Flashcards in Management of Infertility Deck (93)
What is the first step to managing a couple with infertility?
Support and reassurance
Why is support important in infertility?
Can be a very difficult time with external pressure and internal emotions
Do most cases of infertility require intervention?
Why is continuous reassurance important in infertility?
Couples often conceive whilst being investigated and stress can impact relationship
What external support may be helpful for couples with infertility?
- Support groups
What general advice can be given to couples with fertility problems?
- Folic acid
- Frequency of sexual intercourse
What information should women with fertility issues be told regarding folic acid?
They should take 0.4mg/day before conception and up to 12 weeks gestation
Why is folic acid supplementation advised?
To reduce the risk of neural tube defects
What frequency of sexual intercourse optimises chances of conception?
Every 2-3 days
How can alcohol affect fertility in men?
Can affect semen quality
How can alcohol affect fertility in woman?
Advised not to when trying to conceive as can harm any developing foetus
How can smoking affect fertility in men?
Can affect semen quality
What advice are women given about smoking when trying to conceive?
Smoking can harm any developing foetus
What advice are women given about their weight when trying to conceive?
Being BMI >30 or <19 may cause conception to take longer
How can a mans weight affect fertility?
Being over weight can reduce fertility
How are couples with infertility less than 18 months counselled?
By reassurance and lifestyle changes using a 'wait and see policy'
When is a 'wait and see' policy for infertility not recommended?
After 18 months and for women over 30
Why is a wait and see policy not recommended for women over 30?
Waiting may have a significant adverse impact on her lifetime chance of conception using IVF
Where should women over 30 with infertility be referred to?
Rapidly to a specialist infertility clinic that has access to a full range of assisted reproductive technologies
What reproductive technologies can be offered by specialist clinics?
- Intrauterine insemination
- Donor sperm and oocyte
How does management of ovulation disorders vary?
Depending on the group of ovulation disorder
What advice is given to women with Group I ovulation disorders to improve their chances of conception and uncomplicated pregnancy?
- Gain weight (if BMI <19)
- Moderate exercise (if undertaking high levels of exercise)
What treatment can be offered to women with Group I ovulation disorders?
Pulsatile administration of gonadotrophin releasing hormone or gonadotrophins with LH activity to induce ovulation
What treatment options are available for women with Group II ovulation disorders?
- Clomiphene citrate
- Laparoscopic Ovarian Diathermy
- FSH injections
When is clomiphene citrate the drug of choice for Group II ovulation disorders?
When there is stigmata of PCOS, normal FSH and prolactin levels
What % of subjects will clomiphene induce ovulation in?
What proportion of women who ovulate on clomiphene will be able to conceive?
How is clomiphene administered?
From day 2-6 of the cycle with an initial dose of 50mg/day increased to 100 and 150mg/day where necessary
How can ovulation be measured when using clomiphene?
Measuring day 21 progesterone levels