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Endocrine Week 5 2017/18 > 4: Assessment of infertility > Flashcards

4: Assessment of infertility Flashcards

(51 cards)

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1
Q

What infection can cause infertility?

A

Chlamydia

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2
Q

The ___ you are, the less fertile you are.

A

older

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3
Q

A BMI over __ significantly increases your risk of infertility and complications of pregnancy.

A

30 kg/m2

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4
Q

What is the WHO definition of infertility?

A

Failure to achieve pregnancy after 12 months of unprotected intercourse in a couple who have never had a child (without a known reason)

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5
Q

What is primary infertility?

A

Infertility in a couple who have never conceived

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6
Q

What is secondary infertility?

A

Infertility in a couple who have previously conceived

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7
Q

Under which age are you more likely to conceive?

A

30

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8
Q

At which point in the menstrual cycle is conception most likely?

A

Ovulation

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9
Q

Which lifestyle factors affect the chances of conception?

A

Weight

Smoking

Caffeine intake

Recreational drugs

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10
Q

What are the three general causes of infertility?

A

Male factors

Female factors (i.e problems with tubes, reduced egg reserves, endometrosis)

Mixture of the two

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11
Q

What is the name for failure to release an egg?

A

Anovulation

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12
Q

When is anovulation normal?

A

Before puberty

During pregnancy

After menopause

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13
Q

Which eating disorders can cause anovulation?

Why?

A

Anorexia nervosa

Bulimia nervosa

associated low BMI

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14
Q

What are some clinical features of anorexia nervosa?

A

BMI < 18.5

Hair loss

Bradycardia, hypotension

Anaemia

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15
Q

Which endocrine gland functions abnormally in anorexia nervosa?

A

Hypothalamus

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16
Q

Which hormonal changes are seen in anorexia nervosa?

A

Low GnRH…

FSH, LH…

… and oestradiol release

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17
Q

Which pituitary tumour can cause anovulation?

A

Prolactinoma

producing hyperprolactinaemia

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18
Q

Which syndrome causes infarction of the anterior pituitary gland post-partum?

A

Sheehan syndrome

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19
Q

What is the commonest endocrine disorder in woman and causes anovulation?

A

Polycystic ovary syndrome (PCOS)

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20
Q

What are the clinical features of polycystic ovary syndrome?

A

Oligo- or amenorrhoea

Hyperandrogenism symptoms - acne, hirsutism, obesity

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21
Q

What hormone changes are seen in polycystic ovary syndrome?

Study These Flashcards
A

High free testosterone

High LH

(Remember that PCOS causes insulin resistance > hyperinsulinaemia. That causes the inhibition of sex hormone-binding globulin, which usually mops up testosterone, and increases the levels of LH for some reason.)

22
Q

What three factors are diagnostic of PCOS?

Study These Flashcards
A

2 of Rotterdam criteria:

  1. Oligo- or amenorrhoea
  2. Ultrasound evidence of polycystic ovaries
  3. Symptoms of hyperandrogenism - acne, hirsutism, obesity
23
Q

What genetic syndrome causes premature ovarian failure and therefore infertility?

Study These Flashcards
A

Turner’s syndrome

24
Q

What is the karyotype of Turner’s syndrome?

25
What are the clinical features of premature ovarian failure?
**Amenorrhoea** **Menopausal symptoms** - hot flushes, night sweats, atrophic vaginitis (most commonly manifesting as dryness)
26
In premature ovarian failure, negative feedback of the HPO axis kicks in - what hormonal changes are seen?
**High GnRH** **High FSH and LH** in an attempt to compensate for ovarian failure but **low oestradiol** because the ovaries can't produce any
27
Which other endocrine diseases cause menstrual symptoms and can lead to infertility?
**Hyper and hypothyroidism**
28
Tumours producing ___ can cause virilisation and infertility.
**testosterone**
29
Which drugs are **designed** to cause infertility?
**Contraceptives**
30
In females, problems with the ___ tubes themselves can cause infertility.
**Fallopian tubes**
31
What are some **infective** tubal diseases?
**Pelvic inflammatory disease** (chlamydia/gonorrhoea/syphilis/TB...) **Abdominal diseases** e.g appendicitis **Iatrogenic**
32
What is **endometriosis**?
**Presence of endometrial tissue OUTSIDE uterus**
33
What are the clinical features of endometriosis?
**Painful, bloody menstruation** (dysmenorrhoea) **Painful intercourse** (dysparenuria) **Infertility**
34
Which surgeries can cause tubal disease?
**Sterilisation** **Removal of ectopic pregnancies**
35
Which type of disease, following infection by chlamydia, gonorrhoea etc, can cause ectopic pregnancy and infertility?
**Pelvic inflammatory disease**
36
What are some pre-testicular causes of male infertility?
**Hypogonadism** **Hypothyroidism** **Hyperprolactinaemia** **Diabetes** (remember it's a big cause of ED) **Erectile dysfunction**
37
What is a genetic cause of male infertility? What is the karyotype?
**Klinefelter's syndrome** **47 XXY**
38
What are some post-testicular causes of male infertility?
**Obstruction of epididymis, vas deferens** **Vasectomy**
39
Which drugs can cause male infertility?
**Steroids** e.g testosterone, anabolic steroids **Spironolactone** at high doses
40
What happens to the size of the testes in non-obstructive male infertility?
**Reduced size**
41
How palpable is the vas deferens in a) obstructive b) non-obstructive male infertility?
a) Non-palpable b) Palpable
42
What happens to the level of FSH, LH and testosterone in a) obstructive b) non-obstructive male infertility?
**Obstructive** - all normal (not a hormonal problem) **Non-obstructive** - high FSH & LH, low testosterone
43
A progesterone level of more than ___ nmol/L a week before period indicates that ovulation has occurred.
**\> 30 nmol/L**
44
Which investigations are used to determine if the fallopian tubes are patent or not?
**Hysterosalpingiogram** **Laparoscopy**
45
What investigation is done for suspected **endometriosis** in the **_uterus_**?
**Hysteroscopy** remember hyster- means uterus
46
Which imaging can be used to investigate infertility?
**Pelvic USS**
47
Which hormones are measured in a patient who has anovulation?
**Urine HCG** **Prolactin** **TSH** **Testosterone** **LH, FSH and oestradiol**
48
What is a sort-of varicose vein which occurs in the testes and can cause male infertility?
**Varicocele**
49
What is analysed to determine the cause of male infertility?
**Semen** **Hormones** (LH, FSH, testosterone, prolactin, TSH)
50
Again, which imaging can be used to examine the testes?
**Testicular / scrotal USS**
51
Name three **classes** of **contraception** which cause **anovulation.**
**OCP** **Contraceptive implant** **Contraceptive injection**

Endocrine Week 5 2017/18 (7 decks)

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