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RDS Test 1 > B8.001 Infertility: Evaluating the Infertile Couple > Flashcards

B8.001 Infertility: Evaluating the Infertile Couple Flashcards

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1
Q

infertility

A

<35 : no preg with timed intercourse for at least 1 year
>35: no preg with times intercourse for at least 6 mo
women > 40 qualify for immediate eval

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2
Q

relationship between maternal age and fertility/ aneuploidy/ live birth/ miscarriage

A

infertility increased with age, nearly exponential shape after 40
aneuploidy and miscarriage increases with age
chance of live birth decreases with age

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3
Q

prevalence of infertility

A

15% of couples

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4
Q

why might you do an earlier infertility workup

A 
irregular periods
severe endometriosis
known problems with tubes or uterus
known or suspected male subfertility
maternal age > 39
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5
Q

general steps in pregnancy

A
  1. egg release (ovulation)
  2. sperm must reach egg (fertilization)
  3. fertilized egg travels through fallopian tube
  4. implantation of fertilized egg onto inside of uterus
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6
Q

causes of infertility

A

male only 8%
female only 33%
male and female 35%
unexplained 24%

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7
Q

general process of diagnosing infertility

A 
both partners evaluated at the same time if possible
H&amp;P
preconception counseling
genetic screening
diagnostic testing
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8
Q

components of infertility diagnostic evaluation

A

ovulatory function
ovarian reserve
uterine or fallopian tube abnormalities
semen analysis

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9
Q

components of ovulatory function testing

A 
menstrual history
basal body temp
ovulation prediction kits
US monitoring
mid luteal progesterone
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10
Q

causes of WHO 1 infertility

A

stress
exercise
diet

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11
Q

causes of WHO 2 infertility

A

polycystic ovaries
hyperandrogenism
irregular menses

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12
Q

causes of WHO 3 infertility

A

fragile X
autoimmune
Turner’s
galactosemia

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13
Q

treatment of WHO 1 infertility

A

behavioral modification

gonadotropins

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14
Q

treatment of WHO 2 infertility

A

behavioral modifications

letrozole

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15
Q

treatment of WHO 3 infertility

A

hormone replacement therapy

donor oocytes

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16
Q

when would you consider ovarian reserve testing

A 
>35
tobacco use
prior ovarian surgery
prior gonadotoxin exposure
1st degree relative w menopause < 40
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17
Q

how to test ovarian reserve

A

antimullerian hormone
CD3 FSH and estradiol
antral follicle count

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18
Q

how to evaluate uterine or fallopian tube abnormalities

A

MRI
hysterosalpingogram (HSG)
saline sonogram (SIS)
hysteroscopy / laparoscopy

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19
Q

effects of chlamydia on tubal infertility

A

causes a build up of scarring that can block the fallopian tube and prevent fertilization

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20
Q

tubal HSG findings in genital TB

A 
specific:
beaded tube
golf club tube
pipestem tube
cobblestone tube
leopard skin tube
nonspecific:
hydrosalpinx
mucosal thickening
peritubal adhesion
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21
Q

uterine HSG findings in genital TB

A 
specific:
T shaped uterus
pseudounicornate uterus
trifoliate uterus
nonspecific:
endometriosis
syneciae
distortion of uterine contour
venous, lymphatic intravasation
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22
Q

how to assess male factors of infertility

A

semen analysis

  • if abnormal: abstain 2-5 days and repeat
  • if normal: assess frequency and timing of intercourse
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23
Q

workup for male factors of infertility

A 
previous fertility/infertility
sexual dysfunction
GU anomaly
previous GU surgeries
toxic exposures
occupation / lifestyle
med/ psych illnesses
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24
Q

what to assess if semen analysis is abnormal

A

-optimize medical health
-optimize psychological health
-avoid toxins
-healthy lifestyle
IF STILL ABNORMAL
-T, PRL, E2, LH, FSH
-urology consult

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25
oligospermia
low sperm concentration/ count
26
asthenospermia
low sperm motility
27
teratospermia
abnormal sperm morphology
28
steps of semen analysis
1. confirm length of abstinence (2-5 days) 2. produce semen sample 3. liquification (<1 hr on benchtop, 15-30 min at 37C) 4. basic semen analysis performed, viscosity noted
29
what can cause liquification problems
environment/ occupation
30
semen analysis parameters
``` volume > 1.5 mL pH 7.2-8.0 concentration > 15x10^6 motility >39% total motile > 40x10^6 vitality >75% morphology >4% normal WBC < 1x10^6 ```
31
sperm morphology
``` head -acrosomal vesicle -nucleus tail -midpiece w mitochondria -flagellum ```
32
artificial insemination
intrauterine insemination no male factor to mild male factor used with natural cycles in combination with ovulation induction or superovulation
33
treatment of low sperm count
IUI (total motile > 10mil) IVF (total motile < 10 mil) ICSI (total motile < 10 mil)
34
treatment of low motility/ poor forward progression
NECA (adenosine analog) | IUI
35
treatment of anti-sperm antibodies
chymotrypsin/ galactose | IUI
36
chymotrypsin
media which aids in degradation of Ab/sperm complexes | breaks down proteins in ejaculate
37
galactose
media which prevents sperm from binding to Ig
38
treatment of poor liquefaction
chymotrypsin/ chymotrypsin inhibitor | IUI
39
varicocele
swelling of veins that drain the testicle | most common reversible cause of male infertility
40
infection and male infertility
some infections can interfere with sperm production or sperm health or can cause scarring that blocks the passage of sperm some result in permanent testicular damage, but usually sperm can still be retrieved
41
examples of infections that can contribute to male infertility
epididymitis orchitis STIs: gonorrhea, HIV
42
retrograde ejaculation
semen enters the bladder during orgasm | caused by: diabetes, spinal injury, medications, surgery
43
medical causes of male infertility
``` anti sperm Abs undescended testicles hormone imbalances tumors blockage/transport tubule defect ```
44
semen without sperm or fructose
may indicate absence of the seminal vesicles, absence of the vas deferens in the areas of the seminal vesicles, or an obstruction at the level of the seminal vesicles
45
chromosomal/ genetic causes of male infertility
klinefelters (XXY) CF (blockage/absence of sperm canal) kallmann's (hypogonadotropic hypogonadism) kartagener's (dysfunctional ciliated/flagellated cells)
46
medications that can lead to male infertility
``` testosterone replacement therapy long term anabolic steroid use cancer meds certain antifungals ulcer drugs ```
47
environmental causes of male infertility
``` industrial chemicals heavy metal exposures radiation or x-rays overheating the testicles occupation (sitting, outdoor, tight clothing) ```
48
treatments for female infertility
1. ovulation induction or superovulation - letrozole - clomiphene citrate (SERM) - gonadotropins 2. surgery - correct uterine or tube abnormalities 3. intrauterine insemination - male factor or unexplained 4. IVF
49
IUI
intrauterine insemination
50
TDI
therapeutic donor insemination
51
what is IUI
fertility treatments that uses catheter to place washed sperm directly into uterus
52
IVF
in vitro fertilization
53
what is IVF
``` eggs surgically removed from ovary sperm mixed with egg outside body fertilized egg (embryo) places into uterus ```
54
prevalence of IVF
<5% of all fertility treatments
55
treatment for unexplained infertility
clomid + IUI
56
treatment for PCOS infertility
letrozole
57
treatment for bilateral tubal occlusion infertility
IVF
58
preimplantation genetic diagnosis
direct testing of IVF embryos | typically for single, inherited genetic disease
59
preimplantation genetic screening
direct testing of IVF embryos for large scale chromosome abnormalities (trisomy, deletions, duplication) recommended for advanced maternal age and recurrent pregnancy loss
60
impact of stress on chance of getting pregnant
controversial | stress reduction may improve fertility
61
preconception health
``` stop tobacco use no illicit drugs limit alcohol/caffeine maintain a healthy weight take vitamins (folic acid for women, antioxidants for men) get vaccinated Zika precautions ```
62
tobacco and fertility
smoking delays conception for more than a year lowers egg count increased risk of defects and miscarriage lowers chance for success in 3 months after cessation, sperm quality improves
63
marijuana and fertility
reduces sperm number and quality reduces testosterone production reduces number of eggs retrieved with IVF increased risk of premature delivery
64
alcohol and fertility
3 glasses of wine per day impairs fertility in men 2 glasses of wine per day impairs fertility in females decreases embryo quality increases risk of FAS in children
65
caffeine and fertility
lower live birth rates with IVF may inhibit egg maturation not a clear association
66
recessive carrier screen
recommendations vary by ethnicity blood test offered to all women pursuing pregnancy 1/30 caucasians are carriers for CF recent technology can prevent rare genetic conditions in offspring

RDS Test 1 (22 decks)

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