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Flashcards in Subfertility Deck (12):
1

catogries of subfertility their treatments and investigations

Causes 

  • Sperm issues/male factors --> intrauterine insemination (IUI), IVF
  • Ovulatory dysfunction (anovulation) --> medical induction of ovulation (controlled ovarian hyperstimulation)
  • Tubal damage --> IVF
  • Endometriosis/poor endometrial quality --> medically controlled ovarian hyperstimualtion + IUI
  • Coital issues (impotence) --> medical/surgical
  • Unexplained --> timed intercourse, lifestyle changes, controlled ovarian hyperstimulation, IUI, IVF

Investigations

  • Full Hx
  • Semen analysis
  • FSH levels
  • Chlamydia
  • USS
  • If known to have co-morbidties e.g. PID can be offered HSG (hysterosalpingography x-ray) to screen for tubal occlusion

2

Principles of ovulation induction, artificial reproduction, gamete donation, reproductive surgery

Ovulation induction -  Stimulation of ovulation by medication

Artificial reproduction - does what it says on the tin, examples include artificial insemination, IVF

Gamete donation - donation of egg or sperm to be used by someone else

Reproductive surgery - Surgical field examples include vasectomy, IVF

3

causes of infertility and what category they fall into

Ovulatory dysfunction (anovulation)

  • Menopause
  • Polycystic ovarian syndrome
  • Hyperprolactinaemia
  • Anorexia nervosa
  • Hypogonadotrophic hypogonadism
  • Congenital adrenal hyperplasia
  • Hypothyriodism

  • Cushings

Tubal damage

  • Pelvic surgery

  • Fibriods

Endometriosis/poor endometrial quality

  • Endometriosis
  • PID

Unexplained

4

Polycystic ovarian syndrome : definition, cause, diagnosis, DD, how it impact on fertility and treatment

Def: Elevated androgens (testosterone) in woman

Cause: Not known thought to be genetic and environmental. Obesity and lack of exercise are risk factors

DD: hypothyroidism, congenital adrenal hyperplasia , cushings, prolactinoma, androgen secreting tumour

Diagnosis: no ovulation, high androgen levels, and ovarian cysts (sx not cause)

Treatment and fertility: no cure for PCOS and causes anovluation,

Treatment of PCOS wgt loss, exercise, COC for sx, metformin and anti androgens

For fertility:  clomiphene, or metformin

 

5

How does hyperprolactinaemia impact on fertility and what are the most important causes

Hyperprolactinaemia inhibits the secretion of gonadotropin-releasing hormone (GnRH) by the hypothalalmus which in turn prevents the release of FSH and LH

 

Causes: tumours incl prolactinoma, hypothyriodism, antipsychotics, SSRIs, calcium channel blockers, TCA, 

6

Endocrine axis

A image thumb
7

what is Hypogonadotrophic hypogonadism, symptoms and causes

Also known gonadotrophin deficiency syndrome. It is a disorder characterised by ovary or teste (gonad) dysfunction due to insufficient LH and FSH and therefore ostrogen and testosterone

Sx: underdeveloped gonads (testicles and ovaries) include delayed, reduced, or absent puberty, low libido, and infertility.

Causes: 1ary (from birth) usually a genetic condition 2sry developing later usually a tumour

 

 

 

8

Congenital andrenal hyperplasia

Autosomal recessive disease affecting the synthesis (+ve or -ve) of sex steriods

9

what is over produced in cushings

cortisol

10

what is clomiphene

ostrogen and anti estrogen regulator used in the treatment of subfertility

11

12

What can metformin be used in to treat fertility

PCOS