Infertility + Management

what is a miscarriage/spontaneous abortion

lose the baby before 20 weeks gestation

what is a stillbirth

losing the baby after 20 weeks gestation

what is the most common cause of having a stillbirth

congenital anomaly

what is an ectopic pregnancy

blastocyst implants outside of endometrium of uterine cavity

where does an ectopic pregnancy usually occur

fallopian tubes

what is primary infertility

failure to get pregnant after 12 months of regular unprotected intercourse

what is secondary infertility

failure to achieve a second pregnancy after a couple has already had a pregnancy or a child

List some causes of infertility

ovulation disorders, block/damaged fallopian tubes, endometriosis, fibroids, PMOS, cervical problems

how do ovulation disorders cause infertility

decreased ability to release a viable egg for fertilisation, can be due to hormone deficiency = damage to ovaries, infrequent periods, absence of periods

how can blocked/damaged fallopian tubes lead to infertility

Limited egg flow and sperm access. Damage can be due to previous surgery- results in scar tissue deposits or can be caused by PID due to STI’s which can damage tubes. Mx via HSG (hysterosalpingogram) to visualise

how can endometriosis lead to infertility

development of scar tissue in uterus = impair embryo attachment

how can fibroids lead to infertility

benign growth of tissue in uterus that don’t go away and affect implantation success

how can PMOS lead to infertility

follicles are not mature

List some causes of MALE infertility

Impairment or failure of spermatogenesis (60%), Obstruction to the vas deferens (30%), Testosterone production, Obesity can induce hormone dysregulation = impact on sperm quality/ induce libido

List some lifestyle factors that will need to be adjusted to ensure best chances of pregnancy

Stop smoking, Excessive alcohol can be damaging to general health, recreational drugs can affect menstrual cycle and sperm count, reduction of caffeine intake to 1-2 standard cups daily, weight management- keep active, balanced diet

ectopic pregnancy and chromosomal abnormalities increase in women from the age of __

30

thaw cycles have ___ live birth rates than fresh cycles

higher- the body has more of a chance to recover after the IVF cycle

how can we track fertility

cycle tracking, basal body temperature, changes in cervical mucus, ovulation kits

are ovulation kits handy for PMOS

No

What are some examples of ovulation induction

COC, Metformin in PMOS, Letrozole, Clomifene (all oral) or injection of GnRH agonists/ antagonists

How does the COC help with ovulation induction

use it before someone wants to get pregnant for assistance with menstrual cycle regulation for adequate tracking

what is clomifene known as

oestrogen receptor antagonist

how does clomifene work

1. binds to estrogen receptors at hypothalamus

2. hypothalamus detects decreased estrogen levels

3. hypothalamus releases GnRH

4. GnRH stimulates pituitary gland to release LH + FSH

5. leads to development and release of follicles + mature egg

clomifene is unlikely to be successful after _ cycles

6

patients more likely to be UNRESPONSIVE to clomifene include

increased age, extremes of body weight, PMOS, after 6 cycles of tx

what is letrozole classified as

aromatase inhibitor

how does letrozole work

circulating androgens are converted to estrogen hormones. letrozole inhibits aromatase enzymes = reduction in production of estrogen. Hypothalamus detects decreased estrogen + releases GnRH. GnRH stimulates pituitary gland to release FSH + LH = development of follicles and mature egg

letrozole and clomifene are both ___ therapies

timed intercourse / IUI

what are some examples of subcutaneous ovulation induction

follitropin (FSH), Lutropin (recomb LH), Choriogonadotrophin alfa (recomb HCG)

What does IUI stand for

Intrauterine Insemination

When would you use IVF

• Endometriosis unresponsive to hormonal therapy

• Tubal damage

• Infertility for more than 12 months

• Male infertility

• Unexplained infertility

what medications are used in Ovarian hyperstimulation - given on what days

FSH, LH, combo, GnRH agonists/ antagonists - to prevent premature release of developing follicles. given on 2-14 days of cycle

How do GnRH agonists/antagonists work in IVF

• Suppress pituitary gland from releasing premature LH and prevent premature release of developing follicles

do we prefer GnRH agonists or antagonists in IVF

antagonists

what are some examples of GnRH agonists + antagonists

agonists = nafarelin, triptorelin. antagonists = cetrorelix, ganirelix

what medication is known as the ovulation trigger, when is it given? does timing matter?

rHCG. Timing is crucial! given 36 hours prior to egg retrieval- stimulates late follicular maturation and initiates rupture of the pre-ovulatory ovarian follicle of eggs

How is ICSI different to IVF

directly places the sperm into the egg. used when sperm has difficulty penetrating egg wall. embryos monitored for 5 days then transferred

what is progesterones role in support after implantation of embryo, when is it commenced, what form of the drug is to be used

helps to thicken the endometrium and support embryo development. commenced after egg collection if embryo transfer anticipated. form is a pessary, which can be given rectally OR vaginal gel OR injection (not PBS)

is emotional support important in IVF?

yes

can you use 100mg aspirin daily in pregnancy?

yes- lowers the risk of pre-eclampsia

vegemite on toast?

sure