Management of Infertility Flashcards
what lifestyle advice should be given to couples?
both partners stop smoking,
achieve BMI between 18.5 and 30 (but normal BMI is healthiest),
reduce/stop alcohol intake,
take caffeine containing drinks in moderation only,
stop recreational drugs,
stop taking methadone
what is the effect of overweight on fertility in women
overweight women have increased fertility problems (2-5 times more)
increased risk of miscarriage (2-3 times more)
there is also a decreased success with fertility treatments
• Even 10% weight loss drastically improves pregnancy and outcome rates
what is the effect that being overweight has on fertility in men?
have increased fertility problems (2 x more) and increased erectile dysfunction (3 x more)
- even 9 kg weight gain enough to increase infertility
what is the general advice for dealing with infertility?
if appropriate do full history and examination of both partners,
most couples just need reassurance,
advise sexual intercourse every 2-3 days rather than timing intercourse with the menstrual cycle,
consider underlying psychosexual problems and consider need for preconception counselling if there are pre-existing medical conditions
what vitamin supplements should be taken by the woman?
• Folic acid:
- 400 micrograms daily before pregnancy and throughout the first 12 weeks
- 5 milligrams daily for women who are planning a pregnancy/in the early stages of pregnancy IF they: (or their partner) have a neural tube defect, have had a previous baby with a neural tube defect, (or their partner) a family history of neural tube defects, have diabetes
• Vitamin D:
- 10 micrograms of vitamin D daily for pregnant and lactating women, and population groups at increased risk of vitamin D deficiency
infectious disease check
Check if they have had a rubella vaccine, rubella IgG antibodies suggest they are immune
Rubella syndrome: microcephaly, PDA [patent ductus arteriosus], cataracts
Check for chlamydia
what is primary surgical treatment for infertility used for?
- Pelvic adhesions
- Grade 1 and 2 endometriosis
- Chocolate cysts in ovary
- Tubal block
what surgery is done to enhance IVF outcome?
laparoscopy,
hysteroscopy
what is uterine septum?
congenital malformation where the uterine cavity is partitioned by a longitudinal septum,
can do surgical resection
Can also resect intrauterine adhesions (these adhesions can cause amenorrhoea)
what are fibroids?
A fibroid is an abnormal growth in the uterus consisting of dense tissue (unlike cysts which are found in the ovaries and are fluid-filled)
what are the types of fibrinoids?
pedunculated,
subserous,
submucous,
intramural
how should submucosal fibrinoids be treated?
hysteroscopically (resection) to improve conception rates
What is IVF?
in vitro fertilisation
what are the steps of IVF?
- After pre-IVF work-up, ovaries are stimulated and monitored, ovulation is then induced
- Oocytes are retrieved using ultrasound guidance
- Sperms are prepared
- In vitro fertilisation occurs
- Embryo is transferred (using an embryo transfer [ET] catheter)
- There is luteal support
how is male infertility managed?
- Surgery (vasectomy) for obstructed vas deferens (50% success)
- Intrauterine insemination in mild disease
- Intracytoplasmic sperm injection (ICSI)
- Surgical sperm aspiration from epididymis or testicle combined with ICSI
- Donor sperm insemination
