investigating infertile couple reproduction block 1 lecture dr. usman ghani
TRANSCRIPT
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Investigating infertile couple
Reproduction Block1 Lecture
Dr. Usman Ghani
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Overview• Infertility / subfertility• Clinical history and physical examination• Causes and endocrine investigations of
subfertility in men and women• Conclusions
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Infertility / subfertility
• Failure of a couple to conceive after one year of regular, unprotected intercourse
• A number of investigations for the diagnosis of infertility exists
• But there is no agreement on which tests are essential before reaching the exact diagnosis
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Clinical history
• Previous pregnancies
• Use of contraceptives
• Serious illness• Chemo /
radiotherapy
• Congenital abnormalities
• Drug usage• Sexually
transmitted disease• Frequency of
intercourse
Information on clinical historyof the patient should include:
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Physical examination
Information on physical examination should include:
• Hypothalamo-pituitary, thyroid disorders
• Cushing’s syndrome• Galactorrhea• Hirsutism
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In the male:– Semen analysis (volume, sperm density,
motility, presence of abnormal spermatozoa)–Hormone dysfunction is a very rare cause
of infertility in menIn the female:– Endocrine abnormalities are common
• In some couples no cause can be detected
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Endocrine investigationsin the subfertile women
• Investigations depend on the phase of the menstrual cycle
• Presence of ovulation is confirmed by measuring progesterone levels at day 21>30 nmol/L (indicates ovulation)<10 nmol/L (no ovulation)
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Endocrine investigationsin the subfertile women
• Endocrine investigation is of diagnostic value for women who have:– Irregular or no menstruation–No ovulation
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Causes of subfertility in women• Endocrine causes are more common in
women• Excessive androgen secretion by
ovaries due to:–Obesity and Insulin resistance
• Primary ovarian failure caused by elevated gonadotrophins and low estradiol levels (post-menopausal pattern)–Hormone replacement therapy
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Causes of subfertility in women
Hyperprolactinemia• Prolactin is a hormone secreted by
anterior pituitary gland• Acts directly on the mammary glands
to control lactation• Gonadal function is reduced by
elevated levels of prolactin• Can cause infertility in both sexes
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Causes of subfertility in women
• Causes amenorrhea and galactorrhea in women
• No early signs are present in men• Causes of hyperprolactinemia:– Stress–Drug usage–Acute seizures–Pituitary disease
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Causes of subfertility in women
Cushing’s syndrome• Overproduction of cortisol by the
adrenal cortex• Prolonged exposure of body tissues
to cortisol or other glucocorticoids• Causes infertility in women due to:– Increased production of androgens and
hirsutism
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• Eugonadal men with normal sperm analysis do not require endocrine investigations
• In hypogonadal men, testosterone and gonadotrophins should be measured
Endocrine investigationsin the subfertile men
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Causes of subfertility in men• Primary testicular failure due to:–Damage in the testes– Low levels of testosterone
• Hypothalamic-pituitary disease:–Decreased testosterone with low
gonadotrophins– Suggests hypogonadotrophic
hypogonadism
• Hyperprolactinemia (a rare cause)
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Conclusions
• Endocrine abnormalities are a common cause of subfertility in women but are rare in men
• Hyperprolactinemia is a common cause of subfertility in women
• Serum FSH level of >25 U/L indicates primary gonadal failure in both men and women