Infertility Flashcards
What percentage of couples does infertility affect?
About 15%
What is the difference between primary and secondary infertility?
Primary - no previous pregnancy
General causes of infertility?
Coitus problems
Anovulation
Tubal occlusion
Abnormal/absent sperm production
How common is anovulation?
15-20% of women
What can cause anovulation?
Occasional ones are normal, especially in the extremes of reproductive life Hyperprolactinaemia Weight loss Exercise Stress Pituitary tumours Necrosis of pituitary (after a long birth) Ovarian failure Menopause Radio and chemotherapy
What happens in polycystic ovarian syndrome?
Pathogenesis is uncertain
-pituitary or ovarian level?
Increased androgen secretion causing a raised LH:FSH ratio
Get insulin resistance
Multiple small ovarian cysts
Anovulation and amenorrhea or oligomenorrhea
How to diagnose anovulation?
Serum progesterone levels in mid-luteal phase (about day 21)
How to know the cause of anovulation by look at proportions of hormones?
Menopause
- high LH and FSH
- low oestrogen
Ovarian failure
- high LH and FSH
- low oestrogen
Hypo/pituitary failure
-low everything
PCOS
- LH:FSH ratio increased
- normal oestrogen
Methods of inducing ovulation?
Anti-oestrogen - reduces negative feedback to hypothalamus or pituitary, increasing GnRH, increasing FSH
Gonadotrophins - FSH administration
GnRH agonists - pulsation to mimic normal secretion
What can cause tubal occlusion?
Sterilisation
Scarring
Infection from endometriosis
How is tubal occlusion diagnosed?
Laparoscopy and dye insufflation
Hysterosalpingogram
How is tubal occlusion treated?
Re-anastamosis by tubal surgery
Assisted conception
What can cause abnormal or absent sperm production?
Abnormal by testicular disease
Obstruction of ducts by infection or vasectomy
Hypothalamic or pituitary dysfunction
How to investigate infertility?
Do they have regular unprotected intercourse
Is ovulation happening
-regular cycle?
-Take 21 day progesterone
Patent tubes
- history of infection or sterilisation?
- Dye insufflation/HSG
- Adequate sperm count?
Treatment of infertility?
Induce ovulation Overcome tubal occlusion by surgery or IVF If inadequate sperm -inadequate insemination by donor -intracytoplasmic sperm injection
