Causes and Treatments of Subfertility

Question 1

Infertility Definition:

Answer 1

• period of time people have been trying to
  conceive without success, after which
  formal investigation is justified and
  treatment
• failure to achieve pregnancy after 12
  months or more of regular unprotected
  sexual intercourse

Question 2

Primary inferitility:

Answer 2

in couples who have never concieved

Question 3

Secondary infertility:

Answer 3

in couples who have conceived at least once before (with the same or different sexual partner)

Question 4

Subfertility:

Answer 4

any form of reduced fertility that results in a prolonged duration of unwanted lack of conception

Question 5

What % of the population are affected by subfertility?

Answer 5

15%

Question 6

Chances of Pregnancy:
- 1 month
- 6 month
- 1 year
- 2 years

Answer 6

1 month 20%
6 months 60%
1 year 85%
2 years 95%
Role of expectant management

Question 7

Prime Causes of Infertility:

Answer 7

insert diagram

Question 8

Causes of Subfertility:

Answer 8

insert slide

Question 9

Hormonal Control of Ovulation:

Answer 9

insert diagram

Question 10

Anovulation: Causes: Categories:

Answer 10

• hypothalamic ( low GnRH, low FSH/LH, low
  oestrogen)
• pituitary failure (low FSH/LH, low
  oestrogen)
• PCOS
  – Endocrine

Question 11

Anovulation: Hypothalamic Causes:

Answer 11

• weight or exercise related amenorrhoea
• Kallman’s syndrome
• stress
• idiopathic

Question 12

Anovulation: Pituitary Failure Causes:

Answer 12

• Sheehan’s syndrome
• craniopharyngioma
• hypophysectomy
• cerebral radiotherapy

Question 13

Anovulation: Ovarian Causes:

Answer 13

• PCOS

Question 14

Anovulation: Other Endocrine Causes:

Answer 14

• hyperprolactinaemia
• hypothyroidism
• congenital adrenal hyperplasia

Question 15

Hormonal Control of Male Fertility:

Answer 15

insert diagram

Question 16

Male Infertility: Categories:

Answer 16

• hypothalamic failure
• testicular failure

Question 17

Smoking effect on female fertility
Alcohol effect on male fertility

Answer 17

• reduced
• lowers sperm count

Question 18

Assessment:

Answer 18

insert slide

Question 19

Examination:

Answer 19

• female: fibriods
• azoospermia: testicular varicose veins, vas
  deferens, epididymis

Question 20

Subfertility: Initial Investigations:

Answer 20

• hormonal profile: FSH,LH, Progesterone
  (day 21), prolactin, TSH
• chlamydia/STI
• pelvic ultrasound
• rubella status
• cervical screen
• semen analysis
• refer for tubal patency test: (HyCoSy, HSG,
  lap and dye)

Question 21

Semen Analysis

Answer 21

insert slide

*normal values
* what do we look for?

Question 22

Abnormal Semen Analysis

Answer 22

insert slide

Question 23

Hysterosalpino-contrast Sonography(HyCoSy)

Answer 23

insert slide

Question 24

HSG: Hysterosalpinogram:

Answer 24

insert image

Question 25

How many semen analysis samples are taken?

Answer 25

2 few weeks apart

Question 26

Infertility: Female Treatment:

Answer 26

- lifestyle management - ovulation induction - ovarian drilling - reversal of sterilisation - ART: assisted reproductive techniques: IUI, IVF, ICSI

Question 27

Infertility: Male Treament:

Answer 27

- lifestyle management - varicocele - vasectomy - hypogondaotrophic hypogonadism

Question 28

ART

Answer 28

insert slide

Question 29

IUI:

Answer 29

- intrauterine semination

Question 30

IVF:

Answer 30

- in-vitro fertilisation - used to treat failed ovulation induction, tubal disease, endometriosis and idiopathic infertility Disadvantages: multiple pregnancies, ovarian hyperstimulation syndrome 32% success for women under 35 insert flowchart

Question 31

ICSI:

Answer 31

- intracytoplasmic sperm injection - treatment for low sperm count and inability to penetrate egg - injection within laboratory and then re- inserted into female

Question 32

Case: young male and female, unable to conceive for the past 12 months:

Answer 32

- detailed history - frequency of intercourse - idiopathic primary infertility - IVF treatment

Question 33

Case: female, PCOS, infrequent periods

Answer 33

- lifestyle management - hormonal problem - treatment with ovulation induction, ovarian drilling or resection to manage cysts

Question 34

Case: male with oligozoospermia/azoospermia:

Answer 34

- ICSI treatment

Question 35

Case: Vaginismus:

Answer 35

- psychosexual counselling - IUI/IVF - surrogacy

Question 36

Case: Kallmann's Syndrome:

Answer 36

- low gondatrophic releasing hormone - ovulation induction

Question 37

Case: Premature Ovarian failure:

Answer 37

- lack of oovocytes - treatment: egg donation, IVF

Question 38

Case: Hysterctomy:

Answer 38

- surrogacy

Question 39

Case: Coital Difficulty:

Answer 39

- psychosexual counselling - IVF