Subfertility Flashcards
1
Q
CONCEPTION
what percentage of women will conceive within 1 year?
A
- 80% couples will conceive within 1 year if; the woman is under 40, they do not use contraception and have regular intercourse
- Of those that do not conceive in the first year about half will conceive in the second year
2
Q
CONCEPTION
what factors will affect a womans ability to convceive?
A
alcohol
smoking
weight
3
Q
CONCEPTION
alcohol
A
- Women – drinking no more than 1 or 2 units of alcohol once or twice a week and avoiding episodes of intoxication reduces risk of harming the developing fetus
- Men – alcohol consumption within DoH reccomdendation won’t affect semen quality. Excessive alcohol detrimental to sperm
4
Q
CONCEPTION
smoking
A
- Women – reduce fertility/ passive smoking can affect their chance of conceiving
- Men – association with smoking and reduced semen quality (impact on male fertility is uncertain
5
Q
CONCEPTION
weight
A
- BIM >30 likely to take longer to conciver
- Women with BMI <19 with amenorrhoea/oligomehorrhoea, increasing body weight improves chance of conception
- Men with BMI >30 have reduced fertility
6
Q
list some causes of female infertility
A
- Tubal pathology
- Ovulatory disorder
- Uterine factor
- Unexplained
7
Q
FEMALE INFERTILITY
tubal pathology
A
- Pelvic inflammatory disease, endometriosis and previous ectopic pregnancy can result in tubal pathology
- PID is infection of upper part of female reproductive tract (uterus, fallopian tubes and ovaries). It is caused by bacteria spreading from vagina and cervix, most commonly as a result of unprotected intercourse. Most common bacteria is chlamydia
- Women without these comorbidities should be offered hysterosalpingography or hysterosalpingo-contrast-ultrasonography to screen for tubal occlusion
- Women who have comorbidities should be offered laparoscopy and dye test so other pelvic pathology can be assessed
8
Q
FEMALE INFERTILITY
chlamydia
A
- Chlamydia trachomatis – obligate intracellular parasite, weakly gram negative
- 3x as many women as men diagnosed with chlamydia
- Mainly asymptomatic
- Women 15-39 have highest prevelance, followed by women aged 20-24
- Infection can spread to upper genital tract I women causing pelvic inflammatory disease and can result in future infertility or ectopic pregnancy
9
Q
FEMALE INFERTILITY
endometriosis
A
- Cells similar to those in endometrium grows outside of it. Most often this is on ovaries, fallopian tube, peritoneum, pelvic side in rare cases, may occur in parts of body such as lungs
- Main symptoms are dysparinurea, pelvic pain, infertility and dysmenorrhea
- Nearly half of those affected have chronic pelvic pain, 70% pain occurs during menstruation
- 40% infertile
- Less common symptoms – urinary or bowel symptoms
- 25% have no symptoms
10
Q
FEMALE INFERTILITY
endometrioma
1. pathogenesis
2. surgical treatment
A
- 1) invagination and subsequent collection of menstrual debris from endometriotic implants, which are located on the ovarian surface and
2) adherent peritoneum and colonization of functional ovarian cysts by endometriotic cells. - Surgery aims to eliminate endometriotic tissue and to provide sufficient tissue for histological assessment, and to preserve a maximum amount of normal ovarian tissue (where fertility is desired and/or risk of menopause is to be avoided). It has been shown that surgical treatment of endometriotic cysts is associated with the unintentional removal or destruction of ovarian follicles
11
Q
tests for tubal patency
A
- hysterosalpingography
- Hysterosalpingo-contrast-ultrasonography
- laparoscopy and dye
12
Q
FEMALE INFERTILITY
what are uterine factors
A
Uterine fibroids (leiomyomas) are benign smooth muscle tumours of the uterus and grow anywhere in the womb and vary in size considerably
13
Q
FEMALE INFERTILITY
what are the main types of uterine fibroids
A
- Intramural fibroids – most common, develop in musce wall of the womb
- subserosal fibroids – fibroids that develop outside the wall of the womb into the pelvis and can become very large
- submucosal fibroids – fibroids that develop in the muscle layer beneath the womb’s inner lining and grow into the cavity of the womb
14
Q
FEMALE INFERTILITY
how should uterine fibroids me managed in infertile couples
A
- In infertile women, appropriate evaluation and classification of fibroids, particularly those involving or suspected to be involving the endometrial cavity is essential.
- Submucosal fibroids (should be treated hysteroscopically or laparoscopic for large L2) to improve conception rates.
- The management of intramural fibroids should be individualised on a case to case basis subserosal fibroid are unlikely to have any major impact on fertility
15
Q
FEMALE INFERTILITY
uterine polyps
A
- Overgrowth of endometrial cells (cells in the lining of the uterus) can lead to the formation of uterine polyps, also known as endometrial polyps. These polyps are usually noncancerous (benign), although some can be cancerous
- Uterine polyps range in size from a few millimeters to several centimeters. They attach to the uterine wall by a large base or a thin stalk.
16
Q
FEMALE INFERTILITY
uterine polyps signs and symptoms
A
- Irregular menstrual bleeding
- Bleeding between menstrual periods
- Excessively heavy menstrual periods
- Vaginal bleeding after menopause
- Infertility - Polyps can cause infertility by disrupting the lining of the uterus, thus interfering with implantation of a fertilized embryo.
17
Q
FEMALE INFERTILITY
anovulation
A
- when the ovaries do not release an oocyte during a menstrual cycle and thus a common cause of infertility
- Oligomenorrhoea is infrequent menstruation. Usually with menstrual periods occurring at intervals of greater than 35 days, with only four to nine periods in a year.
- Amenorrhea is the absence of a menstrual period in a woman of reproductive age. Physiological states of amenorrhoea are seen, most commonly, during pregnancy and lactation
18
Q
anovulation
WHO classification
A
- WHO1 (15%) – Hypothalamic-pituitary failure. (hypogonadotrophic hypogonadism)
- WHO2 (80%) – Hypothalamic-pituitaryovarian dysfunction (predominately PCOS)
- WHO3 (5%) – Ovarian failure (hyper-gonadotropic, hypo-estrogenic)
19
Q
anovulation
describe hypothalamic pituitary failure (WHO 1)
A
- Results from gonadal failure due to abnormal pituitary gonadotropin levels from either – absenct or inadequate hypothalamic GnRH secretion or failure of pituitary gonadotropin secretion
- tumor of the hypothalamic pituitary region
- Functional forms of Hypothalamicpituitary failure are characterized by a transient defect in GnRH secretion, and are relatively common in women, in response to significant weight loss, exercise, or stress leading to hypothalamic amenorrhea.
- characterized by low circulating sexual steroids associated with low or inappropriately normal gonadotropin levels. Low
- LH/FSH. Low oestrogen
20
Q
PCOS
- symptoms
- diagnosis
- other differentials
A
- menstrual irregularities, hirsutism (increased body and facial hair), acne and infertility.
- • Revised Rotterdam Criteria
•Two of the following three criteria are required:
1: oligo/anovulation
2: hyperandrogenism - clinical (hirsutism) or biochemical (raised FAI or free testosterone)
3: polycystic ovaries on ultrasound - Other aetiologies must be excluded such as congenital adrenal hyperplasia, androgen secreting tumours, Cushing syndrome, thyroid dysfunction and hyperprolactinaemia
21
Q
OVARIAN FAILURE
- what is it
- causes
A
1.Namely Premature Ovarian Failure. The loss of function of the ovaries before the age 40. Associated: Amenorrhea, hypergonadotropism, and hypoestrogenism.
2. • Usually idiopathic • Genetic include Turners syndrome and Fragile X Syndrome • Smoking Radiation/chemotherapy • Autoimmune disease • High FSH/LH, low oestrogen
22
Q
MALE INFERTILITY
ageing man
A
- Oxidative damage to sperm DNA – most sensitive is chromosome 15
- Increase in
• Complex neurological conditions; autism, bipolar disease, schizophrenia, severe epilepsy
• Dominant genetic disorders
• Cleft palate, diaphragmatic hernia, cardiac malformations
• Miscarriages
23
Q
MALE INFERTILITY
WHO reference values for sperm
A
- Semen volume: 1.5 ml or more
- Sperm concentration: 15 million spermatozoa per ml or more
- Total sperm number: 39 million spermatozoa per ejaculate or more
- Total motility (percentage of progressive motility and non-progressive motility): 40% or more motile or 32% or more with progressive motility
- Vitality: 58% or more live spermatozoa
- Sperm morphology (percentage of normal forms): 4% or more
24
Q
MALE INFERTILITY
when should semen analysis be repeated?
A
- If the result of the first semen analysis is abnormal, a repeat confirmatory test should be offered.
- Repeat confirmatory tests should ideally be undertaken 3 months after the initial analysis to allow time for the cycle of spermatozoa formation to be completed. However, if a gross spermatozoa deficiency (azoospermia or severe oligozoospermia) has been detected the repeat test should be undertaken as soon as possible
25
Q
- aspermia
- azoospermia
- oligozospermia
- asthenozoospermia
- teratozoospermia
- necrozoospermia
A
- absence of semen
- absence sperm
- very low sperm count
- poor sperm motility
- sperm carry more morphological defects than usual
- all sperm in the ejaculate are dead
26
Q
causes of male factor infertility
A
- hypothalamus/pituitary malfunction and consequently an inadequate stimulation of otherwise normal genital tract and testicles
- tumors (craniopharynioma, pituitary adenomas, metastases),
- irradiation
- head injury
- debilitating illness(hemochromatosis, sarcoidosis, tuberculosis),
- syndroms:Kallmann’s, Prader-Willi, Laurence- Moon-Biedl idiopathic
27
Q
investigations for male factor infertility
A
- specific history
* low levels of follicle stimulating hormone(FSH) and luteinizing stimulating hormone (LH) modern pulsatile pump
