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Infertility PowerPoint Presentation

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Description : Check out this medical PowerPoint presentation titled "Infertility"by Penne Mott.

This medical PowerPoint presentation talks about infertility, a condition in which a couple is unable to conceive a child despite having regular, unprotected sexual intercourse for a year or more. Infertility can be caused by a variety of factors, including physical problems with the reproductive organs, hormonal imbalances, or certain medical conditions.

There are two types of infertility: primary infertility, which refers to couples who have never been able to conceive a child, and secondary infertility, which refers to couples who have previously conceived a child but are now unable to do so.

There are a variety of treatments available for infertility, depending on the underlying cause. These may include medications to stimulate ovulation, surgical procedures to correct physical problems with the reproductive organs, or assisted reproductive technologies such as in vitro fertilization (IVF). Additionally, lifestyle changes such as maintaining a healthy weight, avoiding smoking and excessive alcohol consumption, and reducing stress can also improve fertility. Its important for couples struggling with infertility to seek medical evaluation and treatment from a qualified healthcare provider.

Tags : male infertility, female infertility, Infertility, female reproductive systems, male reproductive systems, Fertility drugs, Intrauterine insemination, In vitro fertilization, IVF, Intracytoplasmic sperm injection, ICSI, Surgery, Donor eggs or sperm, Gestational carrier

Published on : Apr 18, 2023 | Views : 1685 | Downloads : 10

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Slide 1-

INFERTILITY Assessment and treatment of patients with fertility problems Dr Nitu Raje-Ghatge
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Why learn about it? Its in the curriculum ! Infertility – primary/ secondary Investigations eg hormone tests Knowledge of subfertility secondary care investigations Primary care management Knowledge of specialist treatments and surgical procedures
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Why learn about it.. Expectations from secondary care services! Inappropriate timing of referrals (early/late) Incomplete /inadequate investigations
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What is infertility? NICE: Failure to conceive after regular UPSI for 2 years in the absence of reproductive pathology. P.S NICE suggests offer clinical investigations if failure to conceive after 1 year of UPSI. GP NOTEBOOK: Infertility is the failure of conception in a couple having regular, unprotected coitus for 1 year, provided that normal intercourse is occurring not less than twice weekly.
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Natural conception rates: 80% of couples will be pregnant after 12 cycles. 50% of remaining will conceive during a 2nd year ( hence cumulative rate 90%) 50% in the following 4 years.
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PRIMARY/SECONDARY INFERTILITY PRIMARY – Couple without a prior pregnancy SECONDARY – Couple with previous pregnancy including miscarriage/ectopic.
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Etiology: Male factors Female factors Unexplained -20% Mixed – 15%
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Male Account for 25% Hypogonadotrophic hypogonadism Obstructive azoospermia Surgery Erectile dysfunction Anatomical - Hypospadias - Undescended/ maldescended testis
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Female Peritoneal factors 40%, - Endometriosis. Tubal blockage 20%.
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Etiology (female) Ovulatory dysfunction 15-20% - Hypothalamic/hypogonadotrophic hypogonadism - Hypothalamic pituitary dysfunction (PCOS) - Ovarian failure Uterine cavity abnormalities - Asherman's syndrome - Uterine fibroids. Cervical hostility 5-10%, - Infection - Female sperm antibodies.
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Fertility may be impaired in poorly controlled diabetes.
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History taking (female) Symptoms (past or present) - P I D / STD, - dysparenuria - galactorrhoea, - thyroid symptoms Obstetric history
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History taking (female) Menstrual history - irregularities Surgical history – D & C, abdominal/pelvic surgery Contraception - IUCDs Cervical smear
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History taking (male) Symptoms h/o genital tract infection e.g. mumps orchitis, prostatitis Surgical history - Hernia repair - Testicular surgery for torsion/ undescended /maldescended testis - Prostate surgery
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History taking (male) Trauma to the male genital or inguinal region Occupational history - exposure to lead, cadmium Drug history - Sulphasalazine – impairs spermatogenesis - Phenothiazines/ typical antipsychotics/ metoclopramide increase prolactin levels - Immunosuppresants
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IN BOTH Smoking Alcohol intake Psychological factors
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EXAMINATION General health and nutritional status BMI <19 (F) > 29.(M/F) SSC
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Female: Hirsuitism, galactorrhoea Bimanual examination - adnexal masses (tubo/ovarian, ovarian cyst) - tenderness (PID/ endometriosis) - Uterine fibroids
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Male Hypospadias Size and consistency of each testicle and epididymis; Presence of varicocele or hernia; Size of prostate. Gynaecomastia
Slide 20-

Now what?? Investigate Or Refer
Slide 21-

Early referral if.. Female Age >35 years Amenorrhoea/ oligo menorrhoea PID Abnormal pelvic exam Male Undescended testes Previous genital pathology Previous urogenital surgery In Both Prior treatment for cancer HIV, Hep B, Hep C
Slide 22-

Investigations Primary care Female Assess ovulation. Other hormonal tests Tests for PID Male Sperm analysis Secondary care Tubal patency Uterine abnormality
Slide 23-

Assessing ovulation Do if regular cycles with > 1 year of infertility irregular cycles 1) Serum progesterone 2) LH/FSH levels
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INVESTIGATIONS (Female) 1) Serum progesterone (mid luteal phase ie day 21 of 28 week cycle) Timing is important!!! Regular cycles - 7 days before next MP Irregular cycles - day 28/35 wk then weekly till menstruation occurs
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Interpretation of test
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Assessing ovulation 2) LH/FSH levels High levels – poor ovarian function High LH compared to FSH -PCOS
Slide 27-

Other hormonal tests E2, Testosterone levels – PCOS Prolactin ONLY if - ovulation problems - galactorrhoea, - pituitary problem.
Slide 28-

Other hormonal tests Thyroid tests - only with symptoms/ signs Other androgen profile (DHEAS, Androstenedione, SBHG) – as per etiology
Slide 29-

Tests for PID HVS Chlamydia screening
Slide 30-

Don’t forget!! Rubella status - check immunity - Vaccinate if non immune, avoid conception for 3 months
Slide 31-

Cervical hostility Post coital test - no longer recommended by NICE Mucus invasion test - doubtful significance
Slide 32-

Investigations (Male) Semen analysis Needs prior appointment with lab Abstinence for atleast 3 days Transport to lab in 30- 60 min Repeat abnormal test in next 3 months, earlier if gross abnormality
Slide 33-

Semen analysis- interpretation (WHO values) Volume 2 mls or more Sperm concentration - 20 million/ml Sperm morphology - atleast 30% normal Sperm number - 40 million/ ejaculate Sperm motility – 50% Vitality – 75% WBC - <1 million/ml Anti sperm antibody tests- not recommended by NICE
Slide 34-

Investigations in secondary care
Slide 35-

Tests for uterine/tubal problems HSG/hystero salpingo-contrast USG Laparoscopy + dye test Done only when ovulation tests/Sperm tests normal. Choice of tests depends upon co morbidities
Slide 36-

Management in primary care Principles of care Couple centred management Access to evidence based information Counselling (third person) Contact with fertility support groups Specialist teams
Slide 37-

Positive approach Reassure about cumulative pregnancy rates
Slide 38-

Management in primary care Lifestyle changes - Weight reduction, BMI 19-29 - Smoking cessation- offer support groups - Alcohol reduction <1-2 units/week for women <3-4 units/week for men - S I every 2-3 days - Information about OTC/ recreational drugs
Slide 39-

Management in primary care Pre conceptual advice - Folic acid supplementation - Rubella status - Cervical screening Management of erectile dysfunction - psychosexual couselling - drugs
Slide 40-

Management in secondary care Depends upon the etiology..
Slide 41-

Hypogonadotrophic hypogonadism Pulsatile GnRH Gonadotrophins with LH activity Bromocriptine ( for hyperprolactinaemia)
Slide 42-

Ovarian dysfunction ( hypothalamic dysfunction) 1) Anti- oestrogens eg Clomiphene/ Tamoxifen - 1st line - use for atleast 12 months if ovulating - initiated in secondary care - under USG guidance ( to adjust dose) - shared care when dose established - S/E risk of multiple pregnancy, OHSS
Slide 43-

Ovulatory dysfunction- treatment 2) Metformin - not licensed for ovulatory disorders in UK - used 2nd line with Clomiphene in - anovulatory women with PCOD + BMI >25 + no response to CC
Slide 44-

Others… 3) Gonadotrophins 4) Luteal phase support – - progesterone, - clomiphene 5) Laparoscopic ovarian drilling
Slide 45-

Peritoneal problems (endometriosis) Laparoscopic surgical ablation/ resection of endometriosis + adhesiolysis If ovarian endometriomas, laparoscopic cystectomy
Slide 46-

Uterine/ tubal factors Tubal factors: - Laparoscopic tubal surgery/ tubal microsurgery - Salpingography + tubal catheteristion - Hysteroscopic tubal cannulation Uterine factors - hysteroscopic adhesiolysis - myomectomy
Slide 47-

Assisted reproduction techniques Intra uterine insemination (IUI)
Slide 48-

In vitrio fertilisation Intracytoplasmic sperm injection (ICSI) Donor insemination Oocyte donation
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ACON at CRH Satellite IVF unit Counselling, monitoring and most of treatment , except egg retrieval and embryo transfer.
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Central unit Clarendon Wing, LGI SJUH, Leeds CARE, Manchester
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Questions…..zzzz??