Notes in OG9.5 Infertility Investigations and treatment

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Published	10/04/2024	Investigate infertility after {{c1::12 months }} of trying to conceive if the woman is < 35
Published	10/04/2024	Investigate infertility after {{c1::6 months }} of trying to conceive if the woman is > 35
Published	10/04/2024	Advise a woman undergoing investigations for infertility to drink less than {{c1::1 - 2}} units once or twice a week
Published	10/04/2024	Advise a male undergoing investigations for infertility to drink less than {{c1::3 - 4}} units/day
Published	10/04/2024	If abnormal semen analysis → {{c1::repeat in 3 months::next best step }}
Published	10/04/2024	Mild semen analysis abnormality is defined as → {{c1::2}} or more semen analyses have {{c1::1}} or more variables below the 5th centile…
Published	10/04/2024	Semen volume should be between {{c1::2-6::range}} mLs
Published	10/04/2024	Sperm concentration should be greater than {{c1::15}} million/mL
Published	10/04/2024	Total sperm number per ejaculate should be greater than {{c1::39}} million
Published	10/04/2024	Total sperm motility should be greater than {{c1::40%::%}} or {{c1::32% with progressive motility::%}}
Published	10/04/2024	Sperm morphology (percentage of normal forms) should be {{c1::4%::%}} or more
Published	10/04/2024	Azoospermia: {{c1::No sperm}}
Published	10/04/2024	Oligozoospermia: {{c1::Reduced sperm concentration}}
Published	10/04/2024	Asthenozoospermia: {{c1::Reduced sperm motility}}
Published	10/04/2024	Teratozoospermia: {{c1::Increased % of morphologically abnormal sperm}}
Published	10/04/2024	Hypospermia: {{c1::Reduced volume of ejaculate}}
Published	10/04/2024	In cases of severe oligospermia/azoospermia, {{c1::karyotype}}, {{c1::y chromosome microdeletion studies}}, {{c1::CF screen}}, and {{c1::hormone profi…
Published	10/04/2024	Indication for testicular biopsy in male infertility investigation{{c1::To indicate if any sperm are available for ICSI (Intracytoplasmic sperm inject…
Published	10/04/2024	Baseline investigation for female infertility:bloods{{c1::follicular phase hormone profile on day 3: FSH, LH, estradiol}}{{c1::Day 21 progesterone to …
Published	10/04/2024	Progesterone 7 days before period > {{c1::30 nmol/L::level}} indicates {{c2::ovulation::ovulation/anovulation}}
Published	10/04/2024	If no predisposing factors for tubal disease, offer {{c1::hysterosalpingogram }} or {{c1::HyCoSy }} as tests for tubal patency
Published	10/04/2024	If predisposing factors for tubal disease, offer {{c1::laparoscopy and dye::investigation}}
Published	10/04/2024	Recovery time after a laparoscopy and dye is {{c1::5 - 7 days }}
Published	10/04/2024	{{c2::Antimullerian hormone::hormone}} is done to test {{c1::ovarian reserve}}
Published	10/04/2024	{{c1::Antimullerian hormone::hormone}} is a predictor of likely ovarian response to gonadotrophin stimulation in IVF
Published	10/04/2024	BMI should be between {{c1::19 - 30 }} before commencing treatment for female infertility
Published	10/04/2024	To induce ovulation in hypothalamic pituitary failure (hypothalamic amenorrhoea or hypothalamic hypogonadism) → {{c1::pulsatile administration of…
Published	10/04/2024	For ovulation induction for class 2 anovulation, give:- {{c1::Clomifene::RX}}- {{c1::Metformin::RX}}- or both
Published	10/04/2024	Most common cause of anovulation is {{c1::hypothalamic-pituitary-ovarian dysfunction (primarily PCOS)}}
Published	10/04/2024	How does clomiphene work for ovulation?{{c1::Binds to estrogen receptors in the hypothalamus reducing the negative feedback effect of endogenous estro…
Published	10/04/2024	Clomiphene for ovulation induction should be taken on day {{c1::2 - 6 }} of the cycle
Published	10/04/2024	In the first cycle of clomiphene usage for ovulatory induction, monitor follicular development with {{c1::ultrasound }}
Published	10/04/2024	Clomiphene should not be used for more than {{c1::6::#}} cycles once responding, if used for ovulatory induction
Published	10/04/2024	Cumulative pregnancy rates for clomiphene is {{c1::40 }}% over 6 months
Published	10/04/2024	{{c1::Letrozole::RX}} is as effective as clomifene for ovulatory induction
Published	10/04/2024	Infertility treatment for class 2 anovulation (PCOS):- {{c1::ovulation induction with letrozole or clomiphene}}- {{c1::gonadotrophins or lap…
Published	10/04/2024	When giving recombinant FSH, ultrasound monitoring of follicular development is mandatory due to the risk of {{c1::multiple pregnancy }…
Published	10/04/2024	When giving recombinant FSH for anovulation, {{c1::hCG}} is given when the dominant follicle is > {{c2::17}}mm to trigger ovulation
Published	10/04/2024	Does GnRH have a role in treating hypothalamic-pituitary-ovarian dysfunction (primarily PCOS)?{{c1::No}}
Published	10/04/2024	Is there a risk of multiple pregnancy or ovarian hyperstimulation syndrome in ovarian drilling?{{c1::No::Yes/No}}
Published	10/04/2024	Ovarian drilling works best in women with {{c1::PCOS}} subtype with a normal BMI and hypersecrete {{c2::LH }}
Published	10/04/2024	Only option for group 3 anovulation (ovarian failure) is {{c1::IVF with donor oocytes}}
Published	10/04/2024	Options for patients with infertility due to tubal disease → {{c1::IVF }} or {{c1::Tubal surgery }}
Published	10/04/2024	Offer {{c1::salpingectomy}} or {{c1::tubal clipping }} for visible hydrosalpinx prior to IVF
Published	10/04/2024	Women with previous tubal surgery have a 10 fold ↑ risk of {{c1::ectopic pregnancy }}
Published	10/04/2024	{{c1::Distal::Proximal/Distal}} tubal disease is more common
Published	10/04/2024	Options for proximal tubal disease induced infertility:- {{c1::Selective salpingography plus tubal catheterisation/hysteroscopic tubal cannulatio…
Published	10/04/2024	Options for distal tubal disease induced infertility:- {{c1::Salpingostomy }}- {{c1::Neosalpingostomy }}- {{c1::Fimbrioplasty…
Published	10/04/2024	–Luminal adhesions –Large hydrosalpinx (>2cm.) –Thick-walled hydrosalpinx –Dual blockage (proximal and distal) –Loss of significant length of tubeT…
Published	10/04/2024	Treatment of endometriosis not involving the bowel, bladder or ureter.- {{c1::excision/ablation of endometriosis plus adhesiolysis}}
Published	10/04/2024	Treatment of endometriomas- {{c1::Laparoscopic ovarian cystectomy with excision of the cyst wall}}
Published	10/04/2024	Do not offer hormonal treatments for endometriosis if {{c1::trying to conceive }}
Published	10/04/2024	If a patient has intrauterine adhesions with amenorrhea, offer {{c1::hysteroscopic adhesiolysis }}
Published	10/04/2024	If a patient has infertility and intramural fibroids → {{c1::myomectomy }}
Published	10/04/2024	If mild male factor infertility, advise {{c1::trying to conceive for 2 years }} prior to IVF
Published	10/04/2024	{{c1::Intracytoplasmic sperm injection}} should be used if there are large numbers of abnormal or immotile sperm
Published	10/04/2024	Do not use {{c1::oral ovulation stimulants::RXs}} in unexplained infertility
Published	10/04/2024	Advise {{c1::trying to conceive for two years::tx}} before considering IVF in unexplained fertility
Published	10/04/2024	- Coital or ejaculatory disorders - Donor insemination - Same sex couples - Sperm washing needed - Cervical factor infertilityThes…
Published	10/04/2024	{{c1::Assisted reproductive technology (ART)}}: {{c2::all treatments or procedures that include the in vitro handling of both human oocytes and sperm,…
Published	10/04/2024	- Male factor intertility- Unexplained Infertility - Severe Endometriosis - Failed Ovulation Induction - Tubal disease- Egg donation- Pre-implantation…
Published	10/04/2024	The 5 steps of IVF are:1. {{c1::Ovarian stimulation}}2. {{c1::Oocyte retrieval }}3. {{c1::Insemination }}4. {{c1::Embryo…
Published	10/04/2024	Ovarian stimulation is done by {{c1::downregulating the pituitary with GnRH analogues}}, then giving {{c1::FSH to stimulate follicular recruitmen…
Published	10/04/2024	Oocyte retrieval is done by {{c1::passing a needle with ultrasound guidance through the lateral fornix of the vagina to aspirate follicles c…
Published	10/04/2024	Luteal phase support is done by giving {{c1::progesterone::hormone}} or {{c1::hCG::hormone}} for {{c1::15 days::duration}} to improve i…
Published	10/04/2024	•Severe deficits in semen quality •Obstructive azoospermia •Non-obstructive azoospermia. •Consider if a previous IVF treatment cycle has resulted in …
Published	10/04/2024	• where there is a high risk of transmitting a genetic disorder to the offspring • where there is a high risk of transmitting infectious disease to t…
Published	10/04/2024	•Premature ovarian failure •Gonadal dysgenesis (inc. Turner’s syndrome) •Bilateral oophorectomy •Ovarian failure following chemotherapy or radiotherap…
Published	10/04/2024	Ovarian hyperstimulation syndrome underlying pathology → {{c1::↑ vascular permeability leading to fluid shift from intravascular space to ex…
Published	10/04/2024	Ovarian hyperstimulation syndrome is precipitated by {{c1::hCG::hormone}}
Published	10/04/2024	Early ovarian hyperstimulation syndrome is < {{c1::10 days::duration}} since hCG administration
Published	10/04/2024	Late ovarian hyperstimulation syndrome is > {{c1::10 days::duration}} since hCG administration
Published	10/04/2024	Symptoms of ovarian hyperstimulation syndrome:- {{c1::Abdominal pain }}- {{c1::Abdominal bloating }}- {{c1::Nausea/vomiting&n…
Published	10/04/2024	Treatment of mild ovarian hyperstimulation syndrome{{c1::outpatient::setting}}symptomatic reliefmonitor {{c1::fluid intake, urine output}}observe for …
Published	10/04/2024	Prevent ovarian hyperstimulation syndrome by:- {{c1::Ultrasound monitoring of ovulation induction }}- {{c1::Discontinue IVF cycle if at…
Published	10/04/2024	In Europe, approximately {{c1::15}}% of couples have difficulty conceiving.
Published	10/04/2024	Management for minor abnormal sperm parameters{{c1::anti-oxidant vitamins::RX}}{{c1::intrauterine insemination::procedure}}
Published	10/04/2024	options for assisted reproduction{{c1::in vitro fertilization (IVF)}}{{c1::intra cytoplasmic sperm injection (ICSI)}}{{c1::donor oocytes}}{{c1::donor …
Published	10/04/2024	intrauterine insemination = {{c1::timed introduction of sperm into uterine cavity during natural ovulation or ovulation induction}}success rate in ach…
Published	10/04/2024	{{c1::Age}} is the most significant factor in determining success of IVFsuccess rate ~{{c1::50}}% if < 35 years and {{c1::20}}% at 40 years
Published	10/04/2024	Steps of intracytoplasmic sperm injection (ICSI){{c1::ovarian stimulation}}{{c1::oocyte collection}}{{c1::direct injection of single sperm into oocyte…
Published	10/04/2024	risk of multiple pregnancy with clomiphene = {{c1::8-10::range}}%risk of multiple pregnancy with gonadotrophins = {{c1::15-20::range}}%
Published	10/04/2024	Maximum of {{c1::2}} embryos can be transferred per cycle
Published	10/04/2024	risk factors for ovarian hyperstimulation syndrome{{c1::low}} BMI{{c1::PCOS}}< {{c1::30}} yearshistory of {{c1::elevated response to gonadotrophins…
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Published	10/04/2024	Treatment of moderate to critical ovarian hyperstimulation syndrome{{c1::inpatient}}, potentially ICU-level careclose vitals monitoringmonitor {{c1::e…
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