INFERTILITY Flashcards
Introduction to infertility Introduction to ART (20 cards)
Define infertility
The absence of pregnancy in a woman of reproductive age after one year of unprotected sexual intercourse without a known cause of infertility
Name some causes of infertility
Unexplained Ovulatory disorders Tubal damage Male factors Uterine or peritoneal factors Combined male and female
Name some male factors which may lead to infertility
Hypogonadotrophic hypogonadism Idiopathic semen abnormalities Ejaculation issues Varicocele Tumours Undescended testicles Obstructive azoospermia Infection
Name some risk factors for infertility
Smoking Caffeine Alcohol Raised BMI (>30) Low BMI (<19) Tight fitting underwear (mixed evidence regarding this)
Investigations for infertility (men)
Seminal fluid analysis LH FSH Free serum testosterone Prolactin (if indicated ? prolactinoma)
Investigations for infertility (women)
Day 21 progesterone LH FSH Prolactin Free serum testosterone (if ? PCOS) Serum oestradiol TFTs (if clinically indicated)
Transvaginal US
Hysterosalpingogram (HSG)
Hysterosalpingo contrast sonography (HyCoSy)
Diagnostic laparoscopy + tubal dye test
Name five predictors of IVF success
Female age Number of previous treatment cycles Previous pregnancy history BMI Lifestyle factors
WHO reference values for semen analysis?
Semen volume: 1.5ml or more
pH: 7.2 or more
Sperm concentration: 15 million spermatozoa per ml or more
Total sperm number: 39 million spermatozoa per ejaculate or more
Total motility: 40% or more
Vitality: 58% or more live spermatozoa
Sperm morphology: 4% or more
How should the following causes of infertility be managed?
Male hypogonadotrophic hypogonadism
Obstructive azoospermia
Male hypogonadotrophic hypogonadism - gonadotrophin drugs
Obstructive azoospermia - surgical correction
How should the following causes of infertility be managed?
Group I ovulation disorders (ie hypothalamic pituitary failure)
Group II disorders (eg hypothalamic-pituitary-ovarian dysfunction)
Group I ovulation disorders (ie hypothalamic pituitary failure) - GnRH
Group II disorders (eg hypothalamic-pituitary-ovarian dysfunction often PCOS) - clomifene or metformin or a combination of the two
When may intrauterine insemination be appropriate?
People unable to have vaginal intercourse due to a physical or psychosexual problem
HIV +ve or hepatitis +ve patients
People in same sex relationships
What is the incidence of infertility in the UK?
1 in 7 couples
Name some female factors which may lead to infertility
PID Premature ovarian failure Uterine polyps Endometriosis Fibroids Adhesions Previous ectopic pregnancy Congenital malformations
According to current UK law how long can an embryo be grown for?
Up to 14 days
According to current UK law how long can eggs be frozen for?
Up to 10 years
What is the difference between Preimplantation Genetic Diagnosis (PGD) and Preimplantation Genetic Screening (PGS)?
PGD - looking for a known familial genetic disorder
PGS - looking for embryos at risk of aneuploidy as opposed to a specific disorder
When may ICSI (intracytoplasmic sperm injection) be clinically indicated?
Low sperm count Poor sperm motility Abnormal morphology Anti-sperm antibodies Previous vasectomy Erectile dysfunction
Aside from ejaculation, how may sperm be collected for artificial insemination?
PESA (Percutaneous Epididymal Sperm Aspiration)
TESA (Testicular Sperm Aspiration)
When may PESA be indicated?
If the vas deferens is absent or blocked
When may TESA be indicated?
If there is an absence of sperm in the epididymis or the epididymis is obstructed
