
Treatment of PCOS wgt loss, exercise, COC for sx, metformin and anti androgens
For fertility: clomiphene, or metformin
How does hyperprolactinaemia impact on fertility and what are the most important causes
Hyperprolactinaemia inhibits the secretion of gonadotropin-releasing hormone (GnRH) by the hypothalalmus which in turn prevents the release of FSH and LH
Causes: tumours incl prolactinoma, hypothyriodism, antipsychotics, SSRIs, calcium channel blockers, TCA,
Endocrine axis
what is Hypogonadotrophic hypogonadism, symptoms and causes
Also known gonadotrophin deficiency syndrome. It is a disorder characterised by ovary or teste (gonad) dysfunction due to insufficient LH and FSH and therefore ostrogen and testosterone
Sx: underdeveloped gonads (testicles and ovaries) include delayed, reduced, or absent puberty, low libido, and infertility.
Causes: 1ary (from birth) usually a genetic condition 2sry developing later usually a tumour
Congenital andrenal hyperplasia
Autosomal recessive disease affecting the synthesis (+ve or -ve) of sex steriods
what is over produced in cushings
cortisol
what is clomiphene
ostrogen and anti estrogen regulator used in the treatment of subfertility
What can metformin be used in to treat fertility
PCOS
