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O&G > Subfertility 2 > Flashcards

Subfertility 2 Flashcards

1
Q

How does semen analysis take place?

sample collection

A

collect after 3 days abstinence

examine within 2 hours of collection

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2
Q

What is the normal volume of semen collected?

A

2-5ml

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3
Q

What does it mean if the volume is outside the normal range?

A

low may be androgen deficiency

high may be abnormal accessory gland

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4
Q

What is the normal sperm count?

A

> 20x10^6/ml

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5
Q

What does it mean if the sperm count is outside this range?

A

absence of all sperm (azoospermia) = sterility
fluctuates from day to day
abnormality high may be associated with subfertility

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6
Q

How is sperm motility graded?

A

grade 1 - rapid, linear progressive motility
grade 2 - slow/sluggish linear or non-linear
grade 3 - non-progressive
grade 4 - immotile

Forward progression is V IMP

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7
Q

What else is analysed in the semen?

A

morphology - >30% is normal (very variable, less predictive)

liquefication time within 30 mins

WBC in sample - ?infection, if pus cells then culture semen

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8
Q

How is the DNA of the sperm analysed?

A

integrity of sperm DNA is essential
perform the sperm chromatin structure assay (SCSA) to look at the stability of chromatin and then look at DNA fragmentation index (DFI)

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9
Q

How would testicular damage present an endocrine assessment?

A

high FSH and low AMH

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10
Q

How would obstructive disease present an endocrine assessment?

A

normal levels

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11
Q

How would hypopituitarism present an endocrine assessment?

A

low or undetectable FSH and LH

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12
Q

How would spermatogenic failure present an endocrine assessment?

A

high FSH
low AMH
azopermia
perform a testicular biopsy

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13
Q

What other tests can be carried out to assess the sperm?

A

cytogenetics - may see XXY or XYY karyotype, can screen for CF

Testicular biopsy - may demonstrate spermatogenesis

Reterograde ejaculation - rare

Immunological tests - can get autoimmunity to sperm antigens

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14
Q

What is the most successful way to treat male infertility?

A

ICSI - intracytopalsmic sperm injection

direct injection of single immobilised sperm into oocyte
similar pregnancy rates to IVF
slightly high incidence of genetic tract abnormality in children

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15
Q

How can ovarian hyperstimulation be prevented?

A

use lowest possible effective dose
US monitoring of follicular growth
withdrawing gonadotrophins for a few days

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16
Q

What is hysteroscopy used to investigate?

A

visualise uterine cavity

correct uterine septum, scar tissue, uterine polyps, endometriosis or uterine fibroids

17
Q

What is laparoscopy used to investigate?

A

view and assess pelvic organs
correct endometriosis, tubal damage, hydrosalpinx (fluid-filled fallopian tubes), scar
tissue, uterine fibroids, ovarian cysts + tumours

18
Q

What is laparotomy used to investigate?

A

treat uterine fibroids, large ovarian cysts, or ruptured ectopic pregnancy with
uncontrolled haemorrhage

19
Q

How is PCOS treated?

A

advice regarding diet and exercise
normalisation of weight
treat with COCP

20
Q

What causes hypothalamic hypogonadism?

A

reduction in hypothalamic GnRH release

usual with anorexia, women on diets, athletes and those under stress

21
Q

How can hypothalamic hypogonadism be managed?

A

restore body weight if appropriate
exogenous gonadotrophins or GnRH pump will induce ovulation
Bone protection with contraceptive pill or HRT required

22
Q

What causes hyperprolactinaemia?

A

prolactin reduces GnRH release
due to benign adenomas or hyperplasia of pituitary cells, also associated with PCOS, hypothyroidism and sue of psychotrophic drugs

23
Q

How is hyperprolactinaemia managed?

A

dopamine agonist - dopamine inhibits prolactin

surgery if medical treatment fails or neuro symptoms

24
Q

What are the other methods of managing male subfertility?

A

lifestyle changes
drug exposures addressed
wear loose fitting clothing and testicular cooling advice
FSH + LH +/- hCG to treat hypogonadotrophic hypogonadism

25
Q

What are the causes of coital dysfunction?

A 
Alcohol
Hypotensives 
SSRIs
Beta blockers 
Finasteride 
The pill 
Phenothiazides (loss of libido)
Diabetes (erectile dysfunction) 
Cord pathology
26
Q

What are the advantages of surgical division or removal of adhesions?

A

Pain relief from adhesions

Improved fertility

27
Q

What are the disadvantages of surgical division or removal of adhesions?

A

Risk of creating further adhesions
Risk of bleeding and infection
Risk of injury to bowels and/or incontinence

28
Q

What are the advantages of surgical management of endometriosis?

A

improves conception rates

symptomatic improvement in 70% patients

29
Q

What are the disadvantages of surgical management of endometriosis?

A

difficult due to severe adhesions and anatomic distortion

risks of damaging bowel, bladder, blood vessels and ureters

O&G (25 decks)

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