Week 5 - B - Assessment of infertility Flashcards
How many couples does infertility affect?
1 in 7 couples so is common problem
What are potential factors for the increase in infertility?
Rise in chlamydia infections
Older women trying to concieve
Increase in obesity
What is the definition of infertility?
Failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse
What is the definition of primary and secondary infertility?
o Primary: Couple who have never conceived
o Secondary: Couple previously conceived, although pregnancy may not have been successful eg miscarriage or ectopic pregnancy
In factors affecting infertility, what factors show an increased chance of conception? (intercourse time before ovulation, age of partner, BMI, smoking)
Women less than 30
Previous pregnancy
Less than three years trying to conceive
Intercourse occurring during the six days before ovulation, particularly two days before ovulation
BMI of female 20-30
Both partners non-smokers
What are two hypothalamic disorders leading to anovulatory infertiltiy? (eating disorders causing it)
Anorexia nervosia and Bulimia nervosa
What is the differecne between anorexia and anorexia nervosa?
Anorexia is a general loss of appetite, or a loss of interest in food.
Anorexia nervosa is a serious mental illness.
Patients have not “lost” interest in food, they have intentionally restricted their food intake because of an irrational fear of being or becoming fat
How do the hormone levels of LH, FSH and oestradiol present in anorexia nervosa? What is the commonest endocrine disorder in women?
LH/FSH levels are low
Oestradiol levels are low
Commonest disorder is Polycystic ovarian syndrome (PCOS)
What is this a picture of on ultrasound?
Polycystic Ovary Syndrome
If a female presents with hot, flushes nights sweats and inflammation of the vagina (atrophic vaginitis) below the age of 40 What does this make you think? What causes the atrophic vaginits?
Premature ovarrian failure
Atrophic vaginitis is due to the oestrogen deficiency which is usually causes by menopause
What infective tubal diseases can causes infertility? (STDs) (how do you treat chlamydia)
o Chlamydia – can cause severe tubal disease – treated with azithromycin or doxycycline
o Gonorrhoea
o Other anaerobes
o Syphilis
o TB
Tubal infection causes pelvic inflammatory disease
What can occur due to PID that blocks the distal fallopian tube? distally blocked fallopian tube filled with serous or clear fluid
Hydrosalpinx
What are some features that may indicate hydrosalpinx?
Dysparenuia (pain during intercourse)
Amenorrhea
Ectopic pregnancy
Vaginal discharge
What is the presence of endometrial glands outside uterine cavity known as? What is the most common cause?
Endometriosis
Most commonly causes by retrograde menstruation - when the womb lining (endometrium) flows backwards through the fallopian tubes and into the abdomen (tummy) instead of leaving the body as a period.
What is the treatment of tubual disease?
Salpingosotmy - surgical incision into a fallopian tube.
This procedure may be done to repair a damaged tube or to remove an ectopic pregnancy
What is the main cause of male infertility?
varicocele - – main cause (37%) – a mass of varicose veins in the spermatic cord
Next most common cause is an idiopathic low sperm count
What are endocrine causes of male infertility?
Hypogonadotrophic hypogonadism
- Kallmann syndrome
- Anorexia Testicular failure
- Klinefelters syndrome: 47 XXY
- Chemotherapy/radiotherapy
Hyperprolactinaemia – macro or micro-prolactinoma
- o Acromegaly - due to obesity
- o Cushings disease (androgen excess)
- o Hyper or hypothyroidism
What swab for infertility and what blood test should be carried out in women? (what are the features of the disease that the blood test test for)
- Endocervical swab for chlamydia
- Blood for rubella immunity
(rubella develops in an infant due to maternal infection and then fetal infection with rubella virus. It is characterised by rash at birth, low birth weight, small head size, heart abnormalities, visual problems and bulging fontanelle
How is the tubal patency checked in females?
Hysterosalpingiogram or laparoscopy
What investigations are done to test for male infertility? (how many times for semen analysis)
- History – PMH, occupation, drugs, social, andrology
- Examination – general and genitalia
- Semen analysis – twice over 6 weeks apart
If abnormal semen analysis, what hormones should be tested?
LH/FSH
Testosterone
Thyroid function
Prolactin
If severely abnormal semen analysis, what respiratory disease should be check for?
Screen for CF
If there is an abnormality on genital examination what should be carried out?
o If abnormality on genital examination - Scrotal US
