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Endocrinology > Assessment of fertility > Flashcards

Assessment of fertility Flashcards

(53 cards)

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1
Q

what does GnRH stimulate the release of from the anterior pituitary

A

LH and FSH

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2
Q

in males what cells does FSH stimulate

A

sertoli

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3
Q

what cells does LH stimulate in males

A

Leydig

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4
Q

what is the 1st day of the menstrual cycle

A

first day of bleeding

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5
Q

how long a cycle is oligomenotthoea

A

> 35 days

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6
Q

what is amennorhoea

A

lack of ovulation

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7
Q

what triggers ovulation

A

LH surge

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8
Q

when are the peaks of estradiol and progesterone during the menstruation cycle

A

estradiol peak before ovulation

progesterone peak following ovulation (after released egg, produced by corpus luteum)

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9
Q

where is estrogen secreted

A

ovaries (follicles), adrenal cortex, placenta in pregnancy

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10
Q

how does estrogen affect the endometrium

A

causes it to thicken

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11
Q

what types of cervical mucous does estrogen produce

A

fertile

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12
Q

what is the feedback role of estrogen in the follicular phase

A

+ve feedback stimulating gonadotrophin secretion

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13
Q

what is the feedback role of estrogen in the luteal phase

A

high estrogen concentration inhibits (-ve feedback) secretion of FSH and prolactin

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14
Q

what is secreted by corpus luteum to maintain pregnancy

A

progesterone

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15
Q

how does progesterone affect LH

A

inhibits its secretion

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16
Q

what cervical mucous does progesterone cause

A

infertile (thick)

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17
Q

what are the role of progesterone

A

maintains pregnancy, maintains thickness of endometrium, thermogenic effect (increases basal body temp), relaxes smooth muscles

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18
Q

how do you asses ovulation

A

midluteal (day 21) serum progesterone (if more than 30 nmol than ovulation)

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19
Q

are you likely to be ovulating if you have an irregular cycle

A

no- probably anovulatory

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20
Q

what are ovulatory disorders associated with

A

oligomenorrhea and amenorrhea

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21
Q

what are the components of a diagnostic sperm analysis

A

sperm count
sperm motility
sperm morphology

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22
Q

what is azoospermia

23
Q

is infertility more likely to be caused by male factors or ovulatory dysfunction

Study These Flashcards
A 
male factors (50%)
female (25%)
24
Q

what are 3 the types of ovulatory disorders

Study These Flashcards
A

hypothalamic pituitary failure (not producing GnRH, not stimulating LH and FSH)

hypothalamic pituitary dysfunction (normal hormones/ excess LH, PCOS)

ovarian failure

25
what is hypogonadotrophic hypogonadism
hypothalamic pituitary failure
26
what are reproductive hormones like in hypothalamic pituitary failure
low levels of FSH/LH oestrogen deficiency normal prolactin
27
what reproductive feature is seen in ovulatory disorders caused by hypothalamic pituitary failure
amenorrhoea
28
what can cause hypothalamic pituitary failure
``` stress excessive exercise anorexia/ low BMI brain/ pituitary tumours head trauma/ RTX kallmans syndrome drugs (steroids, opiates) ```
29
how do you manage type 1 anovulation (hypothalamic pituitary failure)
``` stabilise weight (BMI>18.5) hormone therapy (pulsatile Gnrh, gonadotrophin (FSH + LH injections) ```
30
what is the rotterdam diagnostic criteria for PCOS
oilgo/amenorrhoea polycystic ovaries clinical and or biochemical signs of hyperandrogenism (acne, hirsutism) (testosterone, sex hormone binding globulin)
31
what is the fertility 'pre treatment' for PCOS
``` weight loss smoking alcohol cessation folic acid rubella immunity check prescribed drugs semen analysis for partners (patent fallopian tube) ```
32
what can be given to cause ovulation induction in PCOS
clomifene citrate / tamoxifen (estrogenic/ anti estrogenic effects) gonadotrophin injections (directly stimulates ovaries) laparoscopic ovarian diathermy
33
why is there insulin resistance in 50-80% of PCOS patients
diminished biological response to a given level of insulin
34
how does insulin affect hormones in PCOS
acts as co-gonadotrophin to LH -elevated LH or altered LH/FSH insulin lowers sex hormone binding globulin= increased free testosterone leads to hyperandrogenism
35
what is the role of metformin in PCOS
``` can be used for ovulation induction -improves insulin resistance -reduces androgen production -increases SHBG -restores menstruation and ovulation (along with lifestyle modifications) ```
36
what medication does metformin increase the sensitivity to
clomifene
37
what are the risks of ovulation induction
ovarian hyperstimulation multiple pregnancy ?risk of ovarian cancer
38
what are the associated risks of multiple pregnancies
``` hyperemesis anaemia 4 x hypertension 3 x pre-eclampsia 3 x gestational diabetes mode of delivery (post partum haemorrhage) postnatal depression/ stress early/ late miscarriage low birth weight prematurity disability stillbirth/ neonatal death twin twin transfusion therapy ```
39
what is the biggest risk in multiple pregnancies
prematurity and low birth weight
40
what type of twins does assisted conception create
dizygotic twins
41
what twins have the lambinda sign
dichorionic
42
what twins have the T signs
monochorionic
43
what is twin twin transfusion syndrome
imbalance of vascular communication between twins
44
what are the problems associated with prematurity
intensive support, resp support, resp distress syndrome cerebral palsy impaired sight congenital heart disease
45
what are hormones like in ovarian failure
high levels of gonadotrophins, low oestrogen levels
46
what are the clinical signs of ovarian failure
amenorrhea | menopausal
47
what is premature ovarian failure
menopause before the age of 40
48
what are the causes of premature ovarian failure
genetic- turner syndrome, XX gonadal agenesis, fragile X autoimmune ovarian failure bilateral oophrectomy pelvic radio/ chemotherapy unclear
49
what is the treatment for premature ovarian failure
HRT (mainlin missing oestrogen) egg or embryo donation cryopreservation counselling/support
50
what is non-obstructive azoospermia
testicular failure
51
what are the causes of testicular failure
``` genetic: klinefelters, Y chromosome micordeletion orchidectomy/ undescended testes testicular trauma/ torsion/ mumps testicular cancer pelvic radiotherapy, chemotherapy autoimmune disease ```
52
what is the medical treatment for hyperprolactinaemia
dopamine agonist (should be stopped when pregnancy occurs)
53
what is a progesterone challenge test
menstrual bleed in response to a five day course of progesterone- indicates oestrogen levels are normal

Endocrinology (46 decks)

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