Infertility Flashcards
1
Q
What are the top 5 causes of infertility?
A
- anovulatory infertility (PCOS) 25%
- Tubal disease 20%
- Endometriosis (10%)
- Male factor (30%)
- Unexplained
40% of couples with difficulty conceiving will have both male and female component.
2
Q
What is sub fertility defined as?
A
- refer to sub fertility clinic after 1 year of unprotected vaginal sex and not conceiving.
3
Q
what are the main social factors affecting sub fertility?
A
- maternal age >35
- smoking
- coital frequency (2-3x per week)
- alcohol
- female body weight
- Drugs: NSAIDs, chemotherapy, sulphasalazine and androgen injections affect sperm
4
Q
What are the anovulatory causes of infertility?
A
- Pituitary:
- hyperprolactinaemia has an inhibitory effect on all pituitary hormones
- hypopituitarism (global)
- hypothalamic: Wallmans syndrome (GnRH deficiency, associated with anosmia)
- PCOS
5
Q
what tubal problems may arise?
A
- PID (chlamdia or endometriosis)
- fibroids or polyps in the way
- previous abdominal or pelvic surgery (Ashermans syndrome)
- ruptured ectopic
6
Q
what is male sub fertility caused by usually?
A
- idiopathic (50%)
- varicocele (12%)
- infection (7%)
- immunological (3%)
7
Q
define these terms:
- azoospermia
- oligospermia
- asthenozoospermia
- teratozoospermia
A
- no traceable sperm
- <15 million/ ml sperm in ejaculate
- reduced motility
- abnormal morphology
8
Q
what may cause obstructive azoospermia?
A
- blockage, so no sperm can come out
Causes: - infection
- congenital absence of vas deferens (cystic fibrosis)
- vasectomy
- Low sperm production due to low testosterone/ FSH/LH
9
Q
what investigations would you perform in a female?
A
- FSH (+/- LH) and oestrogen at days 1-5, (should be low) confirms ovarian reserve
- rubella and chlamydia serology
- If PCOS suspected then pelvic ultrasound
10
Q
how could you check for tubal dysfunction?
what endometrial factors might inhibit embryo attachment?
A
- hysterosalpingogram
- endometriosis
- fibroids
- polyps
- ruptured ectopic
