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RE > Causes and Treatments of Subfertility > Flashcards

Causes and Treatments of Subfertility Flashcards

1
Q

Infertility Definition:

A
  • 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
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2
Q

Primary inferitility:

A

in couples who have never concieved

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3
Q

Secondary infertility:

A

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

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4
Q

Subfertility:

A

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

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5
Q

What % of the population are affected by subfertility?

A

15%

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6
Q

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

A

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

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7
Q

Prime Causes of Infertility:

A

insert diagram

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8
Q

Causes of Subfertility:

A

insert slide

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9
Q

Hormonal Control of Ovulation:

A

insert diagram

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10
Q

Anovulation: Causes: Categories:

A
  • hypothalamic ( low GnRH, low FSH/LH, low
    oestrogen)
  • pituitary failure (low FSH/LH, low
    oestrogen)
  • PCOS
    – Endocrine
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11
Q

Anovulation: Hypothalamic Causes:

A
  • weight or exercise related amenorrhoea
  • Kallman’s syndrome
  • stress
  • idiopathic
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12
Q

Anovulation: Pituitary Failure Causes:

A
  • Sheehan’s syndrome
  • craniopharyngioma
  • hypophysectomy
  • cerebral radiotherapy
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13
Q

Anovulation: Ovarian Causes:

A
  • PCOS
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14
Q

Anovulation: Other Endocrine Causes:

A
  • hyperprolactinaemia
  • hypothyroidism
  • congenital adrenal hyperplasia
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15
Q

Hormonal Control of Male Fertility:

A

insert diagram

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16
Q

Male Infertility: Categories:

A
  • hypothalamic failure
  • testicular failure
17
Q

Smoking effect on female fertility
Alcohol effect on male fertility

A
  • reduced
  • lowers sperm count
18
Q

Assessment:

A

insert slide

19
Q

Examination:

A
  • female: fibriods
  • azoospermia: testicular varicose veins, vas
    deferens, epididymis
20
Q

Subfertility: Initial Investigations:

A
  • 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)
21
Q

Semen Analysis

A

insert slide

*normal values
* what do we look for?

22
Q

Abnormal Semen Analysis

A

insert slide

23
Q

Hysterosalpino-contrast Sonography(HyCoSy)

A

insert slide

24
Q

HSG: Hysterosalpinogram:

A

insert image

25
Q

How many semen analysis samples are taken?

A

2
few weeks apart

26
Q

Infertility: Female Treatment:

A
  • lifestyle management
  • ovulation induction
  • ovarian drilling
  • reversal of sterilisation
  • ART: assisted reproductive techniques: IUI,
    IVF, ICSI
27
Q

Infertility: Male Treament:

A
  • lifestyle management
  • varicocele
  • vasectomy
  • hypogondaotrophic hypogonadism
28
Q

ART

A

insert slide

29
Q

IUI:

A
  • intrauterine semination
30
Q

IVF:

A
  • 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

31
Q

ICSI:

A
  • intracytoplasmic sperm injection
  • treatment for low sperm count and
    inability to penetrate egg
  • injection within laboratory and then re-
    inserted into female
32
Q

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

A
  • detailed history
  • frequency of intercourse
  • idiopathic primary infertility
  • IVF treatment
33
Q

Case: female, PCOS, infrequent periods

A
  • lifestyle management
  • hormonal problem
  • treatment with ovulation induction,
    ovarian drilling or resection to manage
    cysts
34
Q

Case: male with oligozoospermia/azoospermia:

A
  • ICSI treatment
35
Q

Case: Vaginismus:

A
  • psychosexual counselling
  • IUI/IVF
  • surrogacy
36
Q

Case: Kallmann’s Syndrome:

A
  • low gondatrophic releasing hormone
  • ovulation induction
37
Q

Case: Premature Ovarian failure:

A
  • lack of oovocytes
  • treatment: egg donation, IVF
38
Q

Case: Hysterctomy:

A
  • surrogacy
39
Q

Case: Coital Difficulty:

A
  • psychosexual counselling
  • IVF

RE (52 decks)

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