Infertility Flashcards
What is infertility?
Inability of a couple to conceive after 12 months of regular intercourse without use of contraception
How common is infertility?
1/7 couples report infertility problems
How soon do couples concieve?
>80% of couples will conceive within 1 year if woman is <40 and they do not use contraception with regular sexual intercourse
Of those who do not conceive in the first year, about half will do so in the second year
What are the causes of infertility?
Unexplained
Tubal
Ovulation
Male
When should couples be referred to infertility clinic?
1 year of trying, unless there is an issue, such as
Period irregularity
PMH
Testicular problems
Abnormal tests
HIV/HEP B
Anxiety
Age
- <35 years after 1 year
- 35-45 years after 6 months
- >45 years, little can be offered as IVG is unlikely to work
What investigations (female) are used in infertility investigation?
Rubella immunity: Can’t get pregnant for a month after vaccination as live vaccine
Chlamydia
TSH
Mid Luteal Progesterone: If periods are regular, 7 days prior to expected period/day 28
Day 1-5 FSH, LH, PRL, TSH and testosterone: For irregular periods
TFT: Deranged thyroid function can increase chance of miscarriage
Pelvic USS
Tubal patency test/hysterosalpingography (HSG)
What investigations (male) are used to in infertility investigation?
Semen analysis: Prefer to produce in clinic so sample is as fresh as possible
What is the criteria for IVF?
Non-smoker
Not sterilised
No children
Low BMI <35
Describe the method of IVF
Injection of mature eggs with single sperm
Followed by incubation overnight and put back on day <5 where the best one is picked
Embryo transfer via ultrasound
Freezing embryos if left over
Give a complication of IVF
Ovarian Hyperstimulation Syndrome, Affects 33% of IVF cycles
Describe the pathophysiology of ovarian hyperstimulation syndrome
Vasoactive products are released causing increased capillary permeability causing ascites, pleural effusion, renal and respiratory failure and VTE
What is the mode of action of clomiphene therapy?
Blocks estrogen receptors in the anterior pituitary, leading to increased secretion of FSH and LH
What management is used if failed ovarian stimulation with clomiphene?
Gonadotrophin Therapy:
How is unexplained infertility managed?
Do not offer oral ovarian stimulation agents
Must try to conceive for a total of 2 years before IVF will be considered
What are the 3 groups of ovulatory disorders?
Group 1: Hypothalamic Pituitary failure
Group 2: Hypothalamic-Pituitary-Ovarian Dysfunction
Group 3: Ovarian Failure
