subfertilty/infertility Flashcards
when should investigations take place
after 1 year of trying
when can investigations be done earlier
> 35, amenorrhoea, past PID, oligomenrrhoea, cancer treatments, undescended testis
initial management
advise to stop smoking, lose weight if BMI >29. 0.4mg folic acid a day. decr stress
what should ask her about
menstrual hx, prev pregnancies, contraception, Hx pelvic infection, abdo surgery, drugs
what should ask him about
puberty, prev fatherhood, prev surgery, illnesses- venereal, mumps; job, erectile problems
what should ask them both about
technique, how often doing it, previous tests
examination
general health, sexual development, abdomen and pelvis, seminal analysis if abnormal- endo/penile abnormalities, varicocoeles, normal testes, BMI of man
female causes of subfertility
anovulation or infreq ovulation; tubal damage; uterine factors eg adhesions, ashermans syndrome
if suspect anovulation what blood tests can you do
serum mid luteal progesterone - 7 days before expected period >30 is indicative of ovulation (day 21); day 5 FSH, day 5 LH, blood prolactin.
what does day 5 FSH show
> 10 indicates poor response to ovarian stimulation- may indicate primary ovarian failure, but FSH is pulsatile in its release
what does day 5 LH show
for PCOS
tests of tubal patency
screen for chlamydia first. hysterosalpingogram (contrast X ray), laparoscopy with dye
what does a hysterosalpingogram demonstrate
uterine anatomy and tubal ‘fill’ and ‘spill’
what should you give pre hysterosalpingogram
cefradine with metronidazole and 5 days post op to prevent pelvic infection
what can be seen on laparoscopy with dye
pelvic organs visualised, methylene dye injected through the cervix
what treatment can be given if the cause is hyperprolactinaemia
bromocriptine
treatment of azoospermia
in 50% the sperm are still being produced just not ejaculated. ICSI- intra cytoplasmic sperm injection
treatment with problems of sperm deposition
eg erectile dysfunction. artificial insemination
treatment if anovulation
class 1- hypothalamic pituitary failure- pulsed GnRH. class 2- hypothalamic pituitary dysfunction- clomifene
treatment of tubal problems
surgery
what is clomifene
selective estrogen receptor modulator used in anovulation (SERM)
what happens in IVF
ovaries stimulated, ova collected, fertilised, 2 embryos returned
where does spermatogenesis take place
seminiferous tubules
which cells produce testosterone
leydig cells
what stimulates sertoli cells
testosterone and FSH
what do sertoli cells produce
metabolic support of germ cells and spermatogenesis
causes of male subfertility
idiopathic- testes small and incr FSH; asthenozoospermia/teratozoospermia; varicocoele; genital tract infections; sperm autoimmunity; congenital; klinefelters; obstructive azoospermia; gonadotrophin deficiency
what is asthenozoospermia
motility decreases due to structural problems
what is teratozoospermia
excess of abnormal forms
what is the main tool for male subfertility
ICSI
what may there be a hx of in male subfertility
testicular maldescent, trauma, torsion
what is the primary and secondary subfertility
primary- never conceived before. secondary- have conceived before
what is kallmans syndrome
failure to start puberty or to complete it. decr GnRH
what is sheehans syndrome
hypopituitarism due to ischaemic necrosis due to blood loss and hypovolaemia shock in childbirth
ovulation disorders
premature ovarian failure, radio/chemo, surgical removal, autoimmune, turners, androgen insensitivity
tubal problems
pelvic infection, endometriosis, previous surgery
what does the BMI need to be for IVF
what is the patient at risk of in assisted reproduction
ovarian hyperstimulation syndrome
signs of ovarian hyperstimulation syndrome
ascites, pleural effusion, enlarged ovary- can get torted and twisted
