Causes of Infertility Flashcards Preview

B - Gynaecology > Causes of Infertility > Flashcards

Flashcards in Causes of Infertility Deck (78)
1

What is infertility?

The inability to become pregnant after one year of intercourse without contraception involving a male and female partner

2

80% of couples will conceive in year if what criteria are met?

- woman is under 40
- Don't use contraception
- Have regular intercourse (every 2-3 days)

3

What is the cumulative pregnancy rate over 2 years with the same criteria?

90%

4

What happens with natural female fertility over time?

Declines with age

5

What are the 2 types of infertility?

- Primary
- Secondary

6

What is primary infertility?

When someone who has never had a child has difficulty conceiving

7

What is secondary infertility?

When someone who has had 1 or more pregnancies has difficulty conceiving

8

What are the broad causes of infertility?

- Ovulation disorders
- Tubal disease
- Uterine or cervical causes
- Coital dysfunction
- Male factor
- Unexplained infertility

9

What % of infertility cases are due to ovarian disorders?

25%

10

How many groups of ovulation disorders are there?

4

11

What are the 4 groups of ovulation disorders?

- Type I
- Type II
- Type III
- Type IV

12

What are Type I ovulation disorders also known as?

Hypothalamic-pituitary failure

13

Where are LH and FSH produced?

Anterior pituitary gland

14

What are FSH and LH responsible for?

Stimulating ovulation each month

15

What happens to LH, FSH and oestradiol in type I ovulation disorders?

Lowered

16

What can cause type I ovulation disorders

- Excess weight gain
- Very high or very low body weight
- Recent substantial weight gain

17

What can happen to menses as a result of type I ovulation disorders?

Absent or very infrequent

18

What is type II ovulation disorder also known as?

Hypothalamic-pituitary-ovarian dysfunction

19

What is the most common cause of type II ovulation disorders (and the majority of ovulation disorders)?

PCOS

20

What happens to levels of FSH in Type II ovulation disorders?

Normal

21

What happens to levels of LH in Type II ovulation disorders?

Normal or raised

22

What other hormones can be raised in Type II ovulation disorders?

- Serum anti-mullerian hormone
- Serum tesosterone
- Free androgen index

23

What are Type III ovulation disorders also known as?

Premature ovarian failure

24

What is premature ovarian failure?

Cessation of ovulation due to depletion of the ovarian follicle pool before 40

25

What happens to serum gonadotrophin levels in premature ovarian failure?

Greatly raised

26

What happens to levels of AMH in premature ovarian failure?

Low/undetectable

27

What happens to levels of Oestradiol in premature ovarian failure?

Low

28

What can cause premature ovarian failure?

- Autoimmune conditions
- Genetics
- Chemotherapy

29

What are Type IV ovarian disorders also known as?

Hyperprolactinaemia

30

What happens in Type IV ovarian disorders?

Pituitary gland produces too much prolactin leading to low oestrogen and may cause infertility

31

What is often the cause of hyperprolactinaemia?

Pituitary micoradenoma

32

What is an important cause of hyperprolactinaemia to rule out?

Space occupying macroadenoma

33

What is an iatrogenic cause of hyperprolactinaemia?

Medications e.g. antipsychotic drugs

34

What happens to prolactin levels in hyperprolactinaemia?

They go up obviously

35

What happens to levels of LH and FSH in hyperprolactinaemia?

Low/normal

36

What % of infertility cases are due to tubal disease?

20%

37

How do tubal disorders lead to infertility?

Damage or blocked tubes can keep the sperm from getting to the egg or block passage of the fertilised egg into the uterus

38

What are the potential causes of tubal disease?

- PID
- Previous surgery in abdomen or pelvis
- Pelvic tuberculosis

39

Give an example of previous pelvic or abdominal surgery that can cause infertility?

Surgery for ectopic pregnancy

40

What % of cases of infertility are caused by uterine or cervical causes?

10%

41

How can uterine and cervical disorders lead to infertility?

- Interfere with implantation
- Increase risk of miscarriage

42

What are some uterine disorders that can cause infertility?

- Benign polyps or tumours
- Endometriosis
- Uterine abnormalities present from birth

43

What congenital uterine abnormalities can cause infertility?

- Septum
- Bicornuate uterus

44

How do benign polyps or tumours of the uterus lead to infertility?

Can block fallopian tubes or interfere with implantation

45

What are some possible cervical causes of infertility?

- Cervical stenosis
- Sub-optimal mucus being produced

46

What can cause cervical stenosis?

- Inherited malformation
- Damage to the cervix

47

What sort of mucus is normally produced by endocervical cells at ovulation?

Clear, watery mucus with a high water content and specialised glycoprotein molecules

48

What does the mucus produced at ovulation normally facilitate?

Passage of sperm into the uterine cavity

49

What happens to the mucus after ovulation?

It becomes hostile to sperm under the influence of progesterone

50

What abnormalities of cervical mucus can lead to infertility?

- Cervical infection leading to altered mucus
- Antisperm antibodies in mucus

51

What problems with coitus can lead to infertility?

- Erectile dysfunction
- Premature ejaculation
- Painful intercourse
- Anatomical abnormalities e.g. hypospadias
- Psychological or relationship problems

52

What % of infertility cases are due to male factors?

30%

53

What are some male factors that can lead to infertility?

- Sperm/semen abnormalities
- Varicocele
- Infection
- Ejaculation issues
- Anti-sperm antibodies
- Tumours
- Chemo/radiotherapy
- Undescended testes
- Hormone imbalances
- Defects in tubules
- Genetic defects
- Coeliac disease
- Medications
- Previous surgery
- Environmental causes
- Health and lifestyle

54

What is a varicocele?

A swelling of the veins that drain the testicle

55

How do varicoceles cause infertility?

Unknown - possibly related to temperature regulation

56

What happens to sperm due to a varicocele?

Reduced quality

57

How common is varicocele as a cause of infertility?

Most common reversible cause of male infertility

58

What effects can infections have to lead to infertility?

- Interfere with sperm production
- Interfere with sperm health
- Block passage of sperm

59

What sorts of infections can lead to infertility?

- Epididymitis
- Orchitis
- Some STI's including gonorrhoea and HIV

60

What ejaculation issues can lead to infertility?

- Retrograde ejaculation
- Inability to ejaculate

61

What is retrograde ejaculation?

When semen enters the bladder during orgasm instead of emerging through the penis

62

What conditions can cause retrograde ejaculation?

- Diabetes
- Spinal injuries
- Medications
- Surgery of bladder, prostate or urethra

63

What can cause inability to ejaculate?

- Spinal cord injuries
- Certain diseases

64

What genetic conditions can lead to male factor infertility?

- Klinefelter's syndrome
- Cystic fibrosis
- Kallmann's syndrome
- Kartagener's syndrome

65

What is the genetic defect in Klinefelter's syndrome?

Male born with XXY karyotype

66

What happens as a result of the XXY karyotype in Klinefelter's?

Abnormal development of the male reproductive organs

67

What medications can lead to male factor infertility?

- Testosterone replacement
- Long-term anabolic steroid use
- Chemotherapy
- Certain anti-fungal medications
- Some ulcer drugs

68

What previous surgeries can lead to male factor infertility?

- Vasectomy
- Inguinal hernia repair
- Scrotal or testicular surgeries performed for testicular and rectal cancer

69

How can the environment lead to male factor infertility?

Exposure to certain elements can lead to reduced sperm production/function

70

What environmental factors can affect male fertility?

- Industrial chemicals
- Heavy metal exposure
- Radiation or x-rays
- Overheating the testicles

71

What lifestyle factors can affect fertility in men?

- Drug use
- Alcohol use
- Tobacco smoking
- Emotional stress/depression
- Obesity

72

What recreational drugs can lead to male infertility?

- Anabolic steroids
- Cocaine
- Marijuana

73

What effect do anabolic steroids have on male fertility?

Can cause testicular shrinkage and sperm production to decrease

74

How can cocaine or marijuana affect male fertility?

Temporarily reduce the number and quality of sperm

75

How can alcohol use lead to male infertility?

- Lower testosterone levels
- Can cause ED
- Decreased sperm production
- Can cause liver disease which can cause further fertility issues

76

What effect does tobacco smoking have on male fertility?

Lowers sperm count

77

What % of cases of infertility have no explanation?

25%

78

What is the likely reason for an unexplainable cause of infertility?

Combination of several minor factors in both partners