w5 - assessment of infertility Flashcards
definition of infertility
failure to achieve a clinical preg after 12months in absence of known reason, in a coupleless couple
primary infertility
couple never conceived
secondary infert
previously conceived (altho preg may hve been shite)
what causes a poor prognosis in infertility
if male infertile
endometriosis
tubal factor infertility
anovulatory infertility is infertility due to lack of ovulation, give some conditions causing
hypothalami: anorexia/bulimia, excessive exercise
pit: hyperprolactinaemia, tumour, sheehan syndrome
ovarian: PCOS, premature ovarian failure
OThers: chronic renal failure, testost. secreting tumours, congenital adrenal hyperplasia
drugs - depo-provera, explanon, OCP
clinical + endo features of anorexia
clin
- <18.5 |BMI
- loss of hair
- incr lanugo
- low pulse + BP
- anaemia
endo
-red FSH, LH and oestradiol
what is polycystic ovary syndrome
too much androgen
leads to obesity, hirsutism/acne, cycle abnormalities, infertility
endo - high andro, high lH, impaired glucose tolerance
diagnosis of PCOS iss a score 2/3 of
chronic anovulation
polycystic ovaries
hyperandrogenism
PCOS is an inherited condition, what exacerbates it
weighr gain
commonest endo disorder i nwomen
PCOS
premature ovarian faiilure is the loss of ovarian function before 40. what is the causes
idiopathic genetic (turneers, fragile X) chemo radiotherapy oophorectomy
clinical/endo features of POF
hot flushes
night sweats
atrophic vaginitis
high FSH
high LH
low oestradiol
tubal disease is a umbrella term for infection of female genital tract (endotetrisis, salpingitis, oophoritis, parametritis, tubo-ovarian abcess and peritonitis)
what are the infective causes
pelvic inflam disease (chlamydia, gonorrheoea, anaeorobes, syphilis, TB
transperitoneal spread
-appendicitis/intra-ab abscess
post procedure:
IUCD, insertion hysteroscopy, HSG
non-infective causes of tubal disease
endometriosis surgical (sterilisation/ectopic preg) fibroids polyps congenital salpingitis isthmica nodusa
Clinical Features: abdominal/pelvic pain febrile vaginal discharge dyspareunia cervical excitation menorrhagia dysmenorrhoea infertility ectopic pregnancy
these are the clinical features of __ due to pelvic inflam diseae
define
hydrosalpinx
distally blocked fallopian tube filled with serous or clear fluid. The blocked tube may become substantially distended giving the tube a characteristic sausage-like or retort-like shape.
endometriosis define
presence of endometrial glands outside uterine cavity
aetiology of endometriosis
retrogade menstruation
altered iimmune function
abnor cellular adhesion molecules
genetic also
clinical features of endometiriosis
dysmenorrhoea (perior pain) (classically before menstruation), dysparenuia (sore sex)
, menorrhagia (heavy period)
painful defaecation,
chronic pelvic pain, uterus may be fixed and retroverted,
for endometriosis, scan may show characteristic __ ___ on ovary, infertility, asymptomatic
chocolate cysts
non-obstructive male infertility causes and features
causes
- chemo
- radio
- undescended testes
- idiopathic
clin feats
- low test. volume (orchidometer used to measure)
- reduced 2ndary sexual characteristics
- vas deferens present
endo feats
- high LH
- high FSH
- low Testosterone
oestradiol is a hormone, function
main producer of oestrogen
3 causes of obstructive male infertility
congental abscen (Cystic Fibrosis)
infection
vasectomy
features of obstructive male inferl
norm testie volume (orchidometer)
normal 2ndary sexual characteristics
vas defs may be absent
endo
normal LH, FSH and testosterone
key areas to cover in history for investigating infertility
infertility history gynaecology andrology sex history social PMH surgical history prev ocular history
examination of female for infertility includes
BMI gen exam body hair galactorrhoea pelvic exam, assess uterine and ovarian abnormalities
examination of male for infertility
BMI
gen exam
genital - size/position of testes, penile abnorms, presence vas deferences
presence varicoceles (enlargement of teste veins
tests for female inf.
endocervical swab for chlamydia
cervical smear if due
blood for rubella immunity
midluteal progesterone level (day 21 of 28 day cycle or 7 days prior to expected period in prolonged cycles), progesterone > 30nmol/l suggestive ovulation
Test of tubal patency: hysterosalpingiogram or laparoscopy
Others if indicated: e.g. hysteroscopy, ultrasound scan, endocrine profile and chromosomes
a hysterosalpingiogram is used for
tubal patency
when is hysteroscopy performed
suspected endometrial pathology (uterine septm, adhesions, polyp)
patient with anovulatory cycle (or infrequent periods), what should be tested
urine HCG prolactin TSH sex- testosterone, sex hormone binding globulin pit - LH,FSH and oestradiol
if hirsute present, 2 things that shd be measured
Testosterone
Sex hormone binding globulin (SHBG)
aabnormal semen analysis, shd test 5
LH FSH testosterone prolactin thyroid
patient with sev. abnormal semen analysis/azoospermic, other assessments required
endo profile chromo analysis Y chromsome microdeletions screen - cystic fibrosis testicular biopsy
abnormality on genital examination shd lead to
scrotal US
