Fertility Flashcards
(28 cards)
give 5 causes of infertility
- Failure of sperm problem (most common)
- Ovulation problem
- Tubal problems
- Uterine problems
- Unexplained
give 6 pieces of lifestyle advice for coupls getting pregnant
- 400mcg folic acid daily (woman)
- healthy BMI
- avoid smoking and excessive alcohol
- reduce stress
- aim for intercourse every 2-3
- AVOID timed intercourse
what female hormone testing is done for fertility investigations
- serum LH (high may = PCOS) on day 2-5
- serum FSH (high may suggest poor ovarian reserve) on day 2-5
- progesterone on day 21 : rise = ovulation has occurred
-anti-mullerian hormone : marker of ovarian reserve. high = good ovarian reserve - TFT
- Prolactin if Sx of galactorrhea or amenorrhea
what further Ix can be performed in secondary care to assess fertility
-USS pelvis for PCOS or uterine structural abnormalities
-Hysterosalpingogram to look at patency of fallopian tubes
-Laparoscopy and dye test for patency of fallopian tube, adhesions and endometriosis
what is a hysterosalpingogram
assess shape of uterus and patency of fallopian tubes
x-ray images are taken with a contrast medium
if dye doesn’t fill one of the tubes = obstruction
give 6 treatments options for anovulation
weight loss for PCOS
clomifene to stimulate ovulation
ovarian drilling in PCOS
metformin in insulin insensitivity & obesity
what is clomifene
-A selective oestrogen receptor modulator (anti-oestrogen)
Stops neg feedback of oestrogen on hypothalamus
Greater GnRH release and subsequently greater FSH and LH
how can sperm issues be managed
- surgical sperm retrieval if there is a blockage
- surgical correction of obstruction
- intra-uterine insemination
- intracytoplasmic sperim injection
- donor insemination
give 3 pre testicular causes of male infertility
- hypothalamus or pituitary pathology
- suppression due to stress, chronic conditions or hyperprolactinaemia
- kallman syndrome
can all cause hypogonadotrophic hypogonadism (low FSH, low LH = low testosterone)
Give 2 testicular causes of male infertility
- Testicular damage : Mumps, Undescended testes, Trauma, Radiotherapy, Chemotherapy, Cancer
- Genetic or congenital disorders : klinefelter, Y chromsome deletions, sertoli-cell only syndrome, anorchia (absent testes)
what are the post-testicular causes of male infertility
- ejaculatory duct obstruction
- rertrograde ejaculation
- scarring from epididymitis
- absence of vas deferens
give 5 Ix for male infertility
hormonal analysis : FSH, LH and testosterone
genetic testing
further imagining
vasography
testicular biopsy
what are the 6 steps of IVF
suppressing natural menstrual cycle
ovarian stimulation
oocyte collection
insemination
embryo culture
embryo transfer
how can the natural menstrual cycle be suppressed
-GnRH agonists (e.g. goserelin) : given in luteal phase. Itially stumulates pituitary to secrete large amounts of FSH and LH. There is then negative feedback suppressing natural GnRH, suppressing menstrual cycle.
-GnRH antagonist protocol (e.g. cetrorelix) : from 5-6 days of ovarian stimulation suppresses the body releasing LH and causing ovulation to occur
What Ix are performed in primary care for infertility ?
- BMI - > low could indicate anovulation, high could indicate PCOS
- Chlamydia screening
- Semen analysis
- Female hormonal testing
- Rubella immunity in the mother
what instructions are given to men prior to a semen sample and what is assessed in the sample ?
- Abstain from ejaculation for at least 3 days and at most 7 days
- Avoid hot baths, sauna and tight underwear during the lead up to providing a sample
- Attempt to catch the full sample
- Deliver the sample to the lab within 1 hour of ejaculation
- Keep the sample warm (e.g. in underwear) before delivery
- Assess quantity and quality of semen and sperm
Normal sperm result s
- Semen volume (more than 1.5ml)
- Semen pH (greater than 7.2)
- Concentration of sperm (more than 15 million per ml)
- Total number of sperm (more than 39 million per sample)
- Motility of sperm (more than 40% of sperm are mobile)
- Vitality of sperm (more than 58% of sperm are active)
- Percentage of normal sperm (more than 4%)
Explain the difference between IVF and IUI
- In vitro fertilisation = fertilising egg with a sperm in the lab efore injecting embryo into uterus
- Intrauterine insemination = injecting sperm into uterus
how is ovarian stimulation done in IVF?
- Subcut injections of FSH from day 2 of cycle over 10-14 days
- When enough follicles have developed = injection of human chorionic gonadotropin hCG 36 hrs before egg collection
4 complications of IVF
Failure
Multiple pregnancy
Ectopic pregnancy
Ovarian hyperstimulation syndrome
How does OHSS present ?
- Early : within 7 days of hCG injection
- Late : from 10 days onwards
- Features : Abdominal pain and bloating, N&V, Diarrhoea
Hypotension, Hypovolaemia, Ascites, Pleural effusions, Renal failure, Peritonitis from rupturing follicles releasing blood, Prothrombotic state (risk of DVT and PE)
how is the severity of OHSS defined ?
- Mild: Abdominal pain and bloating
- Moderate: Nausea and vomiting with ascites seen on ultrasound
- Severe: Ascites, low urine output (oliguria), low serum albumin, high potassium and raised haematocrit (>45%)
- Critical: Tense ascites, no urine output (anuria), thromboembolism and acute respiratory distress syndrome (ARDS)
When would progesterone be taken to check for progesterone in a woman struggling with fertility ?
7 days before next expected period
Ovulation causes of infertility
- PCOS
- Hyperprolactinaemia
- Underweight
- Excessive exercise
- Premature ovarian insufficieny
