Gynaecology - Infertility Flashcards
1
Q
Infertility?
What is it?
A
- Failure to conceive after regular unprotected sex for 2 years
- Primary - where couple have never conceived
- Secondary - trouble conceiving after previous birth
- Fertility requires a normal sperm to reach a normal egg then fertilize it.
- Fertilised egg needs to implant into endometrium
- Any hindrance to this process may cause infertility
2
Q
Infertility?
Causes?
A
Classified into male and female:
Male:
- Problem with sperm volume
- pH, concentration, morphology, motility, vitality
- Steroids, Smoking, STIs
Female Hypothalamic ovarian axis
Hypothalamic dysfunction:
- Hypoprolactaemia
- Hypothalamic hypogonadism
- Hypo/Hyperthyroidism
Ovarian dysfunction:
- PCOS
- Premature ovarian failure
Tubal dysfunction:
- PID
- Adhesions from previous surgery
- Cystic fibrosis
Implantation Failure:
- Fibroids
Anatomical abnormality:
- Bicornate uterus
- Mayer-Roitansky-Kuster-Hauser syndrome
3
Q
Infertility?
Symptoms
A
Primary or secondary infertility
Those of underlying cause
4
Q
Infertility?
Investigations?
A
Semen analysis:
- Vol >1.5ml
- pH>7.2
- Sperm conc >15mill/ml
- Morphology >4% normal forms
- Vitality >58% live spermatozoa
- Motility >32% progressive motility
Bloods:
- FBC, U&E, TFTs
- Androgens, SHBG, LH, FSH
- Prolactin
- 21 day progesterone >30nmol/L = Ovulation
Radiology:
- Transvaginal USS
- Hysterosalpingogram
Laparoscopy:
- Including dye tests
5
Q
Infertility?
Treatment?
A
Conservative:
- Patient education
- Regular intercourse 3-4x weekly
- Lifestyle advice - weight loss
Medical:
- Clomifene
- Gonadotrophin therapy
Surgical:
- Ovarian diathermy
- IVF
- Intra-uterine insemination
- Tubal surgery
6
Q
Infertility?
Complications?
A
Psychological implications:
- Depression
- Anxiety
Side fx of treatment:
- Ovarian hyperstimulation syndrome
- Ectopic pregnancies
- Multiple pregnancies
