Endo - Infertility

Question 1

What is infertility?

Answer 1

disease of the reproductive system defined by the failure to achieve after >12 months of regular unprotected sexual intercourse (every 2-3 days)

Question 2

What is primary infertility?

Answer 2

when you haven’t had a live birth previously (miscarriage doesn’t count)

Question 3

What is secondary infertility?

Answer 3

when you have had a live birth > 12 months previously

Question 4

What are the most common cause of infertility in a couple?

Answer 4

→ female factor (30%)
→ male factor (30%)
→ combination of male and female factor (30%)
→ unknown factors (10%)

Question 5

How does infertility psychologically affect couples?

Answer 5

psychological distress

Question 6

How does infertility affect society?

Answer 6

→ less births
→ less tax income
→ investigation costs
→ treatment costs

Question 7

What are the 3 different types of infertility cause in men?

Answer 7

→ pre-testicular
→ testicular
→ post-testicular

Question 8

What are pre-testicular causes of infertility in men?

Answer 8

congenital + acquired endocrinopathies

Question 9

What are testicular causes of infertility in men?

Answer 9

→ conegnital
→ cryptorchidism
→ STDs, infections
→ immunological
→ vascular
→ trauma/surgery
→ toxins (chemo, dxt, drugs, smoking)

Question 10

What are post-testicular causes of infertility in men?

Answer 10

→ congenital
→ obstructive azoospermia
→ erectile dysfunction
→ iatrogenic

Question 11

What is cryptorchidism?

Answer 11

undescended testes

Question 12

What are the 6 main causes of infertility in females?

Answer 12

Question 13

What are the ovarian causes of infertility in females?

Answer 13

→ anovulation (endo)

→ corpus luteum insufficiency

Question 14

What are the pelvic causes of infertility in females?

Answer 14

→ endometriosis

→ adhesions

Question 15

What are the tubal causes of infertility in females?

Answer 15

→ tubopathy due to infection, endometriosis, trauma

Question 16

What are the uterine causes of infertility in females?

Answer 16

unfavourable endometrium due to:
→ chronic endometriosis (TB)
→ fibroids
→ adhesions
→ congenital malformation

Question 17

What are the cervical causes of infertility in females?

Answer 17

ineffective sperm penetration due to:
→ chronic cervicitis
→ immunological (antisperm AB)

Question 18

What is endometriosis?

Answer 18

presence of functioning endometrial tissue outside the uterus

Question 19

What are the symptoms of endometriosis?

Answer 19

→ more menstrual pain
→ menstrual irregularities
→ deep dyspareunia (pain during sex)
→ infertility

Question 20

How is endometriosis treated?

Answer 20

→ hormonal
→ laparascopic ablation
→ hysterectomy
→ bilateral salpingo-oophorectomy

Question 21

What are fibroids?

Answer 21

benign tumours of the myometrium

Question 22

What are the symptoms of fibroids?

Answer 22

→ usually asymptomatic
→ increased menstrual pain
→ menstrual irregularities
→ deep dyspareunia
→ infertility

Question 23

How are fibroids treated?

Answer 23

→ hormonal (continuous OCP, prog, continuous GNRH agonists)

→ hysterectomy

Question 24

What male infertility causes are a result of low GNRH?

Answer 24

→ congenital hypogonadotrophic hypogonadism
→ acquired HH
→ hyperprolactinaemia

Question 25

What male infertility causes are a result of low LH / FSH?

Answer 25

→ hypopituitarism (tumour, infiltration, apoplexy, surgery, radiation)

Question 26

What male infertility causes are a result of low testosterone?

Answer 26

→ congenital primary hypogonadism | → acquired primary hypogonadism

Question 27

What is Kallmann syndrome?

Answer 27

failure of migration of GNRH neurones with olfactory fibres | → can cause anosmia

Question 28

What are the reproductive features of Kallmann syndrome?

Answer 28

``` → cryptorchidism → failure of puberty → lack of testicle development → micropenis → primary amenorrhoea → infertility ```

Question 29

How do hormone levels present in Kallmann's syndrome?

Answer 29

low GNRH, LH, FSH, TESTOSTERONE

Question 30

What is hyperprolactinaemia?

Answer 30

too much prolactin

Question 31

How does hyperprolactinaemia cause infertility?

Answer 31

→ prolactin binds to prolactin receptors on kisspeptin neurons in hypothalamus → inhibits kisspeptin release → decreases the downstream of hormones

Question 32

How is hyperprolactinaemia treated?

Answer 32

→ dopamine agonist (e.g. cabergoline) | → surgery

Question 33

What is Klinefelter Syndrome?

Answer 33

→ sex chromosome disorder | → XXY

Question 34

How does Klinefelter Syndrome present physically?

Answer 34

Question 35

How does Klinefelter Syndrome present hormally?

Answer 35

→ high GNRH → high LH + FSH → low testosterone

Question 36

What are three stages of diagnosis for infertility?

Answer 36

→ history → examination → main investigations

Question 37

What do you look for when taking a history for male infertility?

Answer 37

including duration, previous children, pubertal milestones, associated symptoms (eg. T deficiency, PRL symptoms, CHH features), medical & surgical history, family history, social history, medications/drugs

Question 38

What do you look for during examination for male infertility?

Answer 38

including BMI, sexual characteristics, testicular volume, epididymal hardness, presence of vas deferens, other endocrine signs, syndromic features, anosmia

Question 39

What are the main investigations done when looking for causes of male infertility?

Answer 39

→ semen analysis → blood tests (looking for LH, FSH, PRL, morning fasting T, SHBG (sex hormone binding globulin), albumin, iron studies, pituitary/thyroid profile, karotyping) → microbiology (urine test, chlamydia swab) → imaging (scrotal US, MRI pituitary)

Question 40

What are the general lifestyle treatments for male infertility?

Answer 40

→ optimise BMI → smoking cessation → alcohol reduction

Question 41

What are the specific treatments for male infertility?

Answer 41

→ dopamine agonist for hyperPRL → gonadotrophin treatment for fertility → testosterone → surgery

Question 42

What female infertility causes are a result of low GNRH?

Answer 42

→ congenital → acquired → hyperprolactinaemia

Question 43

What female infertility causes are a result of low LH / FSH?

Answer 43

→ hypopituitarism (tumour, infiltration, apoplexy, surgery, radiation)

Question 44

What female infertility causes are a result of high LH / FSH?

Answer 44

PCOS

Question 45

What female infertility causes are a result of low E2?

Answer 45

→ congenital primary hypogonadism | → acquired primary hypogonadism

Question 46

What is premature ovarian failure?

Answer 46

early menopause

Question 47

What are the causes of premature ovarian failure?

Answer 47

→ autoimmune → genetic → cancer therapy

Question 48

What is PCOS?

Answer 48

polycystic ovarian syndrome

Question 49

How is PCOS diagnosed?

Answer 49

rotterdam diagnostic criteria (2 out of 3): → oligo or anovulation → clinical or biochemical hyperandrogenism → polycystic ovaries

Question 50

How is PCOS treated?

Answer 50

→ metaformin → OCP → diet + lifestyle → progesterone courses

Question 51

What is Turners Syndrome?

Answer 51

→ sex chromosome disorder | → X

Question 52

How does Turner's Syndrome present physically?

Answer 52

Question 53

What do you look for in a history for female infertility?

Answer 53

``` including duration previous children pubertal milestones breastfeeding? Menstrual History: oligomenorrhoea or 1/20 amenorrhoea, associated symptoms (eg. E deficiency, PRL symptoms, CHH features) medical & surgical history family history social history medications/drugs ```

Question 54

What do you look for in an examination for female infertility?

Answer 54

Question 55

What are the main investigations for female infertility?

Answer 55