A rise in which STI is contributing to infertility?
What is the definition of infertility?
Failure to become pregnant after 12 or more months of regular unprotected sex
What is primary infertility?
Infertility in a couple who have never conceived
What is secondary infertility?
Inferility in a couple who have previously conceived
What are the main physiological causes for infertility?
- Before puberty
What are the main gynaecological conditions which cause inferility?
- Hypothalmic - Anorexia/bulimia, excessive exercise
- Pituitary - Hyperprolactinaemia, tumours, Sheehan syndrome
- Ovarian - PCOS, premature ovarian failure
Besides physiological and gynaecological conditions, what else may cause infertility?
- Systemic disorders e.g. CKD
- Endocrine disorders e.g. Testosterone secreting tumours, CAH, thyroid problems
- Drugs e.g. Depo-provera (medroxyprogesterone), explanon, OCP
Anorexia is defined as a BMI of less than what?
What are the key clinical features of anorexia nervosa?
- Loss of hair
- Increased lanugo
- Low pulse
- Low Bp
What is lanugo?
Fine soft hair on the skin
What are the endocrine markers of anorexia nervosa?
Which condition may be brought on by a low oestradiol in anorexia nervosa?
What is the most common endocrine disorder in women?
What are the main clinical features of PCOS?
- Cycle abnormalities
What are the endocrine markers of PCOS?
- High free androgens
- High LH, Low FSH
- High oestrogen
- Impaired glucose tolerance
Which criteria are used to diagnose PCOS and what are they?
- Chronic anovulation
- Polycyctic ovaries*
- Hyperandrogenism (clinical or biochemical)
(2/3 are required)
*At least one ovary must have at least 12 follicles between 2-8 mm in a single plane. These can be uni or bilateral
What may cause premature ovarian failure?
- Genetic (Turner's syndrome)
- Oophorectomy (ovary removal)
What are the clinical features of premature ovarian failure?
- Hot flushes
- Night sweats
- Atrophic vaginitis
What are the endocrine markers of prematrure ovarian failure?
- High FSH
- High LH
- Low oestradiol
What is a hydrosalpinx?
A distally blocked Fallopian tube filled with clear or serous fluid
What is endometriosis?
Presence of endometrial glands outwith the uterine cavity
What are the main causes for endometriosis?
- Retrograde menstruation
- Altered immune function
- Abnormal cellular adhesion molecules
- Genetic causes
Upon USS, what classic sign will endometriosis have on the ovaries?
Characteristic "chocolate" cysts
What are the key clinical features of endometriosis?
- Dysmenorrhoea (painful menstruation)
- Dysparenunia (pain during sex)
- Menorrhagia (abnormally heavy periods)
- Painful defaecation
- Chronic pelvic pain
- Uterus may be fixed and retroverted
- Chocolate ovarian cysts
What can cause non-obstructive infertility in males?
- Klinefelter's syndrome
- Undescended testes
What are the endocrine markers for non-obstructive male inferility?
- High LH/FSH
- Low testosterone
What can cause obstructive male infertility?
- Congenital absence of Vas deferens (sign of cystic fibrosis)
What are the endocrine markers for obstructive male infertility?
How can tubal patency be established in females?
- Hysterosalpingiogram (no known risk factors or tubal pathology)
- Laparoscopy (known risk factors and/or tubal pathology)
- Hysteroscopy (suspected or knopwn endometrial pathology)
Which biochemical tests would be carried out if a patient presented with an anovulatory cycle or infrequent periods?