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Obstetrics & Gynaecology > Subfertility > Flashcards

Subfertility Flashcards

1
Q

What is the definition of subfertility?

Primary and secondary subfertility?

A

Failure to conceive within one year with regular unprotected sex

  • <40 years
  • regular sex (2-3 times a day)
  • unprotected sex

Primary sub-fertility: never conceived
Secondary sub-fertility: conceived even if it ended in miscarriage or abortion

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2
Q

What are the 3 main investigations to conduct for fertility in a women?

A
  1. Ovarian reserve functioning
  2. Semen quality
  3. Tubal patency
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3
Q

What tests are specifically included in ovarian reserve functioning?
This is done to check liklihood of conception and if GnRH analogues in IVF will be successful

A
  • Serum FSH
  • Antral follicular count
  • anti-mullerian hormone
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4
Q

Which specific investigations carried out for infertility workup in a women?

Clue, want to check anovulation

A
  1. Midluteal progesterone- 7 days before period. If ,16 then anovulation
  2. FSH and LH (exclude hypothalamic hypogonadism, PCOS, ovarian failure)
  3. Ovarian reserve functioning
  4. Tubal patency
    - Hysterosalpingogram
    - Laproscopy with dye (if endometriosis, PID, ectopic)
  5. Others- TFTs, prolactin, check rubella status
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5
Q

Which parameters involved in semen analysis?

A

Number: Oligospermia, Azoospermia
Motility: <40%- asthenospermia
Morphology
Total

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6
Q

What is involved in the workup of infertility in a male?

A
  1. Semen analysis (testicular biopsy if azoospermia)
  2. FSH, LH, testosterone
  3. HB1ac, Rubella status, Ductal patency (laproscopy with dye), CF tests, testicular biopsy if azoospermia, serum karyotyping
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7
Q

What are the broad classifications of infertility in women?

A
  1. Anovulatory
  2. Pituitary causes- hyperprolactinaemia
  3. Gonadal dysgenesis- turner’s syndrome, XXX karyotype, testicular feminisation
  4. Tubes, uterine obstruction (think of causes of adhesion)- PID, Asherman’s syndrome, Bicornuate uterus, hydrosalpinx, ENDOMETRIOSIS
  5. Cervical factors- cervical narrowing and shortening, lack of production of cervical mucus, and production antibotics to spermatozoa
  6. Sexual problems- impotence, discomfort during intercourse
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8
Q

What are the WHO classification of anovulatory disorders causing infertility in females?

A

WHO group 1- hypothlamaic hypogonadism
Who group 2- PCOS
Who group 3- premature ovarian insufficiency

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9
Q

Management of infertility in women, anovulatory cycles

  • HH
  • H-P-O axis dysfunction
A

HH- pulsatile GnRH infusion pump
or gonadotrophins with LH to induce ovulation- subcut infusion slowly increase dose every 3-5 days

PCOS- Clomifene- 6 months max-ultrasound monitoring
- Metformin alongside

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10
Q

Why are gonadotrophins with LH given slowly?

A

To prevent follicular overstimulation syndrome- present with nausea, vomiting, diarrhoea, adbo distention, ascites, thromboembolism

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11
Q

What are the conservative measures taken for infertility?

A

BMI <19 or >30- adjust
No alcohol, smoking, drugs
Aerobic exercise for momma
Smear
Rubella status- this causes miscarriage in females and infertility in males
Folate 0.4mg or 5mg in diabetics or AED’s

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12
Q

When should you refer for infertility, and which factors prompt early referral?

A

After 1 year

If female >35, history of PID/STD, previous pelvic or abdo surgery, mestrual disorder, abnormal pelvic examination

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13
Q

What are the broad classifications of causes of infertility in males?

A

Abnormalities of testis/spermatogenesis
Obstruction in ducts
Other

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14
Q

What are the abnormalities of testis/spermatogenesis?

A
  • Genetic- Klienfelter’s syndrome, Testicular feminisation, Kallman’s syndrome
  • Varicocele
  • Cryptochordism (orchidopexy)
  • Testicular tumours, damage
  • Antisperm antibodies
  • Hyperprolactinaemia (uncommon)
  • Cushing’s syndrome
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15
Q

What are the abnormalities of the genital tract causing infertility in males?

A
  • Congenital abscence of vas deferens- Cystic fibrosis
  • Epdidymitis
  • Orchitis- as occurs in mumps
  • functional obstruction occurs with taking SSRI’s
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16
Q

What are other abnormalities causing infertility in males?]

Clue abnormalities of ejaculation?

A 
Azoopsermia 
Asthenospermia- reduced motility in sperm 
Alcohol/smoking 
Drugs- phenothiazines, sulfasalazines
Chemotherapy

Retrograde ejaculation- impotence- most common in diabetics

17
Q

Name some assisted conception techniques?

A
  • Intrauterine insemination
  • Intracytoplasmic insemination- if azoospermia or asthenospermia
  • IVF
  • oocyte donation
  • surrogacy
18
Q

What are the criteria for IVF?

Clue >40 and <40

A

<40- 3 cycles- stop when 40

>40- 1 cycle if never had before- no evidence of low ovarian reserve

19
Q

What are the risks of IVF

A
  • Multiple pregnancy
  • Fetal abnormality
  • Miscarriage/ectopic
  • Ovarian hyperstimualtion syndrome
  • Pelvic infection, intraperitoneal haemorrhage
20
Q

Factors affecting success of IVF?

A
  • Maternal age >40 (ie more likely IUGR, operative delivery, thromboembolism, hypertension in momma, maternal death)
  • If previously worked
  • Length of infertility
  • Maternal disease: eg

Obstetrics & Gynaecology (16 decks)

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