Subfertility Flashcards
What is secondary sub fertility?
Inability to become pregnant or to carry a baby to term after previously giving birth
Conception rates in couples having regular sex
After 1 year - 84%
After 2 years - 92%
Causes of subfertility
Anovulation - 21% Male factor - 25% Tubal factor - 15-20% Unexplained - 28% Endometriosis - 6-8%
Women (67%)
Causes of of anovulation
Premature ovarian failure Turner’s syndrome Surgery/chemotherapy PCOS (80%) Kallman’s syndrome (hypogonadotrophic hypogonadism) Hyperprolactinaemia
Investigations in primary care
Chlamydia screen
Baseline hormone profile (Day 2-5 FSH [should be >10] and LH)
TSH, prolactin, testosterone and rubella status
Mid literal progesterone level (>30 for ovulation)
Semen analysis (selenium, zinc and vitamin c)
Lifestyle modification
Healthy diet Stop smoking and/or recreational drugs Reduce alcohol consumption to less that recommended limits Regular exercise Regular intercourse (Folic acid)
Methods of ovulation induction
Weight loss or gain Clomifene citrate (anti-oestrogen) Laparoscopic ovarian drilling (only for PCOS) Gonadotrophins Metformin
Normal semen analysis
Volume >1.5mls Concentration > 15x10ml Progressive motility >32% Total motility >40% Normal forms >4%
Factors to consider when trying to conceive
Female age Uterine function Duration of trying Lifestyle factors Medical history Previous pregnancy
Hallmarks of PCOS
Elevated LH
Insulin resistance
Leading to:
- ovarian growth
- ovarian cyst formation
- androgen production
Symotoms of PCOS
Androgen excess - hirsuitism, acne
Obesity
Irregular menses
Amenorrhea
Diagnosing PCOS
Serum testosterone
LH (will be increased)
FSH (will be decreased) ratio LH:FSH can be 3:1
Prolactin, TSH
Pelvic USS - enlarged follicles (>10mm)
Criteria for definitive diagnosis of PCOS
2 of the following 3 criteria
i) irregular menses
ii) evidence of androgen excess hirsuitism,acne
iii) polycystic ovaries (>10 per ovary)
Treatment for PCOS
Oral contraceptive - suppress androgens - decreases testosterone and LH
Weight loss
If pregnancy desired:
Metformin
Clomiphene
Factors that affect tubal function
Pelvic surgery
Infection: chlamydia, gonorrhea, PID
Endometriosis
Possible causes of unexplained subfertility
Subtle abnormalities with oocyte and/or sperm function Defective endometrial receptivity Subclinical endometriosis Nutritional factors Undiagnosed or untreated coeliac disease Immunological factors
What is IUI?
Intrauterine insemination
Useful in male subfertility, unexplained subfertility and same sex couples
What is ICSI?
Intracytoplasmic sperm injection
What is premature ovarian failure?
Loss of function of the ovaries before the age of 40
