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Urogenital System > 14.Management and Treatment of the Infertile Couple > Flashcards

14.Management and Treatment of the Infertile Couple Flashcards

1
Q

What is the definition of Primary Infertility

A

The inability to conceive, despite regular unprotected sexual intercourse for 1 year

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2
Q

What is the definition of Secondary Infertility

A

The inability to conceive having had at least one pregnancy despite regular unprotected sexual intercourse for 1 year

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3
Q

What percentage of couples in any population, is infertile?

A

8-10%

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4
Q

What is the most common cause of infertility in women in sub-Saharan Africa?

A

Bilateral tubal occlusion

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5
Q

What is the most common cause of infertility in women in developed countries

A

No demonstrable cause

-Then ovulatory disorders

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6
Q

What percentage of infertile couples is caused by infertility in the female only in Sub-Saharan Africa

A

31%

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7
Q

What percentage of infertile couples is caused by infertility in the male only in Sub-Saharan Africa

A

22%

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8
Q

What percentage of infertile couples is caused by infertility in both partners in Sub-Saharan Africa

A

21%

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9
Q

What percentage of infertile couples is caused by infertility in the female only in developed countries

A

37%

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10
Q

What percentage of infertile couples is caused by infertility in the male only in developed countries

A

8%

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11
Q

What percentage of infertile couples is caused by infertility in both partners in developed countries

A

35%

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12
Q

What are the four steps in the clinical management of the infertile couple

A

History
Examination
Investigations
Treatment

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13
Q

What are five details taken when taking the history of the partners in an infertile couple

A

There is no substitute for a thorough history from both individuals
If they attend together, examine separately and ask about STI and undeclared pregnancies
Look for development of secondary sexual characteristics
Look for features of endocrine disorders
Examine the reproductive organs

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14
Q

When taking the he history of the ovarian cycle, list five aspects

A

Regular cycle?
Cervical mucous cascade
Moliminal(premenstrual) symptoms
Spasmodic dysmenorrhea

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15
Q

What is the examined when doing the Examination of the female half of the infertile couple

A 
BMI
Hair distribution 
Thyroid
Breasts
Vaginal/Pelvic Exam
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16
Q

In the examination for Hirsutism, which 11 sites are examined

A 
Upper lip
Chin
Chest
Upper back
Lower back
Upper abdomen 
Lower abdomen
Forearm 
Arms
Legs
Thighs
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17
Q

What is the grade scale for Hirsutism

A

A scale from 1 to 4, 1 being a few hairs and four being heavy hair growth

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18
Q

What is the purpose of the Hirsutism scoring system

A

It allows initial assessment and facilities comparison whilst on treatment

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19
Q

List six social issues that can be contributing factors to infertility

A 
Smoking
Alcohol
STI
Obesity
Occupation Exposure to heat 
Cell phones
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20
Q

To make a diagnosis at a PRIMARY care level, which 3 assessments/ tests are done

A

Test of ovulation
Tubal patency
Semen analysis

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21
Q

Which tests are performed at the SECONDARY and TERTIARY level when making a specific diagnose for infertility

A 
Trans vaginal ultrasound 
Laparoscopy 
Hysteroscopy
Endocrine anovulation work up
Chromosomes
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22
Q

List 4 tests of Ovulation

A

Mid - Luteal (Day21) Progesterone level
Urinary LH
Serial T/V Ultrasound follicle scan
Basal body temperature

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23
Q

To diagnose Tubal Patency which tests are done

A

Hysterosalpingogram HSG

Laparoscopy and dye insufflation

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24
Q

List four male factors for infertility

A

Azoospermia
Oligozoospermia
Asthenozoospermia
Teratozoospermia

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25
Q

Define teratospermia/teratozoospermia

A

Defined as abnormal sperm morphology (shape)

26
Q

Defined as abnormal sperm morphology (shape)

A

Teratozoospermia

27
Q

Define asthenozoospemia

A

Reduced sperm motility

28
Q

Reduced sperm motility

A

Asthenozoospermia

29
Q

Define Oligozoospermia

A

Low sperm count

30
Q

Low sperm count

A

Oligozoospermia

31
Q

How is the Semenanalysis collected at the HWFMU

A

By appointment
Abstain for 2 days after compulsory ejaculation
Masturbation collection in a private secluded room
24 hour test

32
Q 
Diagnose the cause of infertility in this male:
Volume 3.5mls
Liquefaction: Complete
Viscosity: Normal
Sperm Count: 7M/ml
Motility: 72%
Progression 1.5
A

Oligospermic

Sperm Count is low (<20M/ml)

33
Q

What are three surgical processes for sperm removal

A

PESA: Percutaneous Epididymal Sperm Aspiration
TESA: Testicular Sperm Aspiration
TESE: Testicular Sperm Extraction

34
Q

List five steps in Counseling and Emotional Support for the infertile couple

A 
Education on human fertility in general
Their diagnosis in particular 
Treatment options
Success rate
Adoption
35
Q

What advice would you give to the infertile male who drinks and smokes

A

Stop smoking

<3-4 units of alcohol/week

36
Q

What is the treatment for erectile dysfunction

A

Viagra

Psychotherapy

37
Q

What is the treatment for women who do not produce ova but which to become pregnant

A

Clomiphene

38
Q

What are two types of Artificial Insemination

A

Artificial Insemination by Husband (AIH)

Artificial Insemination by Donor (DI)

39
Q

What are three treatment methods for fertility with an infertile male

A

Artificial Insemination
Intrauterine Insemination
Assisted Conception

40
Q

What are the treatment methods for the infertile female with amenorrhea

A

Treatment directed at the cause

E.G. Bromocriptine for hyperlactinaemia

41
Q

What are the treatment methods for the infertile female with tubal occlusion

A

Surgery vs In Vitro Fertilization IVF

42
Q

What are the treatment methods for the infertile female with Endometriosis

A

Medical and surgical treatment

43
Q

What five treatments can be used for the Induction of ovulation

A 
Clomiphene Citrate
Letrozole
hMG,human menopausal gonadotrophin 
Pure FSH
GnRH agonists
44
Q

What are the steps to induction of ovulation for Oligo-amenorrhea

A

Clomiphene citrate 50-100mg od po x 5days , from day 5-9 of the cycle

Serial ultrasound
- track follicle growth

Trigger ovulation with injection of hCG

45
Q

What is the treatment for the female with ovarian failure

A

Oocyte donation

46
Q

What is the treatment for the infertile female with hyperprolactinaemia

A

Dopamine agonist

Neurosurgical ablation

47
Q

What is the treatment for the infertile female with Polycystic Ovarian Syndrome, PCOS

A

Metformin, clomiphene,ovarian endocoagulation

48
Q

Describe the process of Intrauterine Insemination

A

Ovulation induction with ultrasound monitoring

Washed sperm instilled in the uterine cavity on the day of ovulation

49
Q

Describe In Vitro Fertilization (IVF)

A

Fertilization in a glass dish

50
Q

Define In vivo fertilizartion

A

Occurs in the fallopian tube

51
Q

List 8 indications for In-Vitro Fertilization (IVF)

A 
Tubal Factors 
Endometriosis 
Cervical factors
Immunological causes
Offspring of women treated with DES 
Male infertility 
Multifactorial infertility
Unexplained infertility
52
Q

List two examples of Tubal factors that are indications for in Vitro Fertilization

A

Irreversible tubal damage

Failed tubal surgery

53
Q

List two examples of Endometriosis that are indications for in Vitro Fertilization

A

If no pregnancy after medical or surgical treatment

Oocyte recovery rate is lower with persistent stage III or IV organs

After resection ovarian function may be altered

54
Q

List two examples of Cervical Factors that are indications for in Vitro Fertilization

A

Sperm fail to penetrate mucous

55
Q

List two examples of immunological causes that are indications for in Vitro Fertilization

A

Anti-sperm antibodies

56
Q

List two examples of male infertility that are indications for in Vitro Fertilization

A

Azoospermia amenable to treatment with intracytoplasmic sperm injection

57
Q

What are five indications for Oocyte donation

A 
Premature menopause
Chemotherapy induced ovarian failure
Autoimmune Ovarian Failure 
Physically inaccessible ovaries
Autosomal dominant or sex linked disorders
58
Q

What is the criteria for In Vitro Fertilization

A

Patients less than 40
(Over 40 have poor results with increased abortion rates)

Normal FSH

Ovulation spontaneous or readily induced

Good health (mental and physical)

59
Q

In vitro fertilization IVF steps

A

Parenteral induction of ovulation
Oocyte retrieval
In vitro fertilization
Embryo transfer

60
Q

How many embryos are implanted in the uterus in in vitro fertilization

A

3

61
Q

What is the take home baby rate of in vitro fertilization

A

12-15%

62
Q

List three other techniques for Artificial Pregnancy

A

Gamete Intra Fallopian Transfer
Zygote Intra Fallopian Transfer
PROnuclear Stage Oocyte Transfer

Urogenital System (17 decks)

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