Infertility Flashcards
Incidence
1 in 7 couples
Risk factors
Age
Smoking
BMI (<18 and >30)
Steroids (sperm)
Seat warmers for sperm
Who can be referred before 1 year
Age 36 and over
Known clinical cause or risk factors
Ovulatory disorders cause what proportion of infertility
21%
Normal range mid-luteal progesterone
> 30
Tubal disease causes what proportion of subfertility
14%
Semen analysis parameters
Volume >1.5ml
Concentration 15m
Normal forms 4%
Motility 40%
Total sperm 39m
Vitality 58% or more live spermatazoa
Main cytokine implicated in OHSS
VEGF
Pathophysiology of OHSS
Ovarian enlargement
Systemic effects of inflammatory mediators
Increased vascular permeability
Prothrombotic effect
OHSS incidence
3-8% for moderate and severe disease
Mild in 1/3 of traditional IVF
OHSS triggers
IVF
Clomiphene
Monofollicular ovulation induction gonadotrophin induction
Pregnancy
Risk factors for OHSS
Previous OHSS
PCOS
Increased AFC
High levels of AMH
Successful conception after IVF
Multiple pregnancy after IVF
Symptoms of OHSS
Abdominal distension and pain
Nausea and vomiting
SOB
Oliguria
Oedema
Thrombosis
Classification of OHSS
Early - within 7 days of HCG trigger
Late - 10 or more days after HCG trigger
Investigations for suspected OHSS
Bloods - FBC, CRP, LFT, U&E, clotting, serum osmolality, ABG
ECG
CXR
USS
CTPA