Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Gynaecology > Fertility > Flashcards

Fertility Flashcards

(69 cards)

Start Studying
1
Q

1st

A

1st

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

When are a couple ‘subfertile’

A

If conception has not occurred after a year of regular unprotected intercourse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What % of couples are ‘subfertile’?

A

15%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What % of fertility problems are due to anovulation?

A

30%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What % of fertility problems are due to male problems?

A

25%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What % of fertility problems are due to fallopian tube damage?

A

25%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What % of fertility problems are due to coital problems?

A

5%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are 30% of fertility problems?

A

30% are unexplained

Total adds up to more than 100% because more than one is often present

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What 3 investigations can be done for ovulation

A

1) Progesterone serum levels rise in mid-luteal phase suggests ovulation has occurred eg. day 21 of 28 day cycle or day 28 of a 35 day cycle
2) US monitor follicular growth (often not performed as time consuming)
3) Urine predictor kits to indicate if LH surge has taken place

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What % of fertility problems are due to cervical problems?

A

Less than 5%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is needed to diagnose PCOS? x3

A

Two or more out of

1) PCO on USS
2) Irregular periods (>35 days apart)
3) Hirsutism - clinical (acne/excess body hair) or biochemical (raised serum testosterone)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What can occur in some women around the time of ovulation?

A

Increase vaginal discharge
Spotting
Pelvic pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Examination signs of ovulation

A

Temperature normally drops 0.2 degrees preovulation and then rises 0.5 degrees in luteal phase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the only concrete proof of ovulation

A

Conception

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What % of women have PCO

A

20%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Other drug treatment for PCOS symptoms

A

Metformin to reduce insulin levels and therefore androgens and hirsutism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What influences susceptibility to PCOS?

A

Genetics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the first step in pathology of PCOS?

A

Disordered LH production and peripheral insulin resistance - compensatory raised insulin levels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the effect of raised insulin and LH in PCOS?

A

Raised insulin and LH causes ovaries to increase androgen production
Insulin also increases adrenal androgen production and reduce hepatic production of steroid hormone binding globulin - therefore increased free androgen levels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What do increased androgen levels in PCOS lead to?

A

Disrupt folliculogenesis leading to excess small ovarian follicles and irregular or absent ovulation
Also cause hirsutism (acne and body hair)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

How does weight influence pathology of PCOS?

A

Increased body weight leads to increased insulin and consequently androgen levels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are health complications of PCOS?

A

50% develop type II diabetes in later life

30% develop gestational diabetes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Treatment of symptoms in PCOS if fertility not required x2

A

COC- will regulate menstruation and treat hirsutism

Cyproterone acetate or spironolactone - treat hirsutism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Ovarian causes of anovulation (other than PCOS)? x3

A

Premature ovarian failure
Gonadal dysgenesis
Luteinized unruptured follicle syndrome - egg never released - unlikely to occur every month

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Topical drug used in PCOS?
Eflornithine - topical antiandrogen used for facial hirsutism
26
How does hypothalamus cause anovulation?
Reduced GnRH release leads to amennorhoea because of reduced stimulation of pituitary therefore reduced FSH and LH and in turn reduced oestradiol
27
In whom is hypothalamic hypogonadism common?
Women with AN | Women on diets, athletes and those under stress
28
Medical cause of hypothalamic hygonadism
Kallmann's syndrome - GnRH secreting neurones fail to develop
29
How does pituitary cause anovulation?
Hyperprolactinaemia reduces GnRH release - eg. benign tumour or hyperplasia of pituitary cells
30
What do women with hyperprolactinaemia commonly have
Oligomenorrhoea or amenorrhoea with galactorrhoea and SOL signs if pituitary tumour
31
How does pituitary damage cause anovulation?
Reduced FSH and LH release - GnRH is normal - eg. Sheehans syndrome
32
First line to treat anovulation in PCOS?
Clomifene - limited to 6months use - antioestrogen working on hypothalamus and pituitary receptors therefore increases release of LH and FSH
33
Problem with Clomifene which means ovulation rate (70%) is higher than live birth rate (40%)
Oestrogenic therefore it thins the endometrium
34
Risk with clomifene
Risk of multiple pregnancy
35
Second line drug for ovulation in PCOS
Metformin - often used in clomifene-resistant patients to increase their response (also treats hirsutism)
36
Surgical treatment for PCOS
Laparoscopic ovarian diathermy
37
What can be used to induce ovulation in PCOS if clomifene has failed and if weight is normal
Purified or recombinant FSH or LH - daily SC Injections in a dose step-up regimen until ovaries begin to respond Or GnRH pump SC
38
What is a complication of gonadotrophin stimulation treatment
Ovarian hyperstimulation syndrome (OHSS) - very large and painful follicles (more common during IVF than standard ovulation induction)
39
Risk factors for OHSS x4
Gonadotrophin stimulation Younger than 35 Previous OHSS Polycystic morphology on US
40
Where does LH act on in testis
Leydig cells to produce testosterone
41
What do FSH and testosterone act on in testis?
Sertoli cells - involved in synthesis and transport of sperm
42
What is needed for semen analysis?
Sample should be produced by masturbation with last ejaculation occurring 2-7 days previously Sample analysed within 1-2h of production
43
What should be done if semen analysis is abnormal?
Repeat after 12 weeks
44
General advice for male subfertility
Drug exposures | Loose clothing and testicular cooling
45
What is azoospermia
No sperm in semen sample
46
What is oligospermia
Less than 15million/ml
47
What is severe oligospermia
Less than 5million/ml
48
Causes of abnormal semen anaylsis
Unknown Drugs: smoking/alcohol/drugs (Sulfasalazine or steroids) /chemicals exposure Impaired cooling Antisperm antibodies - common after vasectomy reversal Infections Varicocele Genetic abnormalities (XXY)
49
Indications for assisted conception x6
``` All/any other methods have failed Unexplained subfertility Male factor subfertility (ICSI) Tubal blockage (standard IVF) Endometriosis Genetic disorders ```
50
What does high FSH and LH and low testosterone imply with male subfertility
Primary testicular failure - may be associated with cryptorchidism
51
Options if male subfertility is not treatable
Intrauterine insemination if mild-moderate dysfunction | IVF if more severe - ICSI or donor sperm
52
Law with contacting sperm/egg donors
Children can contact donor from age of 18 - therefore there is a national shortage of donors
53
Causes of tubal damage leading to subfertility
PID Endometriosis Previous pelvic surgery can lead to adhesion formation
54
Cervical problems causes subfertility
Antibody production by the women - antibodies agglutinate and kill the sperm Infection in the vagina or cervix that prevent mucus production Cone biopsy for carcinoma
55
Detection of female structural problems
Laparoscopy and dye test - to visualise and assess tubes | Hysterosalpingogram - contrast inserted through cervix
56
What is IUI
Intrauterine insemination - washed sperm injected directly into uterus - can be performed in normal cycle but more success if gonadotrophin ovulation induction first
57
Who is IUI suitable for?
Couples with unexplained subfertility, cervical, sexual and some male factors
58
Fors and againsts of IUI
Much cheaper | Less successful
59
What is needed for IUI
Patent tubes for oocyte to reach sperm | Cycles need to be regular and ovulatory
60
What is IVF
Fertilised outside uterus and then transferred back
61
What does recipient need in ooctye donation?
Oestrogen and progestrone to prepare endometrium for transfer of fresh embryos
62
Who is IVF suitable for?
Don't need patent tubes | Need normal ovarian reserve so that sufficient oocytes can be collected
63
How is ovarian reserve assessed for IVF?
Used to be FSH but now AMH is much better - produced by ovary therefore direct measure of reserve
64
Complications with egg collection in IVF
Intraperitoneal haemorrhage and pelvic infection
65
Fertilisation, culture and transfer stage of IVF details
Eggs incubated with washed sperm and transferred to growth medium Cultured until cleavage (day 2-3) or blastocyst (day 5-6) stage and then transcervical uterine transfer Spares can be frozen - traditionally 2 cleavage embryos are transferred or single blastocyst Then progesterone or hCG given until 4-8 weeks gestation
66
What is ICSI?
Intracytoplasmic sperm injection - sperm injected into oocyte cytoplasm Useful for male factor infertility
67
What is PGD
Preimplantation genetic diagnosis - day 3 embryos contain about 8 cells - one or two removed and tested for genetic abnormalities with PCR
68
Who is PGD good for?
Couples who are carriers of single gene defects eg. cystic fibrosis Chromosome translocations therefore high risk of aneuploidy Sexing for male affected disease eg.haemophilia Older women >37 can have all embryos screened for abnormal ones
69
What is asthenospermia
Absent or low motility

Gynaecology (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions