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Obstetrics and Gynaecology > Infertility > Flashcards

Flashcards in Infertility Deck (16):
1

Definition

Failure to conceive within 12 months given adequate opportunity

2

Rates of conception at 12 months and 24 month

90% at 12 months
95% at 2 years

3

Female causes

1. Amenorrhea/ovulatory dysfunction
Hypothalamus/pituitary
PCOS
Premature ovarian failure
Uterine outflow disorders
2. Tubal defect
3. Endometriosis
4. Other

4

Male causes

1. Hypogonadism->primary and secondary
2. Cryptocrchidism
3. XXY
4. Disordered sperm transport
5. GU surgery

5

History

1. Duration of trying
2. Frequency of intercourse and technique->coitus every other day mid cycle
3. Contraceptive history
4. PID, endometriosis
5. Age of partners
6. Menstrual history: premenstrual symptoms, regularity, ovulation pain, vaginal secretions (thin=E, thick=P)
7. FHx->PCOS, fragile X
8. PMHx: surgery, infections, pain, liver/renal/heart/thyroid
9. Pap smears, LLETZ (cervical incompetence)
10. Medication, alcohol, smoking, drugs
11. Previous pregnancies->miscarriages

6

Examination

1. General
++Male pattern hair, acne, obesity, acanthosis nigricanc
Adipose->+adrenal, PCOS, diabetes
Galactorrhea (+prolactin)
Thyroid examination
2. Genital
Pelvic organs->fibroids, cysts, endometriosis, PID
Vagina->structural, muscle spasm

7

Investigations in women

1. Ovulatory
TSH->both hyper/hypothyroid can disrupt ovulation
Prolactin->elevates interferes
Androgens (androgen secreting tumors), sex hormone binding globulin
Day 21 serum Progesterone
LH, FSH->if elevated menopause/resistant ovarian
2. Tubal damage->done by specialist infertility gynaecologist
Sonohysteroscopy
Hysterosalpingogram
Laparoscopy
3. Other
Lipids
Glucose
FBC
VZ, rubella screen
Pelvic USS

8

PCOS: LH, FSH, SHBG

LH day 2-5 cycle
If +LH, normal FSH,
+testosterone, low SHBG=
PCOS
Early follicular FSH/estradiol
- may respond to IVF

9

Investigations in men

Semen analysis->must not ejaculate for 2 days, semen produced by masturbation, all require (if abnormal) repetition at 3 months (duration of spermatogenesis)
TSH
Prolactin
Karyotype
Lipids
Glucose

10

Treatment in men

Treat hormonal deficiency
Donor insemination
IVF
Intracytoplasmic sperm injection

11

Management in women

1. Referral to fertility specialists
2. Clomiphene cutrate->5 days in early proliferative
Anti-estrogen at pituitary= ++FSH->+follicle growth and ovulation
70-80% fertility in 12 cycles

12

Side effects of clomiphene citrate

Hot flushes
Nausea
HeadA
+Menstrual pain
+Chance of multiple pregnancies

13

Complication of IVF

1. Perinatal morb/mortality
2. Multiples
3. Ovarian hyperstimulation
Mild= bloating, pain, ascites
Moderate= distension, NV, ascites, hematology and blood chemistry altered
Severe= ++Ascites, requiring hospitalisation, pleural effusion, prekidney failure, anuria

14

Mechanisms of ascites, in ovarian hyperstimulation

1. Ascites
extravasation and increased leakage of
protein-rich fluid from the intravascular space into the
abdominal cavity, owing to an osmolar differential.

15

Pain and renal impairment in ovarian hyperstimulation

1. Pain
Torsion
Hemorrhage
Rupture
2. Renal
Extravasation of fluid

16

Hypercoagulable in ovarian hyperstimulation

Hemoconcentration and hypovolemia from third spacing and fluid shift
Also +estrogen