Infertility Flashcards
(22 cards)
What % of couples conceive within 1 year?
80%, if woman <40
What % of women <40 conceive within 6 cycles of AI?
50%
What % of women <40 conceive within 12 cycles of AI?
75%
When can a couple be assessed for potential fertility issues?
- A couple with no known cause of infertility who have not conceived after 1 year of UPSI
- A person/couple with no known cause of infertility using artificial insemination who have not conceived after 6 cycles
When should earlier assessment for fertility issues be considered?
- Woman is 36 or older
- Known or predisposing factors for infertility
- People who are unable to have VI
- Planned treatment which may result in infertility e.g. cancer
If initial semen analysis abnormal, when should it be repeated?
3/12
Unless azoospermia, in which immediate repeat required
What are the normal semen analysis parameters?
Semen volume - >/= 1.5ml
pH >/=7.2
Concentration >/= 15 million spermatozoa per ml
Total sperm volume >/= 39 million spermatozoa per ejaculate
Total motility >/= 40% or >/= 32% with progressive motility
Vitality >/= 58% live spermatozoa
Sperm morphology >/= 4%
What are the predictors of low ovarian response to gonadotrophin stimulation?
- Total antral follicle count of 4 or less on day 3 of cycle
- AMH 5.4 or less
- FSH >8.9
What are the predictors of good ovarian response to gonadotrophin stimulation?
- Total antral follicle count >16 on day 3 of cycle
- AMH 25 or greater
- FSH <4
A progesterone level of what suggests ovulation has occured?
> 30
In what situations would you offer laparoscopy and dye test rather than hysterosalpingogram?
- PID
- Endometriosis
- Prev ectopic
What are the Group 1 ovulation disorders?
Hypothalamic-pituitary failure - hypogonadotrophic hypogonadism
Kallman syndrome
Sheehan’s syndrome
Pituitary tumours
Stress/exercise-induced amenorrhoea
What are the Group 2 ovulation disorders?
Hypothalamic-pituitary dysfunction - eugonadotrophic hypogonadism
PCOS
What are the Group 3 ovulation disorders?
End organ damage - hypergonadotrophic hypogonadism
POI
Turner’s
Fragile X
When do couples qualify for IVF?
2 years of regular UPSI
What is associated with higher rates of conception at insemination - fresh or frozen sperm?
Fresh
What is the IVF eligibility criteria <40?
For women <40, offer 3 cycles of IVF if:
- Not conceived after 2 years of regular UPSI
- Not conceived after 12 cycles AI
- If they reach 40 during treatment complete the cycle but do not offer further cycles
What is the IVF eligibility criteria >40?
For women 40-42 who meet above criteria, offer 1 cycle of IVF if:
- No previous IVF
- No evidence low ovarian reserve
How many embryos can be transferred in women <37?
Use single-embryo transfer in first cycle
In second cycle, transfer 1 embryo if one or more top-quality embryos available, otherwise consider 2
In third cycle, transfer no more than 2 embryos
How many embryos can be transferred in women age 37-39?
In first and second cycles, use single embryo transfer if one or more top-quality embryos available, otherwise consider 2
In third cycle, transfer no more than 2 embryos
How many embryos can be transferred in women 40-42?
Consider double embryo transfer
How should embryo transfer be planned with an oocyte donor?
Plan strategy based on the AGE OF THE DONOR
