Fertility Flashcards
(20 cards)
What is subfertility?
When a women of reproductive age has not concieved after 1 year of regular unprotected SI
Can have female, male or unexplained causes
Subfertility is more men or women?
30-40% women
25-30% men
Women causes of subfertility
6
hypothalamic pituitary failure
Hypothalamic pituitary ovarian failure
Ovarian failure
Prolactinaemia / thyroid diease
Tubual disorders
Uterine anomalies
What causes hypothalamic pituitary failure?
(Low gonadotrophins and low oestrogen)
- low weight
- excessive exercise
- Kallman’s syndrome
- Sheehan’s syndrome
What causes hypothalamic pituitary ovarian dysfunction?
normal gnRH, normal oestrogen
- PCOS
What causes ovarian failure?
High GnRH, low estrogen
- premature ovarian insufficiency
What causes issues with prolactinaemia or thyroid diease?
Prolactinoma
primary hypothyroidism
chronic renal failure
drugs
What tubal issues cause subfertility?
PID, adhesions, endometriosis, salpingectomy
What uterine abnormalities cause subfertility?
Fibroids
Ashermans
What investigations are done for infertility in a man
Semen analysis (2 tests 3 months apart)
What does azoospermia in semen analysis indicate?
Varicocele
What investigations are done for female infertility
Mid luteal progesterone to confirm whether ovulation is occuring
If patient has irregular cycle - do a day 2/3 LH and FSH too
- blood hormone profile
- TVUSS for uterine abnormalities
- Tubal assessment if hormones are normal - laparoscopy and dye
1st line management for subfertility?
wait until regular intercourse established for atleast 12 months every 2-3 days
advice:
- BMI 20-25
- folic acid
- regular intercourse
- smoking no alcohol no
Management 2nd line for subfertility if conservstive methods dont work
if it is unexplained, mild endometriosis or male cause - try another 12 months!
Medical:
- induce ovulation :
1st : clomiphene
2nd : FSH and LH injections
3rd : pulsatile GnRH or DA agonists
If medical management doesnt work, when would surgical intervention be indicated?
Operative lap : adhesions, cysts, endometriosis
Myomectomy : fibroids
Tubal surgery : amendable blocked tubes
Laparoscopic ovarian drilling : PCOS unresponsive to medical management
What assisted conception techiques can be offered?
Intrauterine insemination
IVF - with tubal pathology whose treatment isnt working
Intracytoplasmic sperm injection - male infertility - if oligospermia
Donor insemination - if azoospermia
Donor egg with IVF - poor eggs or ovarian failure
What is ovarian hyperstimulation?
Due to GNRH therapy
Symptoms of ovarian hyperstimulation syndrome
Abdo pain and distension + ascites
