204/205: Female and Male infertility Flashcards Preview

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Flashcards in 204/205: Female and Male infertility Deck (23)
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1

How does testosterone excess affect sperm levels?

Excess testosterone -> decreased sperm

  • Testosterone inhibits GnRH, LH/FSH via negative feedback
  • Gonadotropins LH and FSH are needed for spermatogenesis
    • Testosterone will not result in sperm

 

2

How does a varicocele affect sperm production?

Impairs sperm production

  • Varicocele causes blood to pool
  • More blood = increased testicular temperature
  • -> impaired sperm production

 

Tx = surgical intervention or radiologic embolization

3

What causes Asherman's syndrome?

Uterine scarring, usually iatrogenic

Can interfere with fertility

4

How does marijuana affect sperm count?

Decreased, due to suppressed LH/FSH

5

How does prolactin excess affect sperm levels?

Prolactin inhibits hypothalamic GnRH secretion

  • -> Decreased LH/FSH
  • -> Decreased spermatogenesis

 

 

6

What is the prevalence of infertility?

15%

7

What genetic testing should be ordered for men with congenital bilateral absense of the vas deferens?

CFTR mutation - likely that they are a carrier

Test BOTH partners

  • Even if pt with CBAVD is negative for known CFTR mutations, they may be a carrier of an unidentified mutation; need to know CFTR status of partner

 

Carrier of CFTR mutation can have CBAVD without other symptoms

8

Which aspect of fertility is most affected by maternal age?

Ovarian reserve; we run out of eggs

 

Note: uterus largely unaffeted; donor eggs have the same success rate in older vs. younger uteri

9

Describe the clinical features of congenital bilateral absence of the vas deferens

  • Missing vas deferens, distal 2/3 of epididymis, seminal vesicle
  • Infertility
  • Likely a carrier of CFTR mutation

 

10

List the 3 most common causes of infertility in a person with a uterus

  • Anatomic anbnormality
    • Uterine and/or fallopian tube
  • Ovulatory dysfunction
  • Decreased ovarian reserve (fewer eggs)

 

11

Define infertility

Inability to conceive after one year of unprotected intercourse

 

Note: For female patients 35 and older, consider intervention after 6 months without conceiving - i.e. pt doesn't have to meet the strict definition of infertility to be treated for infertility

 

12

Which part of the hypothalamic/pituitary/gonadal axis is interrupted in hypothalamic amenorrhea?

Pulsatile GnRH secretions from the hypothalamus

 

Remember that both absent and continuous GnRH secretions will inhibit LH/FSH secretion

13

What is the most effective form of male contraception?

Vasectomy

 

Pull out method and/or condoms have higher failure rates b/c may not always be properly executed 

14

What is the best treatment option for a woman with bilaterally blocked fallopian tubes who wishes to conceive a child?

IVF

 

Age and ovarian reserve play a role in likelihood of success

15

Is a vasectomy immediately effective?

NO!

 

  • Must check to make sure ejaculate has no sperm after a few months
  • Surgery is a failure if any motile sperm persist at >6 months; repeat procedure

 

 

16

How long does it take after fever for sperm levels to return to normal?

Up to 3 months

 

If a pt has abnormal semen results <3 months after fever, rechek later

17

Sperm count below ___ is an indication for karyotype testing 

Sperm count below  5 million  is an indication for karyotype testing 

18

What is the first line treatment for ovulation induction in a patient with PCOS?

Describe the MOA

Letrozole

  • Oral non-steroidal aromatase inhibitor
  • Decreased estrogen level -> brain releases more LH/FSH

 

19

List the steps of a complete evaluation for infertility in a person with a uterus

  • History
  • Physical
  • Assess uterine cavity
  • Document tubal patency
  • Confirm ovulation
  • Assess ovarian reserve

 

20

What is the MOA of clopiphene citrate?

Selective estrogen receptor modulator

  • Blocks hypothalamic estrogen receptors
  • This tricks the brain into thinking there isn't enough estrogen
  • -> Increased LH and FSH
  • -> induces ovulation

 

 

21

What is the most common genetic caues of azoospermia?

Klinefelter syndrome (47, XXY)

22

How will semen differ in retrograde ejaculation vs. ejaculatory duct obstruction?

 

Both: Low ejaculatory volume

  • Retrograde ejaculation
    • Normal semen pH (≥7.2)
       
  • Ejaculatory duct obstructiond
    • Acidic semen pH => seminal vesicle secretions are not getting into the ejaculate

 

Prostate secretions are acidic

Seminal vesicle secretions are alkaline

 

23

At what age does fertility peak in a person with a uterus?

When does it begin to significantly decline?

20-24 years old

Significant decline begins at 30-32ish