Infertility Causes

Question 1

What is a hysterosalpingogram?

Answer 1

You inject radio-opaque dye through the cervix and then watch via x-ray as the dye travels through the uterus and tubes. Use this to see if there any space occupying lesions in the uterus or tubes

Question 2

What’s an advantage of using Ultrasound over hysterosalpingogram?

Answer 2

US gives you more info about the myometrium (fibroids or polyps), and you can look at the lumen of the uterus by injecting saline.

Disadvantage: can’t see fallopian tubes as well.

Question 3

What is a laparoscopy?

Answer 3

Thin lighted tube goes into the abdomen to directly visualize the reproductive organs. Used in assessing/repairing problems with fallopian tubes and ovaries.

Question 4

What is a hysteroscopy?

Answer 4

Thin lighted tube goes through the cervix to visualize the cervix and inside the uterus. Can assess and repair problems with endometrium

Question 5

How do you rule out male infertility?

Answer 5

Semen analysis (volume, count and movement analysis)

Question 6

What are the top 3 most common causes of infertility?

Answer 6

1. Male factor
2. Male + female factors combined
3. Tubal factor

Question 7

What are the normal male semen parameters?

Answer 7

Count: >20 million/ml
Motility: >50% motile
Morphology: >30% normal morphology

Obviously, quantity>quality

Question 8

What are your options when there is low sperm count?

Answer 8

> 10 million motile sperm: intrauterine insemination

3-10 million motile sperm: IVF

Question 9

If there is such low sperm count that there isn’t enough in the, what can you do?

Answer 9

Go in there and pull em out:

1. MESA (microsurgical epididymal sperm aspiration)
2. TESE (testicular extraction)

Question 10

What is an example of a tubal obstruction that could prevent egg and sperm from meeting?

Answer 10

Hydrosalpinx: distal obstruction of the fallopian tube due to PID (from Chlamydia) or tubal TB leads to filling of tube with clear/serous fluid.

Question 11

This disorder involves the placement of glands and stroma of endometrium in somewhere other than the endometrium (ovaries, tubes, lungs, brain, MALES) and can cause infertility

Answer 11

What is: endometriosis (just put this in so you remember that connection)

Question 12

PID can travel to the liver and cause hepatic adhesions. This disorder is called

Answer 12

Fitz-Hugh-Curtis

Question 13

When you have pelvic adhesions associated with endometriosis, is it better to ablate or excise them?

Answer 13

Excise, for two reasons:

1. Now you have a tissue biopsy
2. You know you got all of the tissue

Question 14

This syndrome can cause infertility and is associated with ovulatory dysfunction, hyperandrogegism and polycystic ovaries

Answer 14

Polycystic Ovarian Syndrome (PCOS).

This causes infertility because of the problems with ovulation. Lots of estrogen being produced by follicles but there is no progesterone since you are not ovulating (no corpus luteum).

Question 15

How can you treat PCOS

Answer 15

1. Medically with OCP (progesterone)

2. Surgically (cut off part of the ovary or burn the inside–not the best for infertility though)

Question 16

How do you predict diminishing ovarian reserve

Answer 16

1. Age (starts to decline after mid 30’s)
2. FSH/ anti-mullerian hormone (FSH increase with age as the the inhibitory effect of estrogen production from follicles decreases; anti-mullerian decreases since it is produced by the granulosa cells)
3. Antral follicle counts (literally, how many follicles can you see on the ovaries on US.

Question 17

What are some congenital abnormalities that can cause infertility. (They breezed through this in lecture, but just know that they exist)

Answer 17

1. Uterine didelphys: double uterus with 2 separate cervices
2. Bicornuate uterus: horn shaped uterus; 2 horns separated by a septum
3. Unicornuate uterus: uterus forms from one of the paired mullein ducts and the other duct doesn’t develop properly
4. Septate uterus: outside looks normal, but the inside is separated into 2 sections by a septum (hard to tell this from #3)

Question 18

What is the most common cause of hysterectomy?

Answer 18

Leiomyoma. Can cause obstruction leading to infertility. Use hysterosalpingogram to dx. Need to watch the injection not see dye go around the mass, otherwise its hard to see on X-ray film.

Question 19

What is the name of the small growths inside the endometrium that can cause infertility?

Answer 19

Endometrial polyps

Question 20

After D&C, you can get uterine scarring. What can this also lead to? (Big hint, what’s the name of the deck you’re in)

Answer 20

Infertility, by obstructing the tubes.