How does fertility change with age?
Declines with age due to ovarian egg reserve declining
What are the different steps of conception?
- Ovulation
- Sperm production
- Fertilisation
- Implantation
Descibe the hypothalmo-pituitary gonadal axis?
Describe the ovulation cycle?
What are the two phases of the ovarian cycle?
Follicular phase
Luteal phase
Describe the hormonal control for male reproduction?
What does FSH act on in males and what effect does it have?
Spermatogonia in seminiferous tubules of testes, causing spermatogenesis
What does LH act on in males and what effect does it have?
Leydig or interstitial cells of testis, causing formation of androgens (testosterone)
Normal conception relies on?
- Functioning hormonal axis and gonads
- Ovarian reserve
- Regular ovulation
- Normal sperm production
- Fertilisation
- Egg and sperm interaction
- Patent fallopian tubes
- Normal uterine cavity for implantation
What lifestyle factors impact ferility?
- Age
- BMI
- Smoking
- Alcohol
- Recreational drug use
- Stress
What is inferility?
Infertility = inability to conceive over a 12 month period despite regular exposure to unprotected intercourse
Infertility is describe as being over what period?
12 months
Describe the epidemiology of inferility (% of woman affected and fraction of couples in Western world)?
- 10% of woman are effected
- 1/7 couples in western world are affected
When should people be referred for infertility clinic?
- No conception after one year of regular unprotected intercourse
- Refer earlier if
- Age > 35 years
- Known cause for infertility
Describe the aetiology of female inferility?
- Ovulatory dysfunction (most common)
- Diminishing ovarian reserve
- Endometriosis
- Uterine factor
- Tubal factor
Describe the aetiology of male infertility?
- Hormone problems
- Hormonal control
- Erection and ejaculation problems
- Prostate surgery
- Damage to nerves
- Ejaculation problems
- Timing of intercourse
- Medication
- Sperm production problems
- Genetic cause
- Failure of testes to descend
- Infections
- Torsion
- Varicocele
- Drugs
- Radiation damage
- Sperm antibodies
- Heat
- Blockage of sperm transport
- Infection
- Prostate related problems
- Absence of vas deferens
- Vasectomy
How is inferility investigated?
- Are eggs available
- Ovarian reserve test – blood test and scan
- Blood tests – FSH
- USS – antral follicular count
- D21 serum progesterone to check if ovulation is happening
- Levels > 20nmol/L show satisfactory ovulation
- Couples can use LH ovulation kits or ovulation calendar themselves
- Are sperm available
- Semen analysis
- Can they meet
- Intercourse
- Fallopian tubes
- Check patency with hysterosalpingogram (HSG) if no pelvic infection or gynaecological problems in the past, if there are use laparoscopic dye test
- Any other factor
- Serum production
- Thyroid function test
- Chlamydia screening
- Pelvic US for uterine problems
- Rubella immunity
- Cervical smear up to date
What is the normal lower limit for the following semen reference values: volume, total sperm number, concentration, vitality, progressive motility, total motility, normal morphology?
Volume - 1.5 million
Total sperm number - 39 million
Concentration - 15 million/ml
Vitality - 58%
Progressive motility - 32%
Total motility - 40%
Normal morphology - 4%
What things are looked at in semen analysis?
Volume - 1.5 million
Total sperm number - 39 million
Concentration - 15 million/ml
Vitality - 58%
Progressive motility - 32%
Total motility - 40%
Normal morphology - 4%
What investigations are done to see if eggs are available?
- Ovarian reserve test – blood test and scan
- Blood tests – FSH
- USS – antral follicular count
- D21 serum progesterone to check if ovulation is happening
- Levels > 20nmol/L show satisfactory ovulation
- Couples can use LH ovulation kits or ovulation calendar themselves
What investigations are done to see if egg and sperm can meet?
- Intercourse
- Fallopian tubes
- Check patency with hysterosalpingogram (HSG) if no pelvic infection or gynaecological problems in the past, if there are use laparoscopic dye test
What investigation is done to see if sperm is available?
Semen analysis
Describe the management for inferility?
- Egg
- Optimise BMI, healthy lifestyle, exercise – 1st line
- Medication (ovulation induction) – 2nd line
- Clomiphene citrate – 1st medication to give
- Gonadotrophins – 2nd medication to give
- Laparoscopic ovarian drilling – 3rd line
- Sperm – very low sperm count of no sperm (azoospermia)
- Medical treatments – gonadotrophins
- Surgical sperm retrieval – epididymis/testis
- Donor sperm – intrauterine insemination
- ICSI (intracytoplasmic sperm injection)
- Tubes
- Role of surgery limited to mild tubal disease
- IVF (in-vitro fertilisation)
- Others
- Endometriosis – ablation or resection of spots, adhesiolysis, cystectomy for endometrioma
- Uterine surgery – removal polyp/fibroid, adhesiolysis for synechiae
What is the management for unresolved inferility or unknown cause?
IVF treatment
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Female Reproductive Physiology38
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Male Reproductive Physiology22
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Antenatal Care and Screening27
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Contraception73
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Pharmacology in Pregnancy and Breast Feeding33
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Physiology in Pregnancy47
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Sexually Transmitted Infections - Introduction20
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Genital Symptoms43
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Common Pathologies of Pregnancy61
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Maternal and Perinatal Mortality23
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Infant Feeding22
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Normal Labour25
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Abnormal Labour51
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Obstetric Emergencies14
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Postnatal Care33
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Complications in Pregnancy 148
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Complications in Pregnancy 236
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Infections in Pregnancy42
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Multiple Gestation14
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Eclampsia13
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Antenatal Growth Chart7
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Infertility32
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Secondary Amenorrhoea and Menopause31
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Menstrual Disorders55
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Pelvic Organ Prolapse33
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Female Urinary Incontinence34
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Endometrial Carcinomas12
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Cervical Screening31
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Cervical Cancer13
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Ovarian Cancer21
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Vulval Cancer21
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Female Genital Mutation13
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Pathology of Breast Disease53
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Treatment of Breast Disease27
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STI's Self-Learning Guide17
