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Assessment of Infertility Flashcards

(48 cards)

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1
Q

name 6 possible factors contributing to infertility?

A 
older women
rise in increase in chlamydia infections
increase in obesity
increasing male factor infertility (reduced sperm quality, increase testicular cancer rate etc)
increasing awareness of treatments
change in expectations
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2
Q

what are the chances of getting pregnant?

A

at 6 months = 75%
at 12 months = 90%
at 2 years = 95%

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3
Q

what is infertility?

A

failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse (in absence of a known reason) in a couple who have never had a child

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4
Q

primary vs secondary infertility?

A 
primary = couple never conceived
secondary = couple previously conceived although pregnancy may not have been successful (e.g miscarriage, ectopic etc)
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5
Q

what factors can increase chances of conception?

A 
woman under 30
previous pregnancy
less than 3 years trying to conceive
intercourse occurring around ovulation
womans BMI between 18.5-30
caffeine intake less than 2 cups of coffee per day
no use of recreational drugs
both partners non smokers
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6
Q

when does age of mother peak and dip for conception?

A

peaks around 20-24 (around up to 30)

lowest after 40 (very common to miscarry if over 45)

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7
Q

what is anovulatory infertility?

A

infertility due to lack of ovulation

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8
Q

physiological causes for anovulatory infertility?

A

before puberty
pregnancy
lactation
menopause

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9
Q

gynaecological causes for anovulatory infertility?

A

hypothalamic (anorexia,bulimia, excessive exercise)
pituitary (hyperprolactinaemia, tumours, sheehan syndrome)
ovarian (PCOS, premature ovarian failure)

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10
Q

other causes of anovulatory infertility?

A 
systemic disorder (chronic renal failure)
endocrine disorder (testosterone secreting tumours, congenital adrenal hyperplasia, thyroid)
drugs (Depo-Provera, explanon, OCP)
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11
Q

clinical features of anorexia?

A 
BMI <18.5
loss of hair
increase lanugo
low pulse and BP
anaemia
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12
Q

endocrine features of anorexia?

A

low FSH
low LH
low oestradiol

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13
Q

what can cause polycystic ovary syndrome?

A

inherited

weight gain can exacerbate

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14
Q

clinical features of polycystic ovary syndrome?

A

obesity
hirtutism or acne
cycle abnormalities
infertility

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15
Q

endocrine features of polycystic ovary syndrome?

A

high free androgens
high LH
impaired glucose tolerance

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16
Q

how is polycystic ovary syndrome diagnosed?

A

2 out of:

  • chronic anovulation
  • polycystic ovaries
  • hyperandrogenism (clinical or biochemical)
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17
Q

what can cause premature ovarian failure?

A 
idiopathic
genetic (turners syndrome, fragile X)
chemotherapy
radiotherapy
oophorectomy
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18
Q

what are the clinical and endocrine features of premature ovarian failure?

A 
hot flushes
night sweats
atrophic vaginitis
high FSH
high LH
low oestradiol
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19
Q

name 3 infective causes of tubal disease in females

A 
pelvic inflammatory disease (chlamydia and other STD etc)
transperitoneal spread of appendicitis, intra-abdominal abscess etc
following procedure (IUCD insertion, hysteroscopy, HSG)
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20
Q

name 6 non-infective causes of tubal disease in females?

Study These Flashcards
A 
endometriosis
surgical (sterilisation, ectopic pregnancy)
fibroids
polyps
congenital
salpingitis isthmica nodosa
21
Q

what are the clinical features of hydrosalpinx due to pelvic inflammatory disease?

Study These Flashcards
A 
abdominal/pelvic pain febrile
vaginal discharge dyspareunia
cervical excitation menorrhagia
dysmenorrhoea
infertility
ectopic pregnancy
22
Q

what is endometriosis?

Study These Flashcards
A

presence of endometrial glands outside uterine cavity

23
Q

aetiology of endometriosis?

Study These Flashcards
A

retrograde menstruation is most likely cause
altered immune function
abnormal cellular adhesion molecules
genetic

24
Q

what are the clinical features of endometriosis?

Study These Flashcards
A 
dysmenorrhoea (usually before menstruation)
dyspareunia
menorrhagia
painful defaecation
chronic pelvic pain
uterus may be fixed and retroverted
scan may show characteristic "chocolate cysts" on ovary
infertility
asymptomatic
25
endocrine causes of male infertility?
hypogonadotropic hypogonadism hypothyroidism hypoprolactinaemia diabetes
26
genetic causes of males infertility?
kleinfelter syndrome Y chromosome deletion immotile cilia syndrome
27
other physical causes of male infertility?
``` erectile dysfunction ejaculatory failure testicular torsion varicocele undescended testes heat, radiation, tight clothing around testes obstructive ```
28
drugs causing male infertility?
smoking (tobacco and marijuana) anabolic steroids testosterone supplements
29
give 4 non-obstructive causes of male infertility
``` XXY genotype chemotherapy radiotherapy undescended testes idiopathic ```
30
what are the clinical and endocrine features of non-obstructive male infertility?
``` low testicular volume reduced secondary sexual characteristics vas deferens present high LH, FSH low testosterone ```
31
name 3 obstructive causes of male infertility
congenital absence (cystic fibrosis) infection vasectomy
32
what are the clinical and endocrine features of obstructive male infertility?
normal testicular volume normal secondary sexual characteristics vas deferens may be absent normal LH, FSH and testosterone
33
important aspects of female examination in fertility clinic?
BMI general exam assessing body hair distribution and galactorrhoea pelvic examination assessing for uterine and ovarian abnormalities/tenderness/mobility
34
important aspects of male examination in fertility clinic?
BMI general exam genital examination assessing size/position of testes, penile abnormalities. presence of vas deferens and presence of varicoceles
35
what investigations can be done in females?
endocervical swab for chalmydia cervical smear if due bloods for rubella immunity midluteal progesterone level test of tubal patency (hysterosalpingiogram or laparoscopy) others if indicated (hysteroscopy, US, endocrine profile and chromosomes)
36
how is mid luteal progesterone level measured?
day 21 of 28 day cycle or 7 days prior to extended period in longer cycles progesterone > 30nml/L is suggestive of ovulation
37
when is a hysterosalpingiogram used to assess tubal patency?
if no known risk factors tubal/pelvic pathology | if laparoscopy contraindicated (i.e obesity, previous pelvic surgery, crohns)
38
when is a laparoscopy used to test tubal patency?
possible tubal/pelvic disease (e.g PID) known previous pathology (e.g ectopic pregnancy, ruptured appendix, endometriosis) history suggestive of pathology previously abnormal HSG
39
when is a hysteroscopy used?
only used in cases where suspected or known endometrial pathology (i.e uterine septum, adhesions, polyps)
40
when might a pelvic US be used?
when abnormality on pelvic examination (enlarged uterus/adnexal mass) when required from other investigations (polyp seen at HSG etc)
41
what endocrine tests should be done if anovulatory or infrequent periods?
``` urine HCG prolactin TSH testosterone and SHBG LH, FSH and oestradiol ```
42
what endocrine tests should be done if hirsutism present?
testosterone | SHBG
43
what endocrine tests should be done if amenorrhoea be done?
``` endocrine profile (as in an anovulatory cycle) chromosome analysis ```
44
investigations in male infertility?
history examination (general and genitalia) semen analysis - twice over 6 weeks apart
45
what semen parameters are commonly used in semen analysis?
``` volume pH concentration motility morphology WBC ```
46
what assessments are done is semen analysis is abnormal?
LH and FSH testosterone prolactin thyroid function
47
what assessments should be done if semen analysis is severely abnormal?
endocrine profile (same as abnormal semen) chromosomal analysis and Y chromosome microdeletions screen for CF testicular biopsy
48
what assessment should be done if an abnormality if found on male genital examination?
scrotal US

Endocrine (45 decks)

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