Infertility Flashcards
(103 cards)
1
Q
What is infertility?
A
The inability to conceive over a 12 month period despite exposure to regular, unprotected sexual intercourse
2
Q
How many couples are affected by infertility?
A
One in seven couples
3
Q
What percentage of couples conceive within one year?
A
84%
4
Q
What percentage of couples conceive within two years?
A
92%
5
Q
What is primary infertility?
A
It refers to a patient who’s never conceived a child in the past experiencing fertility issues
6
Q
What is secondary infertility?
A
It is the inability to conceive after previously giving birth to a baby – either in this relationship or a previous one
7
Q
What are the five causes of infertility?
A
Sperm Problems
Ovulation Issues
Tubal Problems
Uterine Problems
Unexplained
8
Q
What percentage of infertility issues are caused by sperm problems?
A
30%
9
Q
What percentage of infertility issues are caused by ovulation problems?
A
25%
10
Q
What percentage of infertility issues are caused by tubal problems?
A
15%
11
Q
What percentage of infertility issues are caused by uterine problems?
A
10%
12
Q
What percentage of infertility issues are unexplained?
A
20%
13
Q
What are the four risk factors of infertility?
A
Age
Smoking
Alcohol
Obesity
14
Q
What are the four risk factors of infertility?
A
Age - A woman’s fertility gradually declines with age, specifically after the mid 30s
Smoking
Alcohol
Obesity
15
Q
Why does a woman’s fertility decrease with age?
A
This is due a decrease in the ovarian reserve and a decrease in the quality of the eggs
16
Q
Why does smoking increase the risk of infertility in females?
A
It accelerates the decline in the ovarian reserve in females
17
Q
Why does smoking increase the risk of infertility in males?
A
It decreases the sperm count in men
18
Q
Why does obesity increase the risk of infertility in females?
A
It decreases the quality of eggs
19
Q
Why does obesity increase the risk of infertility in males?
A
It decreases sperm count
20
Q
When do we refer patients to a fertility clinic?
A
When there has been no conception after one year of regular unprotected intercourse
This can be reduced to six months if the woman is older than 35 years old or there is a known cause of infertility
21
Q
What are the five investigations used to diagnose female infertility?
A
Blood Tests
Chlamydia Screening
Ultrasound Scan
Hysterosalpingogram
Laparoscopy Dye Test
22
Q
What are the six blood tests used to diagnose infertility in females?
A
Serum LH Levels
Serum FSH Levels
Anti-Mullerian Hormone
Serum Progesterone Levels
Serum Prolactin Levels
Thyroid Function Test
23
Q
When do we measure LH levels to diagnose infertility?
A
On day one to five of the menstrual cycle
24
Q
How are LH levels used to help investigate infertility?
A
A high LH may suggest polycystic ovarian syndrome, which is a condition associated with infertility
25
What is the normal LH level?
Under 10miu/ml
26
When do we measure FSH levels to diagnose infertility?
On day one to five of the menstrual cycle
27
How are FSH levels used to help investigate infertility? Why?
A high FSH may suggest a poor ovarian reserve
This is because is indicates the pituitary gland is producing excess FSH in an attempt to stimulate follicular development
28
What is anti-mullerian hormone?
It is the most accurate marker of ovarian reserve
It is a hormone released by the granulosa cells in the follicles and falls as the eggs are depleted
29
What are the normal levels of anti-mullerian hormone?
These levels should be between 1.5-4 ng/ml in women under the age of 35
30
How are anti-mullerian hormone levels used to help investigate infertility?
A high level indicates a good ovarian reserve
A low level indicates a low ovarian reserve
31
When do we measure progesterone levels to diagnose infertility?
They should be measured seven days prior to the expected next period
In a typical 28 day cycle, this is conducted on day 21
32
How are progesterone levels used to help investigate infertility?
This test is used to determine if the process of ovulation is occurring as at this point in the cycle, ovulation should’ve occurred, and levels should be at peak
33
What are the normal levels of progesterone?
Over 30nmol/L
34
How is an ultrasound scan used to investigate infertility?
It is used to assess the antral-follicular count, which is the number of follicles present in the ovary
It is also used to determine the presence of any uterine or ovarian disease
35
How is a hysterosalpingogram used to investigate infertility?
It is a type of scan used to assess the shape of the uterus and the patency of the fallopian tubes
36
Describe the procedure of a hysterosalpigogram
It involves the insertion of small tube into the cervix
A contrast medium, methylene blue dye, is injection through the tube and fills the uterine cavity and fallopian tubes
An x-ray image is taken with the contrast giving an outline of the uterus and tubes
37
What hysterosalpingogram result indicates infertility?
If the dye doesn’t fill one of the tubes, tubal obstruction is indicated
38
When is hysterosalpingogram contraindicated?
Gynaecological problems
Pelvic infections
39
How is a laparoscopy dye test used to investigate infertility?
It is a type of scan used to assess the shape of the uterus and the patency of the fallopian tubes
40
Describe the procedure of a laparoscopy dye test
During the procedure, a laparoscope is inserted into the uterus to observe the pelvis organs
A methylene blue dye is then injected into the uterus
41
What laparoscopy dye test result indicates infertility?
This dye should spread into the fallopian tubes; however, this will not occur if there is obstruction present
42
What investigation is used to investigate male infertility?
Semen Analysis
43
How is semen analysis used to investigate infertility?
It is used to examine the quantity and quality of the semen and sperm
44
What is the normal semen volume?
> 1.5ml
45
What is the normal semen pH?
> 7.2
46
What is the normal sperm concentrations?
> 15 million per ml
47
What is the normal sperm motility percentage?
> 40%
48
What is the normal sperm morphology percentage?
> 4%
49
What is anovulation?
The lack or absence of ovulation
50
What is the most common cause of anovulation?
Polycystic ovarian syndrome
51
Which investigation result indicates that infertility is due to anovulation?
When serum progesterone levels are low
52
How do we conservatively manage anovulation?
It involves advising patients about weight loss, through a balanced diet and regular exercise
53
What is the first line treatment option for anovulation in overweight patients with polycystic ovarian syndrome?
Conservative management
54
What three drugs are prescribed for anovulation? What is their function?
Clomiphene
Letrozole
Gonadotrophins
These medications stimulate ovulation in a regular and cyclical manner
55
How do we surgically manage anovulation?
Laparoscopic ovarian drilling
56
What is laparoscopic ovarian drilling?
The surgeon punctures multiple holes in the ovaries using a surgical needle or laser therapy
57
What are the two sperm problems that cause infertility?
Low sperm count
Azoospermia
58
What are the two causes of sperm problems?
Insufficient hormone production
Testicular problems
59
Which investigation result indicates that infertility is due to sperm problems?
It is indicated by abnormal semen analysis results
60
What class of drugs are prescribed for sperm problems? What is their function?
It involves prescription of gonadotrophins
These medications increase hormone synthesis production
61
What are the three surgical procedures used to manage sperm problems?
Surgical Sperm Retrieval
Intrauterine Insemination
Intracytoplasmic Sperm Injection (ICSI)
62
When is surgical sperm retrieval conducted?
It is used when there is a blockage somewhere along the vas deferens preventing sperm from reaching the ejaculated semen
63
How is surgical sperm retrieval conducted?
The procedure involves a needle and syringe collecting sperm directly from the epididymis through the scrotum
64
What is intrauterine insemination?
It involves collecting and separating out high-quality sperm, then injecting them directly into the uterus to give them the best chance of success
This can be done with the male partner’s sperm or a donor’s sperm
65
What is ICSI?
It involves injecting a single sperm directly into the cytoplasm of an egg
The sperm selected is of the highest quality
These fertilised eggs become embryos and are injected into the uterus of the woman
66
In which three circumstances is ICSI conducted?
When there are significant motility issues
A very low sperm count
When there are other issues with the sperm
67
What are the three surgical procedures used to manage fallopian tube problems?
Tubal Cannulation
Endometriosis Ablation
In Vitro Fertilisation (IVF)
68
What is tubal cannulation?
It uses hysteroscopy to guide a cannula through the cervix and the uterus into the fallopian tube
This increases the patency of the fallopian tube
69
When is tubal cannulation conducted?
The procedure should only be conducted in those with mild blockage in the distal part of their fallopian tube
70
What is endometriosis ablation?
It is a procedure that surgically ablates the endometrium
71
What procedure is most commonly used to manage fallopian tube problems?
IVF
72
What is IVF?
It involves mature eggs being collected from the ovaries and fertilised by sperm in a lab
The fertilised eggs are then transferred to a uterus
This procedure can be conducted with the partner’s own egg and sperm; however, donor options are also available
73
How are uterine problems managed?
They are managed by removal of polyps, adhesions or other structural abnormalities affecting fertility
74
How do we manage infertility when there is an unexplained cause?
IVF
75
What are the seven steps of IVF?
Menstrual Cycle Suppression
Ovarian Simulation
Oocyte Collection
Oocyte Insemination
Embryo Culture
Embryo Transfer
Pregnancy
75
What are the seven steps of IVF?
Menstrual Cycle Suppression
Ovarian Simulation
Oocyte Collection
Oocyte Insemination
Embryo Culture
Embryo Transfer
Pregnancy
76
How is the menstrual cycle suppressed before IVF?
The prescription of GnRH agonists or GnRH antagonists
77
What GnRH agonist is prescribed before IVF? How is it given?
Goserelin
An injection of a goserelin is given in the luteal phase of the menstrual cycle, around 7 days before the expected onset of the menstrual period
78
How does a GnRH agonist suppress the menstrual cycle?
It initially stimulates the pituitary gland to secrete a large amount of FSH and LH
However, after this initial surge in FSH and LH, there is negative feedback to the hypothalamus, and the natural production of GnRH is suppressed
79
What GnRH antagonist is prescribed before IVF? How is it given?
Cetrorelix
Daily subcutaneous injections of cetrorelix are given starting from fay 5-6 of ovarian stimulation
80
When do we stimulate the ovaries for IVF?
This starts at the beginning of the menstrual cycle
81
How do we stimulate the ovaries before IVF?
FSH subcutaneous injections
82
How long do we stimulate the ovaries before IVF?
10-14 days
83
At what follicle size do we stop ovarian stimulation?
18mm
84
After the FSH injections, what other drug do we use to stimulate the ovaries?
An injection of hCG
85
When are hCG injections given before IVF?
This injection is given 36 hours before collection of the eggs
86
Why do we give hCG injections before IVF?
The hCG stimulates the final maturation of the follicles, ready for collection
87
How are oocytes collected?
A needle is inserted through the vaginal wall into each ovary to aspirate the fluid from each follicle under guidance of a transvaginal ultrasound scan
This fluid contain the mature oocytes from the follicles
88
When do we ask males to produce a semen sample for IVF?
Around the time of oocyte collection
Frozen sperm from earlier samples may be used
89
What two fertilisation methods are used for IVF?
Insemination
Intracytoplasmic Sperm Injection (ICSI)
90
What is insemination?
It involves the sperm being mixed in a culture dish which contains the collected egg
91
How long are fertilised eggs incubated for?
Over 2-5 days
92
At what development stage do we transfer the embryos from incubation to the uterus? When does this usually occur?
Blastocyte
Day five
93
What is the maximum incubation period for IVF?
6 days
94
How are embryos transferred to the uterus for IVF?
A catheter is inserted under ultrasound guidance through the cervix into the uterus
A single embryo is injected through the catheter into the uterus, and the catheter is removed
95
What do we do with the remaining fertilised eggs after embryo transfer?
The remaining embryos can be frozen for up to ten years in case of future attempt
96
When is a pregnancy test conducted after IVF?
16 days after egg collection
97
When do we prescribe progesterone during IVF?
From the time of oocyte collection until 8-10 weeks’ gestation
98
In what form is progesterone prescribed for IVF?
Pessary
99
Why do we prescribe IVF patients progesterone?
This is used to maintain the endometrium
100
Why do we no longer prescribe IVF patients progesterone after 8-10 weeks gestation?
From 8-10 weeks, the placenta takes over the production of progesterone
101
When is an ultrasound scan conducted after IVF? Why?
7 weeks gestation
To check for a fetal heartbeat and rule out miscarriage or ectopic pregnancy
102
What are the four complications of IVF?
Ovarian Hyperstimulation Syndrome
Multiple Pregnancy
Ectopic Pregnancy
Failure
