Infertility Flashcards
(52 cards)
How common is failure to conceive after 1 year?
Approx 15% couples
Up to 25% couples overall
Small increase in prevalence - greater proportion of couples seek help
Considerable psychological distress
What is the average age of first birth?
28.5
First time more babies born > 35 than < 20
What is more likely with increasing maternal age?
Miscarriage
Chromosomal abnormalities
Increased incidence of Down’s syndrome
Increased maternal risks of pregnancy
What are the potential causes of infertility?
Unexplained 25%
Ovulatory 25%
Tubal 20%
Male 30%
Uterine/peritoneal 10%
What are the important principles of care?
See both partners together
Explanation and written advice
Seen by specialist team
What are the psychological effects of fertility problems?
Relationship difficulties (frequencies of intercourse)
Support groups
Counselling
What is the initial advice to people with infertility problems?
80% couples < 40 will conceive in first year
Half remaining will conceive in second year
Inform effect of age
Preconception advice
Refer after one year
What are the female criteria for early referral?
Age > 35
Menstrual disorder
Previous abdominal/pelvic surgery
Previous PID/STD
Abnormal pelvic examination
What are the male criteria for early referral?
Previous genital pathology
Previous urogenital surgery
Previous STD
Systemic illness
Abnormal genital examination
What preconception advice should you give to couples struggling to conceive?
Intercourse 2-3x weekly
Folic acid 0.4mg (5mg high risk)
Smear
Rubella
Smoking cessation services
Pre-existing medical conditions
Drug history (prescribed/recreational)
Environmental/occupational exposure
Alcohol (women none)
Weight (BMI 18-30)
Name 3 reproductive disorders associated with obestiy
PCOS
Miscarriage
Infertility
Lower ART success
Obstetric complications
What affect does obesity have on reproductive success?
BMI > 30 - longer to conceive, lower success with IVF
Losing weight improves anovulation
BFS advice inappropriate to treat if BMI > 35
Men with BMI > 30 reduced fertility
What investigations should you do with a couple who have infertility problems?
Ovulation/ovarian function
Semen quality
Tubal patency + uterus
How do you check ovulation?
Mid-luteal progesterone
- < 16 anovulation
- > 16 but < 30 equivocal
- > 30 ovular
Don’t test - temp, LH urine test, TFTs, prolactin if ovulating, endometrial biopsy
How do you test ovarian reserve function?
FSH - > 8.9 low response, < 4 high response
Antral follicle count - < 4 low response, > 16 high response
Antimullerian hormones - < 5.4 low response, > 25 high response
What should you look for in semen analysis?
Count > 15m/ml
Motility > 40%
Morphology > 4%
Total > 39m
Repeat if abnormal
Anti-sperm antibodies not required
What initial investigations does the GP need to do before referral to NHS fertility clinic?
Hormone profile - D2, FSH, D21 prog
TFT, prolactin - if indicated
Rubella
Smear
Swabs
Semen analysis
What further investigations should you do for male infertility?
Clinical examination - secondary sexual characteristics, testicular size
If count < 5m/ml
- Endocrine (FSH, LF, test, prolactin)
- Karytotype
- CF screen
Testicular biopsy - azoospermia
Imaging - vasogram, USS, urology
Dedicated specialist infertility clinic
Tubal patency testing
Swabs before instrumentation
How can you treat male infertility?
Mild - intrauterine insemination
Moderate - IVF
Severe - intracytoplasmic sperm injection
Azoospermia - surgical sperm recovery, donor insemination
Surgery - correction of epidymal block, vasectomy reversal, varicocele no benefit
Heat - occupation
Underpants/boxers?
Smoking
Alcohol
Occupational exposure
How can you treat hypogonadotrophic hypogonadism?
Gonadotrophins
How can you treat hyperprolactinaemia?
Bromocriptine
What diet/supplements can you give men to help with infertility?
Folic acid 5mg
Zinc 55mg
What is group 1 anovulation?
Low FSH/LH/E2
What can cause group 1 anovulation?
Stress
Weight loss
Exercise
Kallman’s
