Lecture 6: Infertility Flashcards
What is Infertility
Failure to conceive after 12 mo of unprotected intercourse
What is the fertility rate of NZ, and prevalence of infertility in age group vs resolution of infertility for male and female
NZ fertility rate is below the replacement level
25.3% infertile or sought medical help to conceive with prevalence highest in 40-44 yrs
Resolution of infertility 60% in men and 70% in women but early age of diagnosis is more likely to resolve.
What is the percentage distribution of cause of infertility - including ethnicity
Male and Female: 30%
Both =20%
Unexplained= 20%
Affecting Maori and Non-Maori equally but treatment rates are not equal
What are the differential diagnoses for patients with sub/infertility
- Anovulation
- Endometriosis
- Male factor infertility
- PCOS
- Recurrent miscarriage
- Unexplained in 10% of couples
How does mens age affect fertility
Decrease in semen volume, sperm motility, and sperm morphology.
Also higher risk for increased frequencies of mutations
What are positive and negative lifestyle factors for gamete health for men and women
Negative -Smoking -Alcohol -Caffeine Just women -Drugs/ medication -V low and V high BMI Just men -Hot testes: biking
Positive
- Mediterranean diet
- Wom: folic acid and vitamins
- Men: antioxidants, frequent sex
What is Anovulation, commonest cause of anovulatory subfertility and treatment
Oligomenorrhoea: >35 days without menstruation (can be exercise induced due to reduced adipose)
- PCOS commonest cause
- Treated with moderate exercise, weight gain/loss. And
Ovulation induction agent - Letrozole which takes 5 days from day 1 or cholomiphene citrate which has high twin rates.
has success rates of 20-30% in women 37- using 3-4 cycles.
How can ovarian reserve (for POI) be assessed
- Family history of early menopause +
- serum Anti mullerian hormone test (AMH produced by follicles) which can be done any time
(can do antral follicle count but this has to be at day 2-4 and needs skilled USS operator)
Compare why PCOS and Endometriosis cause infertility and their treatments. diagnosis tests
PCOS: leads to absence of periods because there is no ovulation.
Diagnosed on USS, high AMH, high T2
Endometriosis interferes with fertilisation and implantation and can lead to painful periods
Diagnosed on laparoscopy
Treatment
PCOS:
weight loss for high BMI, ovulation induction agent, metformin,
IVF but avoid ovary hyperstimulation syndrome ,
depression, anxiety, poor body image and psychosexual dysfunction
Endometriosis: surgical removal to create a window for pregnancy before it recurs, Lipiodol flushing,
IUI using mild stimulation if mild disease and patent tubes
IVF- but more risk
What are the 4 diagnostic tests that can be done to find out if its the Male factor contributing to infertility
- Semen analysis: if abnormal check for FSH, T2, Chromosomes, CFTR
- Physical examination:
Varioceles (associative), abnormal swelling - Detailed history: history of testicular trauma, mumps, infection, previous vasectomy, chlamydia
- Previous surgeries: - Testicular biopsy
confirms presence of sperm
What are some forms of anovulation that don’t respond to ovulation induction and treatment
Premature ovarian failure (1’ ovarian insufficiency)
- high FSH, low AMH
Treated with trying to identify women early using family history. Donor oocyte
Genetic abnormalities:
Turners syndrome 45 XO- donor oocyte
Androgen insensitivity syndrome 46XY - Surrogate
What is the definition of unexplained infertility and what is the treatment for this couple
Couple unable to conceive with normal patient ovulation, patent tubes, no adhesions or endometriosis and normal semen parameters after having sex for more than a year around ovulation
Treatment is lifestyle changes and expectant management for 5 years before there is funded IUI or IVF treatment as 80% of couples will conceive during that time
