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YEAR 3 REPRO > Infertility > Flashcards

Infertility Flashcards

1
Q

causes of FEMALE INFERTILITY

A

PCOS
THYROID ISSUES
PREVIOUS SURGERY (SCARRING TO CERVIX /UTERUS)
PID
ENDOMETRIOSIS
STI
DRUGS - NSAIDs, CHEMO, ANTIPSYCHOTICS, SPIRONOLACTONE

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2
Q

Causes of MALE INFERTILITY

A

SPERM ISSUES - LACK OF, POOR MOVEMENT, ABNORMAL, CANCER, SURGERY, HIV, STIs,

EJACULATION ISSUES - HYPOGONADISM DUE TO TUMOUR OR DRUGS OR Klinefelter syndrome (XXY47)

DRUGS - SULFASALAZINE, ANABOLIC STEROIDS, CHEMO, CHINESE HERBAL MEDS: triptergium wilfordii

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3
Q

what is asked in a female hx of infertility onn assessment of ovulation?

A

The frequency and regularity of their menstrual cycles. Women with regular monthly menstrual cycles should be informed that they are likely to be ovulating.
Duration of innfertility, previous contraception, previous pregnancies, menstrual hx, med and surg hx, sexual hx, previous ix, psychological assessment.

  • excess body hair, weight gian, acne? (PCOS).

Previous ectopic pregnancies/ miscarriages? menhorragia? dysmenhorragia? (thinking of endometriosis) STI’s? Medicaiton Hx?

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4
Q

female examinnation

A

weight, height, bmi, fat and hair distribution, galactorrhpea (prolactin production increase - sy also bitemporal hemanopia, menorrhagia), abdo and pelvic examination.

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5
Q

hirsutism is caused by?

A

PCOS, cushings, acromegaly, androgen-secreting tumors (ovarian or adrenal) and ovarian hyperthecosis. (ANDROGEN EXCESS)

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6
Q

what is the clinical mesasurement score of hirsutism?

A

Ferriman Gallwey score

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7
Q

what is the biochemical measurements used?

A

Biochemical measurement - Testosterone (T), Dehydroepiandrosterone sulphate (DHEAS) if is greater than 700 mcg/dL (18.9 micromol/L)

adrenal computed tomography (CT) is recommended to look for an androgen-secreting adrenal tumor, 17-OH Progesterone

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8
Q

give one other sign of androgenn excess

A

Acanthosis nigricans

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9
Q

what is found on pelvic examination/ what is looked for?

A

masses, pelvic distortion, tenderness, vaginal septum, cervical abnormalities, fibroids

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10
Q

sy of fibroids

A

pressure symptoms, period issues, infertility

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11
Q

what initial baseline Ix are done to the female and male partners?

A

Female partner: Rubella immunity, Chlamydia, TSH,

if periods are regular: Mid luteal progesterone (7 days prior to expected period);

if periods are irregular please do day 1-5 FSH, LH, PRL, TSH, testosterone. Male Partner`s semen analysis.

Blood levels of LH, FSH, Oestradiol. THEN Progesterone test in the mid luteal phase.
Transvaginal USS, Blood levels of TSH, prolactin (pituitary adenoma) and testosterone.

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12
Q

what ix are donne at the fertility clinic?

A

pelvic us, physical exam, testing for ovulation, semen analysis, tubal patency test

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13
Q

what blood test is done inn the mid-luteal phase?

A

Women who are undergoing investigations for infertility should be offered a blood test to measure serum progesterone in the mid-luteal phase of their cycle (day21 of a 28‑day cycle) to confirm ovulation even if they have regular menstrual cycles

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14
Q

what is the test offered to sccreen for tubal occlusion?

A

hysterosalpingography (HSG)

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15
Q

what is asked in Male hx?

A

Developmental - Testicular descent, Change in shaving frequency, Loss of body hair, Infections - Mumps, Sexually transmitted diseases
Surgical - Varicocelerepair, Vasectomy, Previous fertility, drugs and alcohol - sterioids, smocking, chemo, rec drugs, sexual hx - libido, frequency, any chronic illnesses

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16
Q

what is done in Male examination?

A

BMI, Hair distribution, Abdominal and inguinal examination, Genital examination: Testis, Epididymis, Vas deferens, Varicocoele, Penis

17
Q

what may epididimytis indicate?

A

STD’s - chlamydia, gonorrhoea

18
Q

what is a variococele?

A

is a dilatation of the pampiniform plexus of the spermatic veins in the scrotum. Most men with varicocele and presumptive infertility have abnormal semen parameters, including low sperm concentration and abnormal. Men should not be offered surgery for varicoceles as a form of fertility treatment because it does not improve pregnancy rates.

19
Q

what is Klinefelter’s synodrome?

A

One of the most common causes of primary hypogonadism with impaired spermatogenesis and testosterone deficiency is Klinefelter syndrome, which may occur in up to 1 out of 500 to 700 phenotypic males and in up to 10 to 15 percent of infertile men with azoospermia. It is characterized by sex chromosome aneuploidy, with an extra X (XXY) chromosome being the most frequent. These patients often have very small testes and almost always have azoospermia.

20
Q

what are some reasons for female infertility?

A

Ovulatory dysfunction = excessive exercise, underweight, PCOS
Diminishing ovarian reserve, Endometriosis,
Uterine factors
Tubal factors -fallopian tubes arent patent = infeciton, endometriosis, adhesions

21
Q

what are the 3 groups of ovulatory disorders?

A

Group I: hypothalamic pituitary failure (hypothalamic amenorrhoea or hypogonadotrophic hypogonadism).
Group II: hypothalamic-pituitary-ovarian dysfunction (predominately polycystic ovary syndrome).
Group III: ovarian failure (POI). Offer GnRH to innduce ovulation.

22
Q

what are the features of PCOS (polycystic ovary synodrome)?

A

Androgen excess (clinically - hirsutism, biochemically - testosterone), infrequent periods (anovulation), polycyctic ovaries (us))

23
Q

mainn mx for ovulatory disorders

A

treta the unnderlying cause, weight loss/gain, improve bmi, ovulationn induction by - Clomifene, GnRH, general gonnadotrophins

24
Q

how does clomiphene work and what are its side effects?

A

Clomifene exhibits its Ovulatory inductive function by blocking estrogen receptors in the anterior pituitary, leading to increased secretion of FSH.Selective estrogen receptor modulator, Monitoring - Follicle scanning in 1st cycle, 15% require dose adjustment. Side effects - Vasomotor, Visual.

25
Q

biggest disadvantage of gonadotrophin therapy is

A

multifollicular recruitment and its associated risks of multiple pregnancy and OHSS. For this reason, monitoring scans are advised for every gonadotrophin OI cycle. Starting with low gonadotrophin doses (37.5IU daily) and cautiously increasing in small increments is recommended, in order to minimise the incidence of multifollicular recruitment.

26
Q

when are gonadotrophins used?

A

no ovulation with clomifene, ovulation but no pregnancy, FSH by injection. (upto 3-6 cycles given)

27
Q

what tx is given for tubal factor and endometriosis?

A

Surgery for hydrosalpinges before in vitro fertilisation treatment.

28
Q

what are some reasons for male infertility?

A

Sperm production problems (radiotherapy or infecitons?), Erection and ejaculation problems, Problems in producing hormones for sperm production, Blockage of sperm transport

29
Q

explain azospermia options

A

Micro-epididymal sperm aspiration, Testicular sperm extraction, Urologist appointment if appropriate, IVF/ICSI, Intra-uterine insemination, Surgery, Reversal of vasectomy, Surgical sperm retrieval, Donor insemination.

30
Q

outline the process of IVF tx

A

eggs harvested, mature eggs fertilised in the lab with sperm, incubation where embryos undergo a number of cell divisions, embryos tranferred to the womb by transfer catheter. Embryos can also be preservded by cryopreservation.

31
Q

A 24-year-old presents with an 18-month history of amenorrhoea since stopping the oral contraceptive pill 18 months ago in order to try for a pregnancy. She had been on the combined pill since she was 16, during which time her periods had been regular. Her BMI currently is 31.
What is the most appropriate next step for investigation?

A

A diagnostic laparoscopy
A pelvic ultrasound scan
Hormone profile to check SHBG, free testosterone and FSH and LH and prolactin
MRI of pelvis to exclude pelvic mass

32
Q

What is the most likely diagnosis?

A

Anorexia nervosa/ Hyperprolactinaemia/ Hypogonadotrophic hypogonadism/ Polycystic ovarian syndrome/ Premature ovarian failure

33
Q

Which of the following is correct with regards to the diagnosis of PCOS?

A

A high FSH and LH level/ Affected women are very fertile/ Affects >50% of the infertile population/ Metformin is contraindicated/ Ultrasound appearance of a large number of follicles arranged peripherally in the ovarian cortex of large volume ovaries

34
Q

A 28-year-old with PCOS and primary subfertility of 4 years attends the fertility clinic. Her cycles are very irregular and she is currently on metformin, which is helping with her weight control (BMI 28), but is she still is amenorrhoeaic. She is very keen to commence with fertility treatment. An hysterosalpingogram confirmed bilaterally patent tubes.
What is the most appropriate initial management of her subfertility?

A

Advice on weight loss and review in 6 months/ Intrauterine insemination for six cycles/ Laparoscopic diathermy to ovaries/ Ovulation induction with clomifene 50 mg for 6 months/ Recommend one cycle of IVF treatment

35
Q

name a dopamine agonist?

A

bromocriptine - used for a prolactinoma

YEAR 3 REPRO (27 decks)

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