Flashcards in Infertility Deck (17):
What percentage of couples does infertility affect?
What is the difference between primary and secondary infertility?
Primary - no previous pregnancy
General causes of infertility?
Abnormal/absent sperm production
How common is anovulation?
15-20% of women
What can cause anovulation?
Occasional ones are normal, especially in the extremes of reproductive life
Necrosis of pituitary (after a long birth)
Radio and chemotherapy
What happens in polycystic ovarian syndrome?
Pathogenesis is uncertain
-pituitary or ovarian level?
Increased androgen secretion causing a raised LH:FSH ratio
Get insulin resistance
Multiple small ovarian cysts
Anovulation and amenorrhea or oligomenorrhea
How to diagnose anovulation?
Serum progesterone levels in mid-luteal phase (about day 21)
How to know the cause of anovulation by look at proportions of hormones?
-high LH and FSH
-high LH and FSH
-LH:FSH ratio increased
Methods of inducing ovulation?
Anti-oestrogen - reduces negative feedback to hypothalamus or pituitary, increasing GnRH, increasing FSH
Gonadotrophins - FSH administration
GnRH agonists - pulsation to mimic normal secretion
What can cause tubal occlusion?
Infection from endometriosis
How is tubal occlusion diagnosed?
Laparoscopy and dye insufflation
How is tubal occlusion treated?
Re-anastamosis by tubal surgery
What can cause abnormal or absent sperm production?
Abnormal by testicular disease
Obstruction of ducts by infection or vasectomy
Hypothalamic or pituitary dysfunction
How to investigate infertility?
Do they have regular unprotected intercourse
Is ovulation happening
-Take 21 day progesterone
-history of infection or sterilisation?
-Adequate sperm count?
Treatment of infertility?
Overcome tubal occlusion by surgery or IVF
If inadequate sperm
-inadequate insemination by donor
-intracytoplasmic sperm injection
What is looked at in semen analysis?
Volume more than 2ml
Sperm count more than 20 million per ml
Motility more than 50%
Morphology more than 50%