Subfertility Flashcards
What are the requirements for conception?
Progressively motile normal sperm capable of reaching and fertilizing the oocyte.
Timely release of a competent oocyte.
Free passage for the sperm to reach the oocyte and for the embryo to reach the uterus.
A mature endometrium that allows implantation.
What are some causes of infertility?
unexplained (30%) ovulatory male factor tubal endometriosis other factors
What congenital disease causes the absence of vas deferens bilaterally?
cystic fibrosis
Obstructive vas deferens
normal testes
descended epidydimis
no vas deferens felt
Maternal age
fertility declines
decline in number of oocyte
increased rate of chromosomal abnormalities in oocyte leads to higher aneuploidy and miscarriage rates
Why do we often screen for chlamydia in fertility screening?
PID secondary to chlamydia is the commenest cause of tubal damage
also need to screen before instrumentation as the bacteria like the dye
What is the GOLD STANDARD for examining tubes?
laparoscopy
Hysterosalpingogram
done 2-5 days after menustration
antibiotics given to prevent flare up if H/O PID
safe, easy to use
How can we induce ovulation?
Clomifene for women with PCO
FSH injections for resistance PCO or HGHG
Clomifene
Anti-oestrogen which induces gonadotrophin release by occupying oestrogen receptors in the hypothalamus, thereby interfering with feedback mechanisms; chorionic gonadotrophin is sometimes used as an adjunct.
What is the most common cause of tubal damage?
PID secondary to chlamydia
