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BRS > infertility > Flashcards

infertility Flashcards

1
Q

What is infertility defined as?

A

Disease of reproductive system with inability to have clinical pregnancy after at least 12 months of regular sex (every 2-3 days)

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2
Q

What is primary and secondary infertility?

A

Primary - no live births. Secondary - live birth more than 12 months ago

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3
Q

What are the different types of infertility?

A

Female factor, male factor, combination.

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4
Q

What are the costs of infertility to society and the couple?

A

Psychoglocial distress and less tax revenue as less children

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5
Q

How does the HPG axis work?

A

Kisspeptin neurones bind on kisspeptin receptors on GnRH neurones, GnRH travels to anterior pituitary where gonadotrophs make LH and FSH and go into systemic circulation to ovaries/testes to make oestrogen progesterone testosterone etc

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6
Q

How is male inferitlity causes divided?

A

Pre-testicular, testicular, post-testicular

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7
Q

What are causes of pre-testicular male infertility?

A

Klinefelters syndrome XXY, Y chromosome deletion

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8
Q

What are causes of testicular infertity?

A

Radiation/infection/trauma, cryptorchidism, varicocele (enlargement of testicular veins) , smoking drugs surgery

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9
Q

What are causes of post-testicular infertility?

A

Erectile dysfunction - psychological, high PRL, retrograde ejaculation, mechanical, absence of vas deferens, obstructive azoospermia (absence of spermatozoa in ejaculate)

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10
Q

What is cryptorchidism?

A

Undescended testes through inguinal canal (remain in inguinal canal

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11
Q

What is klinefelter syndrome? What are the symptoms? blood test?

A

XXY - have extra X chromosome, present with infertility, low testosterone high LH/FSH, female features (breast developed, wide hips), small penis, female pubic hair pattern, tall stature, decreased facial hair, narrow shoulders, reduced chest hair.
-hypergonadotrophic hypogonadism (low T, high LH/FSH)

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12
Q

In endocrine male infertility, where can the defects occurs?

A

Hypothalamus, pituitary, gonads

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13
Q

What defects in hypothalamus would cause infertility? What would blood tests show?

A

Congenital hypogonadotrophic hypogonadism - low GnRH - low LH/FSH - low testosteorne (eg. Kallman’s syndrome (anosmic) or normosmic). 2. aquired hypogonadotrophic hypogonadism - low BMI, stress, excess exercise

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14
Q

What defects in pituitary would cause inferrility + blood test?

A

Hyperprolactinaemia, tumours, apoplexy, radiation

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15
Q

What defect in gonads causes infertility + blood test?

A

Congenital primary hypogonadism - klinefelters XXY - low T high LH/FSH. Acquired primary hypogonadism - trauma, cancer, radiation, cryptorochidism

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16
Q

What other endocrine causes of male infertility?

A

High prolactin, hyperthyroidism/hypo (decreases bioavailable testosterone), androgen receptor deficiency

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17
Q

What history should be taken for male infertility?

A

Age of puberty, symptoms, previous children, duration surgical history, family history, medical history, drugs

18
Q

What examination should be performed for male inferitlity?

A

BMI, sexual characteristics, epidydimis hardness, testicular volume, vas deferens prescence, anosmia, endocrine signs

19
Q

What are the main investigations sthat should be done for male infertility? What blood tests should be done? What microbiological investigations? What imaging?

A

Sperm analysis - motility 40% etc. bloods –> morning fasting testosterone, LH, PRL, T sex hormone binding globulin SHBG, abulim/iron, pituitary/.thyroid, karyotyping

20
Q

What treatments for male inferitility?

A

For fertility - gonadotrophin inections. For symptoms - testosterone. Surgery. Dopamine agonists (cabergoline) for hyperprolactinaemia

21
Q

How does hyperprolactinaemia cause infertility and how does it present? Treatment?

A

High prolactin binds to prolactin receptoprs on kisspeptin neurones inhibiting kisspeptin release and therefore downward GnRH hormones and pulsatility turned off.

22
Q

What are sex chromosome disorders in men and women?

A

Klinefelters XXY men, fragile X syndrome (both), turners syndrome (X0), triple x syndrome XXX

23
Q

What are causes of female infertility divided in?

A

pelvic, tubal, ovarian, uterine, cervical

24
Q

What are pelvic causes of female infertiltiy?

A

Endometriosis, adhesions

25
Q

What are tubal causes of infertility?

A

Tubopathy due to infection, endometriosis, , trauma

26
Q

What are ovarian causes ?

A

Endometriosis (anovulation), corpus luteum insufficinecy

27
Q

What are uterine causes of infertility?

A

Fibroids, adhesions, unfavouralbe endometrium due to chronic endometritis

28
Q

What are cervical causes of infertility?

A

Chronic cervicitis, anti-sperm antibodies

29
Q

What is endometriosis? Symptoms? Treatments?

A

Growth of endometrial tissue in places other than the uterus. Responds to oestrogen and bleeds same way as endometrial tissue. Causes menstrual pain, irregularities deep dyspareunia, infertility. Treatments - birth control OCP, laparoscopic ablation, hysterectomy, salpingo-ooperectomy

30
Q

What are fibroids? Symptoms? Treatments?

A

Benign tumorus of the myometrium. Risk increases with age. Usually asymptomatic but respopnd to oestrogen. Can cause menstrual pain & irregularities & deep dyspareunia. Treated with OCP, progesterone, continuous GnRH, hysterectomy

31
Q

What is menarche usually? Primary amenorrhea? Secondary? A-menorrhea? Olig-menorrhea?

A

28 days +/-2 . Primary ammenorrhea no period before 16 yrs. Seoncdary used to have period but stopped for at least 3-6 months. Amenorrhea - no period for at least 3-6 months or less than 3 a year. Oligomennorhea - less periods

32
Q

What is early menopause (premature ovarian insuffiency POI)? Symptoms? How is it diagnosed? Wat are causes?

A

Same symptoms as normal menopause - but earlier. Diangosis is high FSH > 25 on 2 occatsions at least 4 weeks apart. Causes - autoimmune, fragile X, turners, cancer (radiotherapy, chemo) high FSH, low oestrgoen

33
Q

How is PCOS diagnosed? Which is the worst metabolic combination and why?

A

Rotterdam PCOS criteria - need 2/3 of the following - polycystic morhpology on ultrasound, hyperandrogenism clicnial +/- biochemical (clinical - hirsutism, acne, alopecia), oligo or anovulation. Worst metbaolic is hyperandrogenism + anovulation because it slows metabolism.

34
Q

What is treatment for each problem of PCOS?

A

nfertility - IVF, clopmihene, letrozole. Insulin resistance liofestyle change + metformin. Hyperandrogenism - spironolactone (anti androgen) + creams/waxing. Periods - OCP. Progesterone courses for increased endometrial cancer risk

35
Q

What is turner’s syndrome? Symptoms? Blood tests?

A

X0 - loss of one X chrnomosome. Short stature, shield chest, wide nipples, amenorrhea, elbow deformitiy, webbed neck, poor breast development, coarctation of aorta, low hairline, short 4th metacarpal, small fingernails, brown nevi, underdeveloped reproductive tract (low E but high LH/FSH) - hypergonadotrophic hypergonadism

36
Q

What history should be taken for women? What is additional to men?

A

Menstrual hisotry, previous pregnancies, dymptoms, breastfeeding

37
Q

Why foll-phase 17-OHP blood test?

A

congenital adrenal hyperplasia

38
Q

Why mid-luteal progesterone?

A

Successful ovulation if detected

39
Q

Main investigations? What imaging for female infertility?

A

Bloods, oestradiol, androgens, foll phase 17-OHP, mid-luteal progesterone as well. Additional pregnancy test. Imaging transvaginal ultrasound, hysterosalpingogram, MRI pituitary

40
Q

what is kallmans syndrome? blood tests? features?

A

failure of GnRH neurones to migrate with olfactory fibres via olfactory placode into hypothalamus during embyrological development

  • low GnRH, low LH/FSH, low T –> hypogonadrotrophic hypogonadism
  • anosmia, cryptorchidism, failure of puberty, lack of testicle development, micropenis, primary amenorrhea, infertility

BRS (81 decks)

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