W04: Infertility Flashcards
Describe history-taking and examination of a sub fertile couple
a
Outline investigation and treatment options in male and female infertility
a
factors of natural conception
-Functioning hormonal axis and gonads
- Ovarian reserve
- Regular ovulation
- Normal sperm production
- Fertilization- egg and sperm interaction
- patent fallopian tubes
- Normal uterine cavity for implantation
Infertility definition - clinical
Inability to conceive over a 12 month period despite exposure to regular , unprotected intercourse. Represents a prognosis based approach and provides practical guidance on when to initiate investigations.
When to refer
No conception after one year of regular unprotected intercourse
Most major cause for infertility
males = poor-quality semen
females = ovulatory dysf.
& tubal (2nd)
Testing for Causes Infertility- Female
- OV. RESERVE TEST = blood test and scan
- FSH, AMH
- antral follicular count (USS)
- LH ovulation kit
- D21 serum progesterone
- (-) for progesterone on Day 21 = nil ovulation
- > 20nmol/L
- Cervical fluid assessment
+ patent FTubes via HYSTEROSALPINGOGRAM
+ lap. dye test = GOLD STANDARD for F TUBE examination
Testing for Causes Infertility- Male
- semen analysis
Other tests for fertility
*serum prolactin
- TFT
- chalmydia screening
- pelvic USS
- rubella immunity
- cervical smear
Mgmt of ovulation disorders
> optimise health; exercise
ovulation inducers
> clomiphene citrate
> gonadotrophins
> lap ovarian drilling (aids egg release by thinning thicker ovarian walls
Mgmt of sperm disorders
> gonaotrophins
> sx sperm retrieval - epididymis/testis
> donor sperm - intrauterine insemination
> ICSI - injecting sperm into the egg (likely to be in the bg of IVF)
Mgmt of tubal problem
> IVF
conservative sx - limited to mild tubal disease
Indications of IVF
for unresolved infertility; IVF regulated by Human Fert. & Embryo Authority
Procedure of IVF
- gonadotrophin induced superovulation = eggs
OR
donor eggs
- sperm (fresh/frozen/donor)
- monitoring: follicles, timing of ovulation
- insemination
- embryo development
- embryo transfer
- progesterone support
+ pregnancy test after 2 weeks
+ scan at 7w if positive preg test
