Infertility Flashcards
(54 cards)
What are the requirements for fertility?
- Production of normal sperm
- Production of normal eggs
- Sperm needs to traverse the female tract to reach the egg and fertilise it, which requires:
- Capacitation: gaining fertilisation competence
- Time constraints: needs to happen when the egg is in the fallopian tube.
- Sperm needs to penetrate the ZP and fertilise the oocyte
- Implantation of the embryo into the uterus
- A healthy normal pregnancy
What is fertility?
Fertility is a measure of the actual outcome of the reproductive process, i.e., the number of children born to an individual or couple.
What is fecundability?
Fecundability is the probability of conceiving each month, or the monthly chance of pregnancy, either for an individual or for a population.
What is fecundity?
Fecundity is a measure of the ability to conceive and produce a live birth.
What is infertility?
Infertility is the inability to conceive after a period of unprotected intercourse or the inability to carry a pregnancy to term.
The National Institute for Clinical Excellence (NICE) defines infertility as failing to get pregnant after two years of regular unprotected sex.
What is subfertility?
Subfertility is a state of reduced fertility, generally prompting people to seek medical advice after one year of trying to conceive.
What data supports the definition of subfertility?
Of 100 couples without a fertility issue trying to conceive naturally:
- 20 will conceive within one month
- 70 will conceive within six months
- 85 will conceive within a year
- 90 will conceive within 18 months
- 95 will conceive within two years
Is infertility a big problem?
Most couples are unaware of their fertility status until they wish to reproduce. It is estimated that one in six couples have difficulty conceiving.
What are the causes of infertility?
Around 35% of infertility has a male basis, 35% has a female basis, 15% has a basis in both partners, and 15% has no known cause.
What are self-inflicted factors that affect fertility?
Self-inflicted factors include:
1. Age
2. Smoking status
3. Obesity
4. Increasing prevalence of STIs such as chlamydia
What is the first step if a couple presents with perceived infertility?
Step 1: Take a history, including:
- How long have they been trying?
- Family history of infertility?
- Current sexual history?
- Past sexual history?
What are some female factors that could cause infertility?
Female factors include:
1. Ovulatory disorders
2. Tubal damage
3. Endometriosis
4. Uterine abnormalities
5. Problems with implantation, growth, and development
How can we diagnose the causes of infertility in women?
Diagnosis can involve blood analysis, surgery, and radiography, such as measuring FSH or progesterone levels, HSG, and laparoscopy.
What are some ovulation disorders that can cause fertility problems?
Ovulation disorders account for 40% of fertility problems and may include:
1. Absent cycles (Primary or Secondary amenorrhoea)
2. Irregular cycles (Oligomenorrhoea)
3. Anovulatory cycles
What can ovulation disorders be associated with?
Ovulation disorders can be associated with stress, obesity, strenuous exercise, anorexia nervosa, and drug use.
What are disorders of the female tract that can affect fertility?
Disorders include:
1. Tubal obstruction (often due to pelvic infection)
2. Endometriosis (ectopic endometrial tissue growth)
What are some maternal problems that can affect fertility?
Maternal problems account for 40-50% of fertility issues and can include:
1. Cervical incompetence
2. Implantation defects
3. Autoimmune effects
4. Immunological incompatibility
How is a biochemical pregnancy tested?
A biochemical pregnancy is tested by the presence of hCG in blood and urine 18-30 days after the initiation of the last period.
How is a clinical pregnancy detected?
A clinical pregnancy is detected on ultrasound, with a sac visible at 5 weeks and a fetal heart at 7 weeks.
What are reasons for spontaneous pregnancy loss?
4/5 cycles involving unprotected intercourse do not result in pregnancy. Up to 15-25% of clinical pregnancies fail, usually in the first trimester.
What percentage of pregnancy losses are due to abnormal conceptus?
50-60% of losses are due to genetic abnormalities in the conceptus.
What categories can chromosomal abnormalities be split into?
Chromosomal abnormalities can be categorized into:
1. Translocations
2. Errors of ploidy
3. Errors of chromosome number or ‘somy’
What is the effect of delayed reproduction on fertility?
Aneuploidy in oocytes becomes more common with increasing maternal age, leading to higher miscarriage rates and lower live birth rates.
What are emerging diagnostics for females in IVF?
Emerging diagnostics include tests for endometrial receptivity to determine the optimal time for embryo placement.
