Infertility Flashcards

1
Q

Incidence

A

1 in 7 couples

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2
Q

Risk factors

A

Age
Smoking
BMI (<18 and >30)
Steroids (sperm)
Seat warmers for sperm

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3
Q

Who can be referred before 1 year

A

Age 36 and over
Known clinical cause or risk factors

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4
Q

Ovulatory disorders cause what proportion of infertility

A

21%

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5
Q

Normal range mid-luteal progesterone

A

> 30

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6
Q

Tubal disease causes what proportion of subfertility

A

14%

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7
Q

Semen analysis parameters

A

Volume >1.5ml
Concentration 15m
Normal forms 4%
Motility 40%
Total sperm 39m
Vitality 58% or more live spermatazoa

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8
Q

Main cytokine implicated in OHSS

A

VEGF

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9
Q

Pathophysiology of OHSS

A

Ovarian enlargement
Systemic effects of inflammatory mediators
Increased vascular permeability
Prothrombotic effect

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10
Q

OHSS incidence

A

3-8% for moderate and severe disease
Mild in 1/3 of traditional IVF

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11
Q

OHSS triggers

A

IVF
Clomiphene
Monofollicular ovulation induction gonadotrophin induction
Pregnancy

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12
Q

Risk factors for OHSS

A

Previous OHSS
PCOS
Increased AFC
High levels of AMH
Successful conception after IVF
Multiple pregnancy after IVF

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13
Q

Symptoms of OHSS

A

Abdominal distension and pain
Nausea and vomiting
SOB
Oliguria
Oedema
Thrombosis

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14
Q

Classification of OHSS

A

Early - within 7 days of HCG trigger

Late - 10 or more days after HCG trigger

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15
Q

Investigations for suspected OHSS

A

Bloods - FBC, CRP, LFT, U&E, clotting, serum osmolality, ABG

ECG
CXR
USS
CTPA

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16
Q

Examination in OHSS

A

Hydration status
Oedema
Obs
Body weight
Abdominal girth
Palpable mass
Pleural effusion or pulmonary oedema

17
Q

Mild OHSS

A

Abdominal bloating
Mild pain
Ovarian size <8cm3

18
Q

Moderate OHSS

A

Moderate abdominal pain
Nausea and vomiting
Ascites on USS
Ovary size 8-12cm3

19
Q

Severe OHSS

A

Clinical ascites +/- hydrothorax
Oliguria
Haematocrit > 0.45
Hyponatraemia <135
Hypo-osmolality <282 mOsm/kg
Hyperkalaemia >5
Hypoalbuminaemia
Ovarian size >12cm3

20
Q

Critical OHSS

A

Tense ascites/large hydrothorax
Haematocrit >0.55
WCC >25
Anuria
VTE
ARDS

21
Q

Causes of death with OHSS

A

Renal failure
ARDS
Ovarian rupture
VTE

22
Q

OHSS duration

A

7-10 days

23
Q

Hospital admission for OHSS

A

Worsening symptoms
Uncontrolled pain
Inadequate oral intake
Unable to attend for follow up
Critical OHSS

24
Q

Indications for paracentesis in OHSS

A

Severe abdominal pain secondary to ascites
Dyspnoea secondary to ascites
Oliguria despite fluid replacement due to compression of ascites causing hypoperfusion to kidneys

25
Q

Incidence of thrombosis in OHSS

A

0.7-10%

26
Q

Pregnancy complications from OHSS

A

PET
PTB

27
Q

Risks of uterine transplantation

A

> 25% emergency hysterectomy
10% further surgery

28
Q

Risk of complication to donor following uterine transplant

A

10%

29
Q

How to test for rejection of uterine transplants

A

Histological assessment of cervical biopsies

30
Q

When can embryo transfer be done after uterine transplant

A

6-12 month after immunosuppressive therapy