Reproductive System > Infertility > Flashcards

Infertility Flashcards

(52 cards)

Study These Flashcards
1
Q

What is the peak conception rate per cycle?

A

20%

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2
Q

How are conception rates affected by age?

A

Decline with age

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3
Q

What are the requirements for conception?

A
  • Ovulation
  • Sperm production
  • Fertilisation
  • Implantation
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4
Q

What is the hypothalamus-pituitary-gonadal axis?

A

The hypothalamic-pituitary-gonadal (HPG) axis coordinates a tightly regulated feedback loop that consists of gonadotropin-releasing hormone (GnRH) produced by the hypothalamus; follicle-stimulating hormone (FSH) and luteinising hormone (LH) from the anterior pituitary; and the sex steroids estradiol, progesterone, and testosterone
HYPOTHALAMO-PITUITARY-GONADAL AXIS

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5
Q

What happens to estradiol and progesterone levels before and after ovulation?

A

Before:
•Estradiol - sharp decrease (but on decrease at start of ovulation)
•Progesterone - increase
After:
•Estradiol - slow decrease then sharp increase
•Progesterone - sharp increase

OVULATION

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6
Q

What happens to FSH and LH levels before and after ovulation?

A

Before:
•FSH - increase
•LH - sharp increase

However, both on decrease at start of ovulation

After:
•FSH - decrease
•LH - decrease

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7
Q

What hormone is released by the ovaries during fertilisation?

A

Estrogen

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8
Q

What hormones are released by the ovaries during tubal transport and implantation?

A
  • Estrogen

* Progesterone

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9
Q

What does natural conception rely on?

A 
•Functioning hormonal axis and gonads
•Ovarian reserve
•Regular ovulation 
•Normal sperm production
•Fertilization
-egg and sperm interaction
-patent fallopian tubes
•Normal uterine cavity for implantation
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10
Q

What does natural conception rely on?

A 
•Functioning hormonal axis and gonads
•Ovarian reserve
•Regular ovulation 
•Normal sperm production
•Fertilization
-egg and sperm interaction
-patent fallopian tubes
•Normal uterine cavity for implantation
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11
Q

What are the lifestyle factors which affect fertility?

A
  • Age
  • BMI
  • Smoking
  • Alcohol
  • Recreational drug use
  • Stress
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12
Q

What are the lifestyle factors which affect fertility?

A
  • Age
  • BMI
  • Smoking
  • Alcohol
  • Recreational drug use
  • Stress
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13
Q

What is the WHO’s clinical definition of infertility?

A
  • Inability to conceive over a 12 month period despite exposure to regular, unprotected intercourse
  • Represents a prognosis based approach and provides practical guidance on when to initiate investigations
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14
Q

What is the WHO’s epidemiological definition of infertility?

A

Lack of conception after 2 years in women of reproductive age (15-49 years) who are at a risk of becoming pregnant (sexually active, not using contraception)

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15
Q

What is the WHO’s demographic definition of infertility?

A
  • An inability of those of reproductive age (15-49 years) to become or remain pregnant within five years of exposure to pregnancy
  • An inability to become pregnant with a live birth, within 5 years of exposure based upon a consistent union status, lack of contraceptive use, non-lactating and maintaining a desire for a child
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16
Q

What percentage of women globally are affected by infertility based on the demographic definition?

A

10% (likely to be higher)

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17
Q

What proportion of couple are affected by infertility?

A
  • 1 in 7 couples in the western world

* 1 in 4 couples in developing countries

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18
Q

When is it appropriate to refer a couple for infertility?

A
  • No conception after one year of regular unprotected intercourse
  • Referral earlier if:
  • Age>35 years
  • Known cause for infertility
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19
Q

What are the types of infertility?

A
  • Primary/Secondary

* Cause

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20
Q

What are the female factors for infertility?

A
  • Ovulatory dysfunction (35%)
  • Diminishing ovarian reserve
  • Endometriosis
  • Uterine factor - issue with uterus
  • Tubal factor - issue with fallopian tube
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21
Q

What are the male factors for infertility?

Study These Flashcards
A
  • Problems in producing hormones for sperm production
  • Blockage of sperm transport
  • Sperm production problems
  • Erection and ejaculation problems

MALE INFERTILITY

22
Q

What are the investigations used to see if eggs are available?

Study These Flashcards
A

•Age
•Ovarian reserve test - blood test and scan
•Blood test
-FSH, D1-D5 of cycle (<10 iu/L) - good
-AMH (5.0-25.0pmol/L)
•UltrasoundScan - Antral follicular count

23
Q

What are ovulation tests used by couples?

Study These Flashcards
A
  • Natural methods - BBT (basal body temperature), cervical mucus
  • LH ovulation kits (luteinizing hormone)
  • Ovulation calendar

CERVICAL MUCUS

24
Q

What is the ovulation test used by clinicians to investigate?

Study These Flashcards
A

D21 serum progesterone

25
What levels of progesterone give a diagnosis of ovulation?
* Progesterone levels taken at appropriate time - day 21 only if 28/30 day cycle * Levels > 20nmol/l show satisfactory ovulation
26
What are the requirements for the egg and sperm meeting?
* Intercourse | * Patent fallopian tubes
27
How is Fallopian tube patency checked?
* If no pelvic infection or gynaecological problem in past - Hysterosalpingogram(HSG) (dye and x-ray) * If any of above- Laparoscopic dye test
28
How else can the female reproductive organs be investigated?
Laparoscopy
29
What are other fertility tests?
* Serum prolactin - high prolactin/prolactinaemia * Thyroid function test * Chlamydia screening * Pelvic Ultrasound for uterine problems * Also check- Rubella immunity and cervical smear up to date
30
How may ovulation disorders be managed non-pharmacologically?
* Optimise body weight * Healthy lifestyle * Exercise
31
How may ovulation disorders be managed pharmacologically (ovulation induction)?
* Clomiphene citrate | * Gonadotrophins
32
How may ovulation disorders be managed surgically?
Laparoscopic ovarian drilling
33
How is a very low count or no sperm (azoospermia) managed?
* Medical treatments - gonadotrophins * Surgical sperm retrieval - epididymis/testis * Donor sperm - intrauterine insemination * ICSI (intracytoplasmic sperm injection) - IVF
34
How is a tubal problem managed?
* Role of surgery limited to mild tubal disease | * IVF
35
How is endometriosis managed?
Ablation or resection of spots •Adhesiolysis •Cystectomy for endometrioma
36
How may a uterine disorder be managed?
* Removal polyp/fibroid | * Adhesiolysis for synechiae
37
How is unsolved infertility managed?
IVF
38
What does the Human Fertilisation & Embryology Authority (HFEA) do?
* Regulatory authority * Licensing * Inspections * Forms - registration, treatment, outcome * Register
39
What do an egg and sperm form together?
An embryo
40
How are a patients own eggs gathered for IVF?
Gonadotrophin induced superovulation
41
Why might donor eggs be used?
* Age (poor ovarian reserve) * Poor quality * Ovarian failure * Genetic cause
42
How are a patients own sperm gathered for IVF?
* Fresh sample on day of egg collection | * Frozen sample (thawed) from surgical retrieval or fertility preservation
43
Why might donor sperm be used?
* Single woman * Same sex relationship * Azoospermia * Genetic cause * Infection - HIV, Hep B, Hep C
44
What are the key steps in IVF?
* Controlled ovarian stimulation * Follicular monitoring * Timing ovulation * Egg collection * Lab fertilization - Insemination/ICSI * Incubation/embryo development * Embryo transfer * Progesterone support
45
What is Intracytoplasmic Sperm Injection (ICSI)?
Injection of egg with single sperm
46
How are the embryos transferred to the uterus?
Embryos pre-loaded in fine tube of embryo transfer catheter
47
How long are the embryos incubated for?
3-5 days
48
How are embryos freezes and stored?
Each embryo stored in labelled/colour coded "straw"
49
What is the process after the embryo transfer?
* Progesterone pessaries * Normal activity * Pregnancy test after 2 weeks * If positive - scan at 7 weeks
50
What are the risks of IVF?
* Ovarian hyperstimulation syndrome (OHSS) * Multiple pregnancy * Medication side effects * Procedure related
51
What are the longterm effects of IVF?
* Children born- no difference as per short term data. * Risk of ovarian cancer not confirmed * Absolute risk to women and children low
52
What are some other reasons for using IVF?
* Donor gametes * Fertility preservation - gamete/embryo cryopreservation * Ovarian tissue cryopreservation * Preimplantation genetic diagnosis * Assisted hatching * In vitro maturation * Surrogacy
Reproductive System
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