Infertility Flashcards
(30 cards)
Define infertility
Failure to achieve a pregnancy after 12 months or ore of regular (2-3 times a week) unprotected sexual intercourse
Define primary infertility
Never been pregnant
Define secondary infertility
Previous pregnancy (including ectopic + terminations) but struggling to conceive
Define subfertility
Describes any form of reduced fertility that results in prolonged duration of unwanted lack of conception
Causes of infertility
- unknown
- male causes
- female cases: ovulatory causes or tubal factors or uterine + peritoneal disorders
Types of male causes of infertility
Pre testicular
Testicular
Post testicular
Pre testicular causes of male infertility
Hypogonadotropic hypogonadism
Thyroid disorders
Testicular causes of male infertility
- genetic: Klinefelter syndrome XXY (testis don’t descend)
- congenital: cryptorchidism
- infective: mumps
- antispermatogenic agents e.g. chemo
- vascular: torsion, varicocele
Post testicular causes of male infertility
Obstructive:
- congenital: absent vas
- acquired: infective, vasectomy
Coital problems
- sexual dysfunction
Hypospadias
What is hypospadias?
Congenital condition where the urethral opening is lower than normal
Types of ovulatory disorders
- hypothalamic pituitary failure: hypothalamic amenorrhoea, hypogonadotropic hypogonadism
- hypothalamic pituitary ovarian dysfunction: PCOS (most common cause) , high prolactin
- ovarian failure: premature ovarian failure, congenital e.g. Turner’s syndrome 45XO
Causes of tubal damage causing female infertility
PEPE
- PID
- Ectopic pregnancy
- Pelvic surgery
- Endometriosis
- agenesis of fallopian tubes
Uterine + peritoneal disorders that can cause female infertility
- uterine fibroids
- conditions causing scarring/adhesions: e.g. endometriosis, PID, previous surgery, Asherman syndrome
- mullerian development anomalies
Female examination for investigating infertility
- BMI
- secondary sexual characteristics
- acne
- Hirsutism (excess hair)
- pelvic/abdominal exam + swab
Advice to patients experiencing infertility
- smoking cessation
- reduce alcohol intake
- lifestyle changes e.g. stress
- regular intercourse
- weight loss
- reassurance
Investigation of male infertility
- semen analysis
- bloods: LH/FSH, testosterone
- STI screen
- ultrasound scan testes
- karyotyping
Investigations of female infertility
- FSH/LH day 2
- mid luteal phase progesterone (day 21)
- TFTs, prolactin levels, androgens
- STI screen
- pelvic ultrasound scan
- hysterosalphinogram
- laparoscopy
When should you consider early referral to secondary care in infertility?
Woman is >35 after 6/12months
If cause if known
Management options of infertility
- medical treatment: ovulation induction e.g. clomifene
- surgical treatment: tubal occlusions e.g. laparoscopy
- assisted reproductive technology: IVF, intrauterine insemination
When should you consider referral to secondary care in infertility?
If history, exam and investigation are normal in both partners and not conceive after 1 year
What is placenta accreta?
Invasion of conceptus that is too deep
What percentage of couples will conceive naturally within 1 year with regular unprotected intercourse?
84%
Relationship between dopamine and prolactin
Dopamine inhibits prolactin
What is measured in a semen analysis?
- semen volume
- total sperm count
- sperm conc.
- total + progressive motility
- vitality
- sperm morphology
