Clinical: Infertility and ART Flashcards Preview

Block I: Reproduction & Sexuality > Clinical: Infertility and ART > Flashcards

Flashcards in Clinical: Infertility and ART Deck (52):
1

Define infertility

Inability to conceive after 12 months of regular unprotected sexual intercourse

2

Define primary infertility

If NO previous pregnancy

3

Define secondary infertility

If previous pregnancy(ies)

4

When to investigate and/or treat infertility

  • After 12 months usually
  • After 6 months, if obvious problems (i.e. oligomenorrhea, testicular surgery, advanced age)

5

5 causes of infertility

  • Male factor
  • Anovulatory
  • Tubal factor
  • Other
  • Unexplained

6

5 possible components of a history for male factor infertility

  • Previous children
  • Surgery
  • Disease
  • Medication
  • Coital problems

7

4 points to examine for male factor infertiltiy

  • Secondary sexual characteristics
  • Testicular volume
  • Vas deferens
  • Epididymis

8

4 points to consider in seminal analysis  for male factor infertility

  • WHO criteria
  • Volume
  • Leucocytospermia
  • Antibodies

9

3 points of the WHO criteria for male factor infertility seminal analysis

  • 20 x 106/mL
  • 40% motile
  • 40% normal morphology

10

3 types of male factor infertility

  • Oligo-astheno-teratozo-spermia (80 - 90%)
  • Coital or ejaculatory failure (5 - 10%)
  • Azoospermia (5%)

11

5 tests for male factor infertility

  • Serum FSH, LH, PRL ,Testosterone
  • Karyotype
  • Scrotal US
  • Vasography
  • Testicular biopsy

12

3 things to look for in a scrotal US for male factor infertility

  • Masses
  • Varicocele
  • Absent vas

13

Treatment for obstructive male factor infertility

Reconstructive surgery or surgical sperm retrieval

14

Treatment for testicular failure male factor infertility

Donor insemination

15

Treatment for large varicocele male factor infertility

Excision

16

Treatment for hypothalamic disease male factor infertility

GnRH or FSH/LH

17

Treatment for oligo-astheno-teratozo-spermia male factor infertility

Supportive

18

4 points of history for anovulatory infertility

  • Menstrual cycle
  • Weight
  • Previous pregnancies
  • Other symptoms

19

6 points of examination for anovulatory infertility

  • BMI
  • General health
  • Thyroid disease
  • Skin/hair changes
  • Secondary sexual characteristics
  • Pelvic abnormalities (including pregnancy)

20

10 tests for anovulatory infertility

  • Mid-luteal serum progesterone (day 21)
  • Basal body temeprature charts
  • Urinary LH ovulation predictor kits
  • Pelvic US
  • Serum or urinary BhCG
  • Early follicular phase serum (day 2-5) FSH, LH, PRL
  • Serum testosterone and DHEAS
  • Serum TSH
  • Karyotype
  • Laparascopy

21

2 things to looks for in a pelvic US for anovulatory infertility

  • Follicle tracking
  • Other ovarian or uterine abnormalities

22

3 most common types of anovulatory infertility

  • Polycystic ovary syndrome (PCOS)
  • Ovarian failure
  • Hypothalamic/pituitary disorders

23

6 characteristics of PCOS anovulatory infertility

  • Anovulation
  • Normoestrogenemia
  • Mild androgenemia
  • Typical US appearance
  • Raised LH/FSH ratio
  • Often associated with hirsutism and obesity

24

3 potential causes of ovarian failure

  • Premature/age related
  • Iatrogenic
  • Turner's

25

3 hypothalamic/pituitary disorders that may cause anovulatory infertility

  • Hyperprolactinemia
  • Thyroid disease
  • Hypopituitary-hypogonadism

26

6 treatments for PCOS

  • Weight loss
  • Clomiphene citrate
  • FSH and hMG
  • Metformin
  • IVM (in vitro oocyte maturation)
  • IVF (in vitre fertilization)

27

Treatment for ovarian failure anovulatory infertility

Oocyte donation

28

Treatment for hyperprolactinemia anovulatory infertlity

Bromocriptine

29

Treatment for hypothyroidism anovulatory infertility

Thyroxine

30

Treatment ofr hypopituitary-hypogonadism anovulatory infertility

GnRH or hMG

31

4 components of history for tubal factor infertility

  • Previous pregnancies (abortions)
  • STDs
  • Previous pelvic surgery
  • Pain

32

4 components of examination for tubal factor infertility

  • Scars
  • Pelvic masses
  • Discharge
  • Fixed non-mobile uterus

33

2 tests for tubal factor infertility

Hysterosalpingogram (HSG)

Laparascopy

34

Purpose of HSG for tubal factor infertility

Determine uterine cavity anomalies and tubal patency

35

Phase of menstrual cycle in which HSG is performed

Follicular phase

36

4 disadvantages of performing HSG

  • Painful
  • Risk of infection (tubo-ovarian abscess)
  • Risk of trauma
  • Risk of pelvic irradiation

37

Purpose of laparascopy in diagnosis of tubal factor infertility

  • Allows direct visualization of the tubes and assesses the nature and site of any disease or blockage

38

2 potential surgical morbidities of laparoscopy for tubal factor infertility

  • Visceral damage
  • Laparotomy

39

3 types of treatments for tubal factor infertility

  • Surgical
  • Radiological
  • IVF

40

3 surgical treatments for tubal factor infertility

  • Tuboplasty
  • Salpingostomy
  • Microsurgical anastamosis

41

Radiological treatment for tubal factor infertility

Selective tubal catheterization

42

WHen is surgical treatment appropriate for tubal factor infertility

Young, monopolar disease, non other factors

43

When is radiological treamtent for tubal factor infertility important

Young, cornual-only disease

44

4 possible causes of unexplained infertility

  • Cervical mucus hostility
  • Endometriosis
  • Fibroids
  • Subtle ovulatory, male factor and tubal factor infertility

45

3 characteristics of unexplained fertility

Normal SA, HSG and ovulation

46

5 treatments for unexplained infertility

  • Reassure (50% pregnant within 3 years)
  • Clomiphene citrate (to help ovulation?)
  • IUI (intra-uterine insemination)
  • IVF
  • IVF/ICSI

47

4 tests that couples being examined for infertility require

  • Seminal analysis
  • D21 (mid-luteal) serum progesterone
  • Pelvic ultrasound
  • Hysterosalpingogram

48

Define assisted reproduction

Procedures which involve gamete manipulation

49

5 types of assisted reproduction

  • IUI
  • IVF +/- ICSI
  • IVM
  • TESA/PESA
  • Gamete donation (sperm, oocyte, embryo)

50

5 situations in which IUI is indicated

  • Unexplained infertility
  • Coital dysfunction
  • Mild male factor infertility (over 5million/mL)
  • Failed ovulation induction
  • Endometriosis

51

6 situations in which IVF is indicated

  • Tubal disease
  • Male factor infertility (ICSI)
  • Endometriosis
  • Unexplained infertility
  • Anovulatory infertiltiy (non-responsive)
  • Congenital disease (PGD)

52

3 situations in which IVM is indicated

  • Polycystic ovaries (needing IVF)
  • Contra-indications to ovarian stimulation (i.e. cancers, previous OHSS)
  • Repeated poor embryo quality with IVF