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

Clinical: Infertility and ART Flashcards

(52 cards)

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1
Q

Define infertility

A

Inability to conceive after 12 months of regular unprotected sexual intercourse

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2
Q

Define primary infertility

A

If NO previous pregnancy

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3
Q

Define secondary infertility

A

If previous pregnancy(ies)

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4
Q

When to investigate and/or treat infertility

A
  • After 12 months usually
  • After 6 months, if obvious problems (i.e. oligomenorrhea, testicular surgery, advanced age)
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5
Q

5 causes of infertility

A
  • Male factor
  • Anovulatory
  • Tubal factor
  • Other
  • Unexplained
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6
Q

5 possible components of a history for male factor infertility

A
  • Previous children
  • Surgery
  • Disease
  • Medication
  • Coital problems
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7
Q

4 points to examine for male factor infertiltiy

A
  • Secondary sexual characteristics
  • Testicular volume
  • Vas deferens
  • Epididymis
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8
Q

4 points to consider in seminal analysis for male factor infertility

A
  • WHO criteria
  • Volume
  • Leucocytospermia
  • Antibodies
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9
Q

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

A
  • 20 x 106/mL
  • 40% motile
  • 40% normal morphology
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10
Q

3 types of male factor infertility

A
  • Oligo-astheno-teratozo-spermia (80 - 90%)
  • Coital or ejaculatory failure (5 - 10%)
  • Azoospermia (5%)
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11
Q

5 tests for male factor infertility

A
  • Serum FSH, LH, PRL ,Testosterone
  • Karyotype
  • Scrotal US
  • Vasography
  • Testicular biopsy
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12
Q

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

A
  • Masses
  • Varicocele
  • Absent vas
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13
Q

Treatment for obstructive male factor infertility

A

Reconstructive surgery or surgical sperm retrieval

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14
Q

Treatment for testicular failure male factor infertility

A

Donor insemination

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15
Q

Treatment for large varicocele male factor infertility

A

Excision

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16
Q

Treatment for hypothalamic disease male factor infertility

A

GnRH or FSH/LH

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17
Q

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

A

Supportive

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18
Q

4 points of history for anovulatory infertility

A
  • Menstrual cycle
  • Weight
  • Previous pregnancies
  • Other symptoms
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19
Q

6 points of examination for anovulatory infertility

A
  • BMI
  • General health
  • Thyroid disease
  • Skin/hair changes
  • Secondary sexual characteristics
  • Pelvic abnormalities (including pregnancy)
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20
Q

10 tests for anovulatory infertility

A
  • 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
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21
Q

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

Study These Flashcards
A
  • Follicle tracking
  • Other ovarian or uterine abnormalities
22
Q

3 most common types of anovulatory infertility

Study These Flashcards
A
  • Polycystic ovary syndrome (PCOS)
  • Ovarian failure
  • Hypothalamic/pituitary disorders
23
Q

6 characteristics of PCOS anovulatory infertility

Study These Flashcards
A
  • Anovulation
  • Normoestrogenemia
  • Mild androgenemia
  • Typical US appearance
  • Raised LH/FSH ratio
  • Often associated with hirsutism and obesity
24
Q

3 potential causes of ovarian failure

Study These Flashcards
A
  • 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

Block I: Reproduction & Sexuality (23 decks)

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