L11: Infertility - Pt 1 Flashcards by Ahmed Farag

Q

Def of Infertility

A

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Q

Types of Infertility

A

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Q

Types of Infertility

Primary

A

pregnancy never occurred before.

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Q

Types of Infertility

Secondary

A

pregnancy occurred before even once whatever its mode of termination.

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Q

Types of Infertility

Relative

A

ability of the patient to get pregnant but inability to maintain it till delivery.

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Q

Types of Infertility

Permenant (Sterility)

A

inability of the patient to get pregnant forever due to permeant cause.

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Q

Basic requirement for fertility

A

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Q

Basic requirement for fertility

Female

A

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Q

Basic requirement for fertility

Male

A

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Q

Etiology of Infertility

A

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Q

Etiology of Male Infertility

A

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Q

Etiology of Male Infertility

Congenital

A

Absent vas deferens OR duct obstruction.
Hypospadias OR epispadias.
Testicular hypoplasia OR crypt-orchidism.

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Q

Etiology of Male Infertility

Traumatic

A

Injury of the vas during repair of hernia.

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Q

Etiology of Male Infertility

Inflammation

A

Orchitis, prostatitis, STDs… etc

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Q

Etiology of Male Infertility

Neoplastic

A

Any neoplasm destructing testicular tissues.

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Q

Etiology of Male Infertility

Dysfunction

A

Failure of sperm deposition as in impotence, premature and retrograde ejaculations.
Abnormal spermatogenesis.
Abnormal seminal fluid or sperm motility.
Immunological factors e.g., antibodies against sperms.
Varicocele “its role is controversial”.

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Q

Etiology of Male Infertility

General Causes

A

Genetics
Smoking
Alcoholism
Liver cell failure
Idiopathic.

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Q

Dx of Male Infertility

A

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Q

Dx of Male Infertility

Hx

A

Age, job, and residence of the husband.
Previous marriage, and having or no previous child
History of diseases, trauma, surgery… etc..

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Q

Dx of Male Infertility

Ex

A

The cause may be detected e.g.:

loss of body hair, obesity, gynecomastia. varicocele, hypospadias, testicular hypoplasia.

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Q

Dx of Male Infertility

INVx

A

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Q

INVx in Male Infertility

A

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Q

INVx in Male Infertility

Semen Analysis

A

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Q

Value of Semen Analysis

A

The 1st investigation + most important done to evaluate infertile couple.

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Physical Characters of **Semen** - Volume - Color - Odor - pH - Viscosity - Liquefecation

Microscopic Characters of **Semen** - Total Sperm Count - Sperm Conc. - Sperm Motility - Sperm Morphology - Sperm Viability - WBCs

Terms related to semen quality

If any abnormality in the semen is detected, .......

- No treatment is given except after repetition of analysis in another lab. "2 weeks later"

INVx in **Male Infertility** - Others

INVx in **Male Infertility** - Labs

- CBC - Liver and renal functions

INVx in **Male Infertility** - testicular Bx

In azoospermia

INVx in **Male Infertility** - Culture

For infection

TTT of **Male Infertility**

TTT of **Male Infertility** - Medical

TTT of **Male Infertility** - Surgical

- Vein ligation in varicocele. - Treatment of hypospadias.

TTT of **Male Infertility** - ART

Etiology of **Female Ovarian Infertility**

Etiology of **Female Ovarian Infertility** - Physiological

All causes of physiological amenorrhea.

Etiology of **Female Ovarian Infertility** - Pathological

Dx of **Female Ovarian Infertility**

Dx of **Female Ovarian Infertility** - Symptoms

Dx of **Female Ovarian Infertility** - Signs

Dx of **Female Ovarian Infertility** - INVx

INVx for **Female Ovarian Infertility** - Labs

INVx for **Female Ovarian Infertility** - Imaging

U.S For serial measurements: - Done to follow up the follicular growth and maturation. "the mature Graafian follicle is about 18-25 mm".

INVx for **Female Ovarian Infertility** - Endoscopic Laparoscopy

For direct visualization of the stigma of ovulation.

INVx for **Female Ovarian Infertility** - Histopathological

Premenstrual endometrial biopsy shows: * No secretory changes. * Luteal phase defect.

TTT of **Female Ovarian Infertility**

TTT of **Female Ovarian Infertility** - Correction of General Conditions

- Treatment of general causes. - Treatment of hypothalamic and pituitary as in amenorrhea.

TTT of **Female Ovarian Infertility** - Induction of Ovulation

Induction of Ovulation in **Female Ovarian Infertility** - Medical

Dose of **Clomiphene citrate - Clomid**

- Used as 50 - 150 mg/day for 5 days starting from 2nd - 5th day of cycle for 6 months.

Success Rate of **Clomiphene citrate - Clomid**

Ovulation rate is 70% & pregnancy rate is 40%

What Causes lower Pregnancy Rate in **Clomiphene citrate - Clomid**?

It may be due to - Antiestrogenic effect on cervical mucus & endometrium. - Luteal phase defect. - Improper coitus timing. - Other undiagnosed factors of infertility.

What Cuases Drug resistance to **Clomiphene citrate - Clomid**?

- No documented ovulation after 6 months of treatment with the usual daily dose.

????

Medical Induction of Ovulation in **Female Ovarian Infertility** - tamoxifen

As selective direct estrogen receptor inhibition.

Medical Induction of Ovulation in **Female Ovarian Infertility** - Bromocriptine

As anti-prolactin in hyper-prolactineamia.

Medical Induction of Ovulation in **Female Ovarian Infertility** - Metformin

As ant-insulin in PCOS.

Induction of Ovulation in **Female Ovarian Infertility** - Surgical

- Laparoscopic ovarian drilling (unilateral or bilateral). - Bilateral wedge resection (NOT used now).

Def of **Ovarian hyper-stimulation syndrome (OHSS)**

- It is a common complication of induction of ovulation as the ovaries may enlarge ≥ 12 cm with risk of peritoneal irritation OR ovarian rupture.

CP / Grades of **Ovarian hyper-stimulation syndrome (OHSS)**

CP / Grades of **Ovarian hyper-stimulation syndrome (OHSS)** - Mild

There is abdominal distension, pain, sickness and diarrhea.

CP / Grades of **Ovarian hyper-stimulation syndrome (OHSS)** - Moderate

There may be excess fluid in the abdomen leading to more pain and discomfort.

CP / Grades of **Ovarian hyper-stimulation syndrome (OHSS)** - Severe

TTT of **Ovarian hyper-stimulation syndrome (OHSS)**

Indications of using ovulatory drugs

Pre-requisites for TTT with ovulatory drugs in infertility cases