Subfertility Flashcards
What is subfertility?
When conception has not occurred after 1 year of unprotected sexual intercourse
What are the different types of subfertility?
- Primary: Never conceived
2. Secondary: Has conceived previously
What is oligozoospermia?
<15 million/ml sperm
What is asthenozoospermia?
A reduction in sperm motility around 30%
What is teratozoospermia?
A reduction in sperm morphology around 4%
What is azoospermia?
No sperm
What is severe oligospermia?
<5 million/ml
In what cases can you refer women to subfertility clinic before 1 year of trying to conceive? (2)
- If the women is >36 YO
2. Known clinical cause of infertility eg. PCOS
What is the effect of an increased maternal age on fertility? (3)
- Decreases fertility due to a decrease in ovarian reserve
- Increase in miscarriage rates
- Increase in foetal chromosomal abnormalities
What is the effect of maternal BMI >30 on fertility? (3)
- Takes longer to conceive
- Increased miscarriage rate
- Increased pregnancy complications
What is the effect of maternal BMI <20 on fertility? (3)
Annovulation
What is the effect of paternal BMI >30 on fertility?
Reduced fertility
What is the effect of maternal smoking on fertility?
Reduced fertility
What is the effect of paternal smoking on fertility?
Reduced semen quality
What is the effect of paternal alcohol intake on fertility?
Reduces semen quality
What is the effect of Maternal alcohol intake on fertility?
No effect on fertility - intoxication harms a developing foetus
What important questions do we need to know when assessing a females fertility? (10)
- Age
- LMP + details of menstruation
- Any history of dysmenorrhoea
- Coital frequency and problems
- Previous pregnancy history and problems
- Previous PID/surgery
- Medical history + meds
- FH - DVT + genetic disease
- Smoking/alcohol/BMI
- Smear test
What important questions do we need to know when assessing a males fertility? (8)
- Age
- Occupation
- How many children he has
- Social - smoking, drinking, drugs
- Previous operations
- History of mumps/trauma
- Medical conditions + drugs
- Coital problems and frequency
List 7 causes of infertility + how common they are
- Unexplained - 30%
- Ovulatory disorders - 3-%
- Tubal damage - 25%
- Male factors - 25%
- Cervical problems - 5%
- Coital problems - 5%
- Uterine or endometrial problems
What is Clomifene citrate?
Ovarian stimulating agent
How is Unexplained infertility managed?
- Do not offer climifene citrate
2. Offer IVF if women has not conceived after 2 years of regular unprotected sex
What are 3 psychological effects of infertility?
- Relationship problems
- Stress
- Loss of libido
How do we apporoach managing psychological effects of infertility?
- Counselling
- Support groups
- Specialis teams
Why is it important to take folic acid up to 12 weeks of gestation?
Reduces the risk of having a baby with neural tube defects
What is the recommended daily dose of folic acid
0.4 mg
In which 2 circumstances should we consider giving 5 mg of folic acid daily?
- Previous infant with a neural tube defect
2. Mums taking anti-epileptic medication
How often is it recommended to have sexual intercourse to optimise the chance of pregnancy?
Every 2-3 days
When should artificial insemination happen?
Around ovulation
List 4 non-pathological causes of abnormal semen analysis
- Unknown
- Smoking/alcohol/drugs/chemicals/tight underwear
- Genetic
- Antisperm antibodies
How do we investigate male infertility?
- Semen analysis - repeat in 12 weeks if abnormal
- Scrotum examination
- Bloods- FSH/LH/TST/prolactin and testosterone
- Karyotyping
- Cystic fibrosis
What are the causes of abnormal/absent sperm release? (5)
- Idiopathic
- Drug exposure - alcohol/smoking/drugs
- Exposure to chemicals
- Varicocele - 25%
- Anti-sperm antibodies
Which 2 medications cause abnormal sperm release?
- Sulfasalazine
2. Anabolic steroids
In patients with antisemen antibodies, what do you see on semen analysis? (2)
Poor motility
clumping
When are men at a high risk of developing antisperm antibodies?
After vasectomy reversal
What are the causes of abnormal semen?
- Infection - mumps, epididymitis
- Testiculer abnormalities - Klinefelter syndrome XXY
- Obstruction: Cystic fibrosis leading to congenital absence of the Vas
- Hypothalamic problems
- Kallmans syndrome
- Retrograde ejaculation - into bladder
What happens to FSH, LH and testosterone in kallmans syndrome?
Reduced
What causes retrograde ejaculation? (2)
- Diabetes
2. TURP
What happens to FSH, LH and testosterone in primary testicular faliure?
High FSH, LH
Low testosterone
What causes primary testicular failure? (3)
- Cryptorchidism
- Surgery
- Radiotherapy/chemotherapy
What do you need to test for if a patient presents with azoospermia and absent Vas deferens?
Cystic fibrosis work up
What are the 4 classifications for male infertility aetiology?
- Hypothalamic pituitary disease - secondary hypogonadism 1/2%
- Testicular disease - primary hypogonadism 30/40%
- Sperm transport problems 10/20%
- Unexplained - 40/50%
How is male infertility managed? (oligo/moderate/azoopermia) to assist in conception
- Optimise lifestyle factors
- Oligospermia - intrauterine insemination
- Moderate/severe oligospermia: IVF +/- ICSI
- Azoospermia: surgical sperm retrieval then IVF +/- ICSI or donor insemination
What lifestyle advice do you give infertile men
- Loose clothing
- No smoking, alcohol, drugs
- Loose weight
What does IVF stand for?
In vitro fertilization
What does ICSI stand for?
Intracytoplasmic injection
What medication can we use to manage male infertility?
- Hypogonadotrophic hypogonadism - injections of LH/FSH +/- HCG for 6 months
- Corticosteroids (unclear)