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203: Reproductive system, fetal development, pregnancy and birth > Subfertility > Flashcards

Subfertility Flashcards

1
Q

Requirements for contraception

A

Motile and normal sperm
- Able to reach and fertilise oocyte

Release of competent oocyte on time

Free passage for sperm to oocyte

Free passage for embryo to uterus

Mature endometrium for implantation.

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2
Q

Infertility

A

Inability to conceive after repeated unprotected intercourse
- 2 years

Can be investigated after 1 year

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3
Q

Top 5 common causes of infertility

A

Unexplained

Ovulatory

Male factor

Tubal
Endometriosis

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4
Q

Infertility statss

A

1 in 6 have problem with conceiving

Combined male and female factors accounts for 39% of the cause

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5
Q

Early investigation indications

- Female

A

> 35

Amenorrhoea/ Oligomenorrhoea

Previous abdo/ pelvic surgery

Previous STD/ PID

Abnormal pelvic examination

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6
Q

Early investigation indications

- Male

A

Previous genital pathology

  • Testicular maldescent
  • Surgery
  • Infection
  • Trauma

Previous STD

Systemic illness

Abnormal genital examination

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7
Q

Normal sperm count

A

> 15 million per ml

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8
Q

Normal sperm motility

A

> 40%

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9
Q

Normal sperm morphology

A

> 4%

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10
Q

Normal volume of semen

A

1.5-6 ml

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11
Q

Causes of azoospermia/ oligospermia

A

Primary testicular failure
- Most common

FSH/ LH/ Testo levels low

Y chromosome microdeletion

Cystic fibrosis

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12
Q

Female age and fertility

A

Fertility declines with age due to reduction in total oocytes

Also an increased rate of chromosomal abnormalities in oocytes

  • Increased aneuploidy
  • Increased miscarriage
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13
Q

Anti-mullerian hormone

A

Produced by Granulosa cells
- Pre-antral and small antral follicles

Good indicator of ovarian reserve
- Declines with age

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14
Q

Ovulation assessments

A

Ovulation detection kit [LH, urinary]

Cervical mucous

Basal body temperature

Follicular tracking- ultrasound scan
- Costly

Mid-luteal phase p4 (7 days before menstruation0

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15
Q

Mid luteal P4

A

Measurement of progesterone 7 days before menstruation

- >30 nmol/L = ovulation

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16
Q

Investigations for oligo/amenorrhoea

A

FSH/LH levels

  • Normal in PCOS
  • High in Premature ovarian failure
  • Low in hypogonadotrophic hypogonadism

Oestrogen levels

  • Normal in PCOS
  • Low in POF
  • Low in Hypogonado Hypogonad

Prolactin

Thyroid function

Androgens

SHBG

17
Q

Most common cause of tubal damage

A

Pelvic inflammatory disease secondary to a chlamydia infection.

18
Q

Proximal and distal tubal disease

A

Proximal less common (25%)
- Closer to the uterus

Distal (75%)

19
Q

Factors that increase risk of tubal damage

A

Pelvic inflammation
- 54% risk after 3 episodes (12% then 23%)

Septic abortion

Ruptured appendix

Pelvic surgery

Ectopic pregnancy

20
Q

Hysterosalpingogram (HSG)

  • Description
  • Infection
A

Fluoroscopy of uterus and tubes
- 2-5 days before menstruation

Antibiotics given to avoid infection flare-up
- 1% infection risk

21
Q

HSG advantages and disadvantages

A

Advantages

  • Relatively safe
  • Easy
  • Precisely highlights the uterine cavity and tubes.

Disadvantage
- Cannot assess the peritoneum

22
Q

Hysterosalpingo-contrast- ultrasonography (HyCoSy)

A

Ultrasound that uses contrast medium

Advantages

  • No radiation
  • Can assess ovaries and uterus

Disadvantage

  • Time consuming
  • Requires training
23
Q

Laparoscopy and dye [hysteroscopy]

A

Invasive

  • Can diagnose and treat endometrisosis + adhesions
  • More sensitive
  • More specific

Risk of visceral injury

24
Q

Imaging techniques best for detecting uterine abnormalities

A

Hysteroscopy- best

HSG
Transvaginal ultrasound

25
Q

Clomifene citrate

A

Drug used to induce ovulation
- PCOS

Mechanism
- Inhibits oestrogen receptors in the hypothalamus–> Prevents inhibition of GnRH release

Multiple pregnancy risk

26
Q

FSH injections

A

Used to stimulate ovulation

  • Resistant PCOS
  • Hypogonado hypogonad
27
Q

Intrauterine insemination

  • When it should not be offered
  • Advantages
  • Success rate
A

Unexplained infertility
Mild endometriosis
Low sperm count

Advantages

  • Less stress
  • Less invasive
  • Less tech
  • Cheap

Success rate
- 10% per cycle

28
Q

NICE guideline for IUI

A

Not offered for unexplained infertility
- IVF instead

Offered for

  • Single women
  • Same sex couple
  • Heterosexual w/ intercourse problem
29
Q

IVF indications

A

Tubal damage

Low sperm quality

Unexplained infertility

Low ovarian reserve

30
Q

IVF process

A
  1. Controlled ovarian hyperstimulation
  2. Egg collected
  3. Egg fertility in virto
    - Intra-cytoplasmic sperm injection
  4. Embryo left to develop
  5. Embryo transferred into uterus for implantation.
31
Q

IVF success rate <35 years old

A

30-35%

203: Reproductive system, fetal development, pregnancy and birth (23 decks)

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