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Flashcards in Infertility Deck (17):
1

What percentage of couples does infertility affect?

About 15%

2

What is the difference between primary and secondary infertility?

Primary - no previous pregnancy

3

General causes of infertility?

Coitus problems
Anovulation
Tubal occlusion
Abnormal/absent sperm production

4

How common is anovulation?

15-20% of women

5

What can cause anovulation?

Occasional ones are normal, especially in the extremes of reproductive life
Hyperprolactinaemia
Weight loss
Exercise
Stress
Pituitary tumours
Necrosis of pituitary (after a long birth)
Ovarian failure
Menopause
Radio and chemotherapy

6

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

7

How to diagnose anovulation?

Serum progesterone levels in mid-luteal phase (about day 21)

8

How to know the cause of anovulation by look at proportions of hormones?

Menopause
-high LH and FSH
-low oestrogen

Ovarian failure
-high LH and FSH
-low oestrogen

Hypo/pituitary failure
-low everything

PCOS
-LH:FSH ratio increased
-normal oestrogen

9

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

10

What can cause tubal occlusion?

Sterilisation
Scarring
Infection from endometriosis

11

How is tubal occlusion diagnosed?

Laparoscopy and dye insufflation
Hysterosalpingogram

12

How is tubal occlusion treated?

Re-anastamosis by tubal surgery
Assisted conception

13

What can cause abnormal or absent sperm production?

Abnormal by testicular disease
Obstruction of ducts by infection or vasectomy
Hypothalamic or pituitary dysfunction

14

How to investigate infertility?

Do they have regular unprotected intercourse
Is ovulation happening
-regular cycle?
-Take 21 day progesterone

Patent tubes
-history of infection or sterilisation?
-Dye insufflation/HSG
-Adequate sperm count?

15

Treatment of infertility?

Induce ovulation
Overcome tubal occlusion by surgery or IVF
If inadequate sperm
-inadequate insemination by donor
-intracytoplasmic sperm injection

16

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%

17

What is infertility defined as?

Failure to conceive within one year