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Repro > 17 - Infertility > Flashcards

17 - Infertility Flashcards

1
Q

Define infertility?

A

inability of a couple to conceive after 12 months of regular intercourse without use of contraception

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2
Q

How should the couple be seen at the consultation?

A

together -

because both partners are affected by decisions surrounding investigation and treatment

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3
Q

what is usually the % of couples who conceive within a year and which 2 factors play a role?

A

80% -

if woman is < 40yrs

no contraception and regular intercourse

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4
Q

of those who do not conceive in first year, what % conceive in their 2nd year of trying?

A

10%

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5
Q

What % of couples conceive within 2 years of trying?

A

90%

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6
Q

4 questions which must be asked to find the route of the infertility?

A

are eggs available?

are sperm available?

can egg and sperm meet?

can the embryo implant?

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7
Q

7 questions which both male and female partners should be asked as part of history?

A

Duration of infertility

Previous contraception

Fertility in previous relationships

Medical and surgical history

Sexual history

Previous investigations

Psychological assessment

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8
Q

2 questions women should be asked as part of their history?

A

Previous pregnancies and complications

Menstrual history

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9
Q

what should women be asked about their menstrual history? (3)

A

regularity

frequency

flow

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10
Q

7 things involved in female examination?

A

Weight

Height

BMI (kg/m2)

Fat and hair distribution

Galactorrhoea

Abdominal examination

Pelvic examination

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11
Q

define Galactorrhoea?

A

milk secretion from breasts not due to breast-feeding

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12
Q

what is hirsutism?

A

condition in women that results in excessive growth of dark or coarse hair in a male-like pattern — face, chest and back

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13
Q

reason for hirsutism?

A

NCCAH - non-classic congenital adrenal hyperplasia

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14
Q

why is diagnosis of PCOS important?

Polycystic Ovary Syndrome

A

Cushing’s syndrome

Acromegaly

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15
Q

what is the clinical measurement of Androgen excess?

A

Ferriman Gallwey Score

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16
Q

name 3 biochemical measurements of androgen excess?

A

testosterone

DHEAS >700 mcg/dL

17-OH progesterone

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17
Q

how does acanthosis nicrigans present and what does it indicate?

A

dark lines under the arms/ at the back of the neck

indicates androgen excess

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18
Q

5 possible findings on a pelvic examination?

A

masses

pelvic distortion

tenderness

vaginal septum

cervical abnormalities

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19
Q

3 ways in which fibroids can present?

A

pressure symptoms

period problems

infertility

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20
Q

3 baseline investigations for women?

A

Rubella immunity

Chlamydia

TSH

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21
Q

which other investigation should women undergo, depending on their periods?

A

regular periods - mid luteal progesterone

irregular - day 1-5 FSH, LH, PRL, TSH, testosterone

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22
Q

which baseline investigation should be done for men?

A

semen analysis

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23
Q

describe 5 investigations to be carried out at the fertility clinic?

A

Pelvic Ultrasound

Physical examination

Testing for ovulation

Semen analysis repeat if required

Tubal patency test

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24
Q

when should a tubal patency test be performed?

A

just after period has finished but before you ovulate -

~day 7 - 12 of regular 28 day menstrual cycle

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25
Q

what is tubal patency test used for?

A

ultrasound procedure used to assess the patency of the fallopian tubes and detect abnormalities of the uterus and endometrium

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26
Q

what should women with regular monthly menstrual cycles be told?

A

that they are likely to be ovulating

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27
Q

what should women be offered to confirm ovulation? (even if regular cycles)

A

blood test to measure serum progesterone

in mid-luteal phase

28
Q

what should women with irregular cycles be offered to confirm ovulation?

A

blood test to measure serum progesterone (later in cycle) and LH and FSH

29
Q

what should women with no comorbidities be offered to screen for tubal/ uterine abnormalities?

A

HSG - HysteroSalpingoGraphy

30
Q

what is HSG a good test for?

A

good for ruling out tubal occlusion

31
Q

what is tubal patency test AKA?

A

HyCoSy

32
Q

what 3 things should men be asked in terms of developmental history?

A

testicular descent

change in shaving frequency

loss of body hair

33
Q

which 2 infections should men be specifically asked about?

A

mumps

STDs

34
Q

which 2 surgical procedures should men be specifically asked about?

A

variocele repair

vasectomy

35
Q

which 6 environmental/ drugs factors should men be asked about?

A

alcohol

smoking

anabolic steroids (bodybuilding)

chemotherapy

radiation

recreational drugs

36
Q

which 3 questions should men be asked about in terms of sexual history?

A

libido (sex drive)

frequency of intercourse

previous fertility assessment

37
Q

what 6 things are involved in male examination?

A

Weight

Height

BMI (kg/m2)

Fat and hair distribution (hypoandrogenism)

Abdominal and inguinal examination

Genital examination

38
Q

what 4 things are assessed in a male genital examination?

A

Epididymis

Testes

Vas deferens

Varicocele

39
Q

what does epididymitis cause?

A

seminiferous tubular necrosis and disrupts spermatogenesis

40
Q

name 4 causes of epididymitis?

A

Chlamydia trachomatis

Gonorrhoea

TB

Mumps

41
Q

what is a varicocele?

A

dilatation of the pampiniform plexus of the spermatic veins in the scrotum

42
Q

why are varicoceles more common on the left side?

A

due to anatomical venous drainage

43
Q

where does the internal spermatic vein drain into on the RIGHT side?

A

inferior vena cava

44
Q

where does the internal spermatic vein drain into on the LEFT side?

A

left renal vein @ a right angle

45
Q

describe 2 treatment methods for varicocele which are NOT recommended?

A

surgery

embolisation

46
Q

what is Klinefelter syndrome?

A

one of most common causes of hypogonadism with impaired spermatogenesis

47
Q

how is Klinefelter’s characterised?

A

aneuploidy - an extra X (XXY) chromosome being the most frequent

48
Q

how does Klinefelter’s present in patients?

A

very small testes

azoospermia (almost always)

49
Q

define azoospermia?

A

semen contains no sperm

50
Q

name 2 conditions affecting vas deferens?

A

Cystic fibrosis

CBAVD (congenital bilateral absence of vas deferens)

51
Q

how many groups of ovulatory disorders are there?

A

3

52
Q

describe group I of ovulatory disorders?

A

hypothalamic pituitary failure

53
Q

describe group II of ovulatory disorders?

A

hypothalamic-pituitary-ovarian dysfunction

54
Q

describe group III of ovulatory disorders?

A

ovarian failure

55
Q

Group I ovulatory disorders - treatment and management?

A

increase body weight if BMI < 19 / reduce exercise if it is excessive

gonadotrophin-releasing hormone/ clomifene
(to induce ovulation)

56
Q

4 ways to diagnose PCOS?

A

androgen excess - Hirsutism, Testosterone

infrequent periods - anovulation

polycystic ovaries - US scan

57
Q

what type of drug is Clomifene?

A

selective oestrogen receptor modulator

58
Q

recommended does for clomifene?

A

50mg – 150mg Day 2-6

59
Q

2 ways in which to manage clomifene?

A

Follicle scanning in 1st cycle

15% require dose adjustment

60
Q

2 side effects of clomifene?

A

vasomotor

visual

61
Q

what should women with hydrosalpinges be offered as a treatment?

A

salpingectomy by laparoscopy before IVF treatment

62
Q

2 surgical sperm retrieval procedures for azoospermia?

A

Micro-epididymal sperm aspiration

Testicular sperm extraction

63
Q

what should women with unexplained infertility be offered rather than Clomifene?

A

IVF treatment

64
Q

why can women with unexplained fertility NOT be given clomifene?

A

it is a stand-alone treatment and does not increase the chances of a pregnancy or a live birth

65
Q

describe the process of ICSI - intracytoplasmic sperm injection?

A

injection of MATURE eggs with single sperm before incubating overnight

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