ESA 4 - Reproductive System > Infertility > Flashcards

Infertility Flashcards

(49 cards)

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1
Q

What is infertility defined as?

A

The failure of contraception in a couple having regualr, unprotected coitus for one year

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2
Q

What % of couples will be pregnant after 12 cycles?

A

80%

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3
Q

What are the categories of infertility?

A
  • Primary
  • Secondary
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4
Q

What is primary infertility?

A

No previous pregnancy

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5
Q

What is secondary infertility?

A

Previous pregnancy, successful or not

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6
Q

What proportion of couples have difficulty conceiving?

A

Around 1 in 7

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7
Q

How many people in the UK have trouble conceiving?

A

3.5million

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8
Q

What should be included in a female infertility history?

A
  • Age
  • Duration of infertility
  • Information about menstrual cycle
  • Tubal or pelvic surgery
  • PID
    Menorrhagia
  • Pelvic pain
  • Sexual history
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9
Q

What information should be obtained about the menstural cycle in an infertility history?

A
  • Length of cycle
  • Predictability of cycle
  • Age of menarche
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10
Q

What is an important consistuent of the sexual history when taking a female infertility history?

A

Any infections?

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11
Q

What should be included in a male infertility history?

A
  • General health
  • Alcohol/smoking
  • Previous surgery to testes
  • Drug history
  • Previous infections
  • Sexual dysfunction
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12
Q

What should be included in infertility examination?

A
  • BMI
  • Signs of secondary sexual characteristics
  • Galactorrhoea
  • Pelvic examination - feel for structural abnormalities
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13
Q

When is a male infertility examination performed?

A

Do not usually perform a male examination in the absense of relevant history

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14
Q

What is looked for on a male infertility examination?

A

Testicular size and descent

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15
Q

What are the causes of infertility?

A
  • Male factors
  • Ovulatory disorders
  • Tubal damage
  • Uterine or peritoneal disease
  • Other factors, including unexplained infertility
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16
Q

What % of infertility is due to male factors?

A

30%

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17
Q

What male factors cause infertility?

A
  • Idiopathic oligospermia
  • Variococele
  • Abnormal sperm production
  • Hypothalamic/pituitary dysfunction
  • Ductal obstruction
  • Failure to deliver sperm to vagina
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18
Q

What may result in abnormal sperm production?

A

Testicular disease

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19
Q

What may cause ductal obstruction?

A
  • Post-infective epididymitis
  • Post-vasectomy
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20
Q

What may result in failure to deliver sperm to the vagina?

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A
  • Hypospadias
  • Impotence
21
Q

What % of infertility is caused by ovulatory disorders?

22
Q

What can ovulatory disorders be classified into?

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A
  • Group 1 - hypothalamic pituitary failure
  • Group 2 - hypothalamic-pituitary-ovarian dysfunction
  • Group 3 - ovarian failure
23
Q

What is polycystic ovarian syndrome?

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A

A syndrome consisting of polycystic ovaries and systemic features resulting from elevated androgens

24
Q

What causes polycystic ovary syndrome?

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A

Unknown pathophysiology, but appears to have genetic component

25
What does polycystic ovary syndrome result in?
* Increased androgen secretion * Raised LH/FSH ratio * Insulin resistance * Multiple small ovarian cysts * Anovulation
26
What is anovulation?
Amenorrhoea or oligomenorrhoea
27
What are the clinical features of polycystic ovary syndrome?
* Hirsuitism * Acne * Obesity * Male-pattern baldness * Oligomenorrhea * Psychological symptoms
28
What are the psychological symptoms of polycystic ovary syndrome?
* Mood swings * Depression * Anxiety
29
What is the Rotterdam Diagnostic Criteria for polycystic ovary syndrome?
2/3 of; * Polycystic ovaries (12 or more follicles on ultrasound * Oligo-ovulation or anovulation * Clinical and/or biochemical signs of hyperandrogenism * Exclusion of other causes of androgen excess
30
What % of infertility is due to tubal damage?
20%
31
What is tubal damage caused by?
* Past pelvic infection * Previous pregnancies * Pelvic surgery * Endometriosis * Mullerian developmental anomaly
32
What pelvic infection can cause tubal damage?
Chlamydia
33
What % of infertility is due to uterine or peritoneal disease?
\<10%
34
What uterine or peritoneal diseases can cause infertility?
* Endometriosis * Asherman's syndrome * Uterine fibroids * Cervical stenosis * Cervical hostility
35
What is endometriosis?
Presence of endometrial tissue in sites other than the uterine cavity
36
Where is endometriosis most common?
In the pelvic cavity
37
What are the clinical features of endometriosis?
* Dysmenorrhoea * Dyspaureunia * Chronic pelvic pain * Infertility
38
What is cervical hostility due to?
Infection or female sperm antibodies
39
What other factors can cause infertility?
* Unexplained * Poorly controlled diabetes * Coital problems
40
In what % of cases is infertility multifactoral?
5-10%
41
When should a women be referred for investigation into infertility?
* When she is of reproductive age and has not conceived after 1 year of unprotected vaginal sexual intercourse, in the absence of any known cause of infertility * When she is of reproductive age, and is using artifical insemination to conceive (with either partner or donor sperm), who has not conceived after 6 cycles of treatment, in the absence of any known cause of infertility
42
Who should recieve early infertility referral?
* Women \>36 years * Known clinical cause of infertility, or a history of predisposing factors for infertility
43
What investigations should be done in a female with infertility?
* Follicular phase LH, FSH (day 2) * Luteal phase progesterone (day 21) if ovulating regularly * Prolactin, androgens, TFTs * Cervical smear * Pelvic USS * Tests of tubal patency
44
What investigations should be done in a male with infertility?
* Sperm analysis * Antisperm antibodies * FSH/LH/testosterone * USS * Karytoype * Cystic fibrosis * Testicular biopsy
45
What are normal semen analysis results?
* Volume \>2ml * pH 7.2 – 7.8 * Sperm count \>20 million per ml * Motility \>50% * Morphology \>50% normal
46
What does management of infertility depend on?
Underlying cause
47
How is ovulation induced?
* Clomifene citrate * Gonadotrophins * GnRH agonists * Weight loss/weight gain * Dopamine agonists * Ovum donation
48
How is tubal occlusion treated?
* Tubal surgery (re-anastomosis) * Assisted conception
49
How are male factors treated in infertility?
* Artificial insemination by donor * Intracytoplasmic sperm injection * GnRH agonists * Dopamine agonists
ESA 4 - Reproductive System
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