Fertility Management - Module 4

Inability to conceive after 12 months of unprotected intercourse

Define infertility

6 months

However, infertility after the age of 35 is ______ months of unprotected intercourse

Postponement of pregnancy until later years

What is the #1 reason for infertility

Amount and quality of eggs significantly decreases as we age

Why is postponing pregnancy until later years a cause of infertility

40%

What % of infertility is due to the women

Ovarian, uterine, cervical

What are the 3 main categories/cause of infertility of in women

Primary and secondary

What are the 2 types of ovarian causes of infertility

Ovulatory dysfunction

What is primary ovarian infertility

PCOS

What is the #1 cause of primary ovarian infertility

Neoplasm of the ovary

What is another example of primary ovarian infertility

Inability to transport ova/embryo (blocked fallopian tubes)

What is secondary ovarian infertility

Previous ectopic in fallopian tube, PID, hydrosalpinx, endometriosis

What are some examples of secondary ovarian infertility

Congenital abnormalities, fibroids, Asherman's

What are some causes of uterine infertility

Septate uterus, uterine agensis

Name two uterine congenital abnormalities that causes infertility

Submucosal

What type of fibroids more commonly affect fertility

Scarring in uterine lining from surgeries, will result in lack of good vascular lining for egg to implant into

What is Asherman's and how does it lead to infertility

Immunologic causes

How can a women have cervical infertility

Women allergic to sperm or cervical mucous too thick for sperm to travel through

What are some examples of cervical causes of infertility

40%

What % of fertility issues are caused by the male

Varicocele, testicular, tubular obstruction

What are the 3 main causes/categories of infertility in men

Mumps, torsion, orchitis, testicular cancer, frequents marijuana use, cryptorchidism (undescended testes)

What are some causes of testicular failure

Since the testicles are in the body the temperature is too high for them to produce sperm

Why does cryptorchidism causes infertility

Vas deference not connecting to the testicles/sperm, so the sperm can't exit

Explain how a tubular obstruction can cause male infertility

Vasectomy or scarring/adhesions

What can cause a tubular obstruction

10%

What % of infertility cases are due to both partners being infertile

10%

What % of infertility cases are unexplained or idiopathic

Assisted Reproductive technology services

What does ART stand for

Ovulation induction, IUI, IVR, ICSI

What are the 4 types of ART

Intrauterine insemination

What does IUI stand for

In vitro fertilization

What does IVF stand for

Intracytoplasmic sperm insertion

What does ICSI stand for

Baseline infertility workups to determine the cause (lab work, ultrasound, testing gametes, etc)

How do they determine the right ART treatment for infertility

8-12

What day in the cycle is a dominant follicle detectable on ultrasound

20-24mm

How big does the dominant follicle get up to

LH surge

What triggers ovulation?

Corpus luteum

What results after the Graafian follicle ruptures

If it continues to hemorrhage within/or if pregnant

In what instance does the Graafian follicle continue to grow

Uterine endometrium

What also reflects hormonal changes

Ovulation impairment

What type of infertility is treated with ovulation induction

No Graafian follicle is produced, so need to stimulate this

Why does ovulation impairment need to be treated with ovulation inductions

Fertility drugs

What is used to ensure ovulation occurs with ovulation induction

Only one Graafian follicle

What is trying to be achieved with ovulation induction

Patent fallopian tubes

Ovulation induction is only suitable for women with:

Follicular monitoring

What is the main role of ultrasound in conjunction with ovulation induction

Daily for a few days prior to expected ovulation

When do we do routine pelvic ultrasound in conjunction with ovulation induction

3 dimensions of the 3 largest follicles on each ovary

What do we have to measure in a patient receiving ovulation induction

Pouch of Douglas

What location should we check for free fluid in a patient receiving ovulation induction treatment

Often get ff in the pouch of Douglas during/after ovulation

Why should we check to see if there is fluid in the pouch of Douglas

FALSE!!!!! Do not use these ever on a ART patient

T/F: you must make to use a lubricated condom and gel or KY jelly when assessing an ART patient with and EV transducer

Lubrication, gel, an KY jelly may contain spermicidal ingredients

Why can't you use any lubrication with an ART patient

No lubricated condoms or non latex probe covers

What CAN you use for the probe cover for an ART patient

Water

If you need lubrication for the EV probe cover, what can you use

Mmt planes used for follicular mmts

What does this image represent

Single Graafian follicle in ovary

What does this image show

3-D follicular tracking/mmts software

What does this image show

Only 3 largest in each ovary

Do we usually measure each follicle? Or how many follicles do we measure?

Concentrated, high-quality sperm are placed directly inside the uterus during ovulation

Define IUI (intrauterine insemination)

Washed sperm

What is another term for "high quality sperm"

Patent fallopian tubes and normal ovarian function

IUI is only suitable for women with:

Male infertility, idiopathic infertility, donor insemination, same sex couples, cervical causes of infertility (thick CX mucous or allergic to sperm)

Way at are some reasons for IUI/what infertility types receive IUI

Only really used for baseline scan

What role does ultrasound play in IUI

Fertilization in a glass or in lab, egg and sperm are taken outside of body and fertilized

What is in vitro fertilization

Blocked fallopian tubes, impaired eggs, impaired sperm, unexplained infertility

What are some reasons for IVF

True

T/F: ultrasound is highly involved in IVF processes and is used almost every step of the way

Initial lab and ultrasound investigations

What is the 1 step of IVF

Ovarian suppression (birth control pills to stop normal ovulatory cycle)

What is the 2nd step of IVF

Ovarian stimulation

What is the 3rd step of IVF

Gonadotropins are administered to hyper stimulate the ovaries

How does ovarian stimulation work

Multiple

How many eggs are produced with ovarian stimulation

Egg or oocyte retrieval

What is the 4th step of IVF

Insemination

What is the 5th step of IVF

Embryo transfer

What is the 6th step of IVF

FSH (follicle stimulating hormone)

What does ovarian reserve testing check

Number of eggs left or ovarian age

What does ovarian reserve testing provide an insight on

<10

FSH value of _______ indicates that eggs are present

No, can only count how many with ultrasound

Are we able to know the # of eggs a patient may have with ovarian reserve testing

Assess uterus, adnex, ovaries

What do we assess on ultrasound for IVF

Fibroids, polyps, congenital abnormalities

What are we looking for when assessing the uterus

Hydrosalpinx/any blockage

What are we looking for when assessing the adnexa

Cysts (PCOS), ovarian cysts, baseline natural follicle count

What are we assessing when looking at the ovary

Baseline antral follicle count

What does BAFC stand for

EV

What is the gold standard for doing BAFC

Number of small antral follicles observed at the beginning of the menstrual cycle

What is BAFC

<10

What BAFC value indicates poor ovarian response to fertility treatment

BAFC

What does this image represent

Hysterosalpingogram

What does HSG stand for

HSG

What is the gold standard for assessing the patency of the fallopian tubes

X-ray with dye or contrast injected into the uterus

What is a HSG

Uterine cavity for congenital abnormality and patency of fallopian tubes

What is assess with a HSG

Contrast spilling into the posterior cul de sac

What finding on a HSG indications at least one fallopian tube is patent

Sonohysterogram

What does SHG stand for

Ultrasound with saline injected into the uterus

What is a SHG

Uterine cavity and patency of fallopian tubes

What does SHG assess for

HSG

Is a HSG or SHG more reliable for assessing the patency of the fallopian tubes

Infection, fainting, and spotting

What are some complications associated with HSG and SHG

Radiation and iodine allergy

What are some complications associated with HSG only

Clamp holds onto uterus during the exam

Why may a patient get spotting after a HSG or SHG

GnRH agonist is given to stop natural ovulation cycle, patient is in a temporary state of menopause

Explain how ovarian suspension/downregulation works

Prevents premature ovulation and controls the timing of the IVF cycle

What is the purpose of ovarian suspension in IVF

Ensure there is no new finding such as an ovarian cyst

What is the purpose of ultrasound during ovarian suspension