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O&G > Fertility > Flashcards

Fertility Flashcards

1
Q

What is Ovarian Hyperstimulation Syndrome

A
  • Complication of infertility treatment that promote the development of eggs in the ovaries
  • Due to multiple developing luteinised ovarian cysts.
  • release of oestrogens, progresterones and VEGf
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2
Q

What are the features of ovarian hyperstimulation syndrome

A 
Abdominal pain and bloating
Nausea and vomiting
Diarrhoea
Hypotension
Ascites
Reduced urine output
Prothrombotic state with risk of VTE
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3
Q

Whats the management of OHS

A
  • Supportive and treating the complications (e.g. ascitic drainage and anticoagulation).
  • They may require admission to ICU in severe / critical cases.
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4
Q

What is the normal amount of time to conceive

A

85% will conceive within a year of regular unprotected sex. 1 in 7 couples will struggle to conceive naturally.

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5
Q

when should you refer for infertility investigations

A
  • 12 months of trying

- 6 months if the woman is >35

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6
Q

What are the causes of infertility

A
  • Sperm problems (30%)
  • Ovulation problems (25%)
  • Tubal problems (15%)
  • Uterine problems (10%)
  • Unexplained (15%)
  • 40% of infertile couples have a mix of male and female causes of infertility.
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7
Q

What general advice should you give regarding fertility

A
  • 400mcg folic acid daily
  • healthy BMI
  • Avoid smoking and drinking excessive alcohol
  • Have intercourse 2-3 times a week.
  • “Timed intercourse” to coincide with ovulation is not necessary or recommended
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8
Q

What investigations should you complete when looking at fertility

A
  • BMI
  • Anti-Mullarian hormone can be measured at any time during the cycle
  • Serum LH and FSH on Day 2-5
  • Serum progesterone on Day 21
  • Ultrasound pelvis
  • Hysterosalpingogram
  • Laparoscopy and dye test
  • Semen analysis
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9
Q

What may an abnormal BMI indicate regarding fertility

A
  • Low: anovulation

- High PCOS

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10
Q

What may an abnormal FSH/LH indicate regarding fertility

A
  • High FSH suggests poor ovarian reserve

- high LH suggests PCOS / ovarian failure.

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11
Q

What may an abnormal serum progesterone indicate regarding fertility

A

A rise indicates that ovulation has occurred and the corpus luteum has formed and started secreting progesterone.

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12
Q

What may an abnormal anti-mullarian hormone indicate regarding fertility

A
  • most accurate maker of ovarian reserve (the number of follicles that the woman has left in her ovaries)
  • released by the granulosa cells in the follicles and falls as the eggs are used up.
  • Low level indicates poor ovarian reserves
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13
Q

Why might you do an US pelvis for fertility

A
  • look for structural abnormalities of the uterus

- look of PCOS

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14
Q

Why might you do an Hysterosalpingogram for fertility

A

check the patency of the fallopian tubes

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15
Q

Why might you do a Laparoscopy and dye test for fertility

A

look at the patency of the fallopian tubes, adhesions and endometriosis.

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16
Q

What is Hysterosalpingogram

A
  • scan used to assess the shape of the uterus and the patency of the fallopian tubes
  • Seems to have therapeutic benefit
  • tubal cannulation under X-ray guidance during the procedure to open up the tubes.
17
Q

How is a Hysterosalpingogram done

A
  • small tube is inserted into the cervix
  • contrast medium is injected through the tube and fills the uterine cavity and fallopian tubes
  • X-ray images are taken giving an outline of the uterus and tubes.
  • If the dye does not fill one of the tubes, then a tubal obstruction can be diagnosed
18
Q

What are the risks of a Hysterosalpingogram

A

-infection: often antibiotics are given prophylactically for patients with dilated tubes or a history of pelvic infections. - Screening for chlamydia and gonorrhoea should be done before the procedure.

19
Q

What is the Laparoscopy and dye test

A
  • dye can be injected into the uterus and should be seen entering the fallopian tubes and spilling out at the ends of the tube when they are patent
  • During laparoscopy the surgeon can also assess for endometriosis or pelvic adhesions and treat these.
20
Q

How do you manage anovulation

A
  • Ovarian drilling: PCOS
  • Clomifene to stimulate ovulation.
  • Letrozole can be used instead of clomifene to stimulate ovulation. It is also an anti-oestrogen (an aromatase inhibitor).
  • Gonadotrophins
  • Metformin
21
Q

What is clomifene

A
  • anti-oestrogen (a selective oestrogen receptor modulator).
  • given day 2-6 of the cycle and stops the negative feedback of oestrogen on the hypothalamus, resulting in greater release of GnRH and subsequently FSH and LH.
  • Stimulates ovulation
22
Q

Why give metformin for anovulation

A

can be used when there is insulin insensitivity and obesity (usually associated with PCOS). It improves these conditions making normal ovulation more likely.

23
Q

How do you manage tubal infertility

A
  • Tubal cannulation during a hysterosalpingogram
  • Laparoscopy to remove adhesions or endometriosis
  • In Vitro Fertilisation
24
Q

How do you manage infertility as a result of uterine abnormalaties

A

Surgery to correct polyps, adhesions or structural abnormalities.

25
Q

How do you manage sperm infertility problems

A
  • Surgical Sperm Retrieval.
  • Intra-Uterine Insemination.
  • Intracytoplasmic Sperm Injection (ICSI).
26
Q

What is surgical sperm removal

A
  • blockage somewhere along the vas deferens preventing sperm from reaching the ejaculated semen.
  • A needle and syringe is used to collect sperm directly from the epididymis.
27
Q

What is inta-uterine insemination

A
  • This involves collecting and separating out high quality sperm, then injecting them directly into the uterus to give them the best chance of success.
  • It is unclear whether this is any better than normal intercourse.
28
Q

What is intracytoplasmic sperm injection (ICSI)

A
  • Sperm are injected directly into the cytoplasm of an egg. - These fertilised eggs are then injected into the uterus of the woman.
  • This is useful when there are significant motility and other issues with the sperm.
29
Q

What is in vitro fertilisation

A
  • This involves fertilising an egg in the lab, and then injecting these fertilised eggs into the uterus.
  • There are many steps along the way and it is a complicated and expensive process.
  • As a result funding criteria are very strict and vary between different areas and couples are limited to a set number of cycles.
  • Each cycle has a roughly 30% success rate.
30
Q

What are you looking at when conducting semen analysis

A

This tests the volume and quality of the semen and sperm.

31
Q

What advice should you give men undergoing semen analysis

A
  • Abstain from ejaculation 3-5 days
  • Avoid hot baths / sauna / tight underwear during the lead up to providing a sample.
  • Attempt to catch the full sample.
  • Deliver the sample to the lab within 1 hour of ejaculation.
  • Keep the sample warm (e.g. in underwear) prior to delivery.
32
Q

What factors may affect the result of semen analysis

A 
Both baths
Tight underwear
Smoking
Alcohol
Raised BMI
Caffeine
33
Q

What factors do they look at when analysing sperm

A
  • Semen volume (more than 1.5ml)
  • pH of semen (>7.2)
  • Concentration of sperm (more than 15 million per ml)
  • Total number of sperm (more than 39 million per sample)
  • “Motility” of sperm (more than 40% of sperm are mobile)
  • “Vitality of sperm (more than 58%)
  • Percentage of normal sperm (more than 4%)

O&G (13 decks)

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