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ENDOCRINOLOGY 2 > INFERTILITY > Flashcards

INFERTILITY Flashcards

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1
Q

What is the definition of infertility?

A

A disease of the reproductive system defined by the failure to achieve a clinical pregnancy after >= 12 months of regular unprotected sex

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2
Q

What is the difference between primary and secondary infertility?

A

Primary - no live births previously

Secondary - have had a live birth > 12 months previously

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3
Q

What is the proportion of couples who have infertility?

A

1 in 7 but then half of these will conceive in the next 12 months

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4
Q

What are the costs of infertility to society?

A

Less births
Less tax income
Investigation costs
Treatment costs

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5
Q

What is a pre-testicular cause of infertility in men?

A

Congenital and acquired endocrinopathies

e.g. Kilinefelters

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6
Q

What are the testicular causes of infertility in men?

A 
Congenital
Cryptorchidism
Infection (STDs)
Immunological (antisperm antibodies)
Vascular (varicocoele)
Trauma/surgery
Toxins (chemo/drugs/smoking)
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7
Q

What are some post-testicular causes of infertility in men?

A

Congenital
Obstructive azoospermia
Erectile dysfunction (retrograde ejaculation, mechanical impairment)
Latrogenic (vasectomy)

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8
Q

What is cryptorchidism?

A

Undescended testes through inguinal canal

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9
Q

List the 5 causes of infertility in women

A
  • Ovarian causes
  • Tubal causes
  • Uterine causes
  • Cervical causes
  • Pelvic causes
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10
Q

What is endometriosis?

A

Presence of functioning endometrial tissue outside the uterus which responds to oestrogen

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11
Q

What are the symptoms of endometriosis?

A

Increased menstrual pain
Menstrual irregularities
Deep dyspareunia (painful intercourse)
Infertility

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12
Q

What are the treatments for endometriosis?

A

Hormonal (e.g. OCP, progesterone)
Laparascopic ablation
Hysterectomy
Bilateral salpingo-oophorectomy (take out affected area)

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13
Q

What are fibroids?

A

Benign tumours of the myometrium which respond to oestrogen

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14
Q

What are symptoms of fibroids?

A 
Usually asymptomatic
Increased menstrual pain
Menstrual irregularities
Deep dyspareunia (painful intercourse)
Infertility
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15
Q

What are the treatments for fibroids?

A

Hormonal (e.g. OCP, progesterone, GnRH agonists)

Hysterectomy

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16
Q

What causes hypogonadotrophism, hypogonadism and low GnRH in male infertility?

A

Congenital hypogonadotrophic hypogonadism
e.g. Kallmann syndrome (anosmic)

Acquired hypogonadotrophic hypogonadism
e.g. low BMI, XS exercise, stress

Hyperprolactinaemia

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17
Q

What causes hypogonadotrophism and hypogonadism in male infertility?

A

Hypopituitarism e.g. tumour, infiltration, apoplexy, surgery, radiation

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18
Q

What causes hypergonadotrophism and hypogonadism in male infertility?

A

Congenital primary hypogonadism
e.g. Klinefelters

Acquired primary hypogonadism
e.g. cryptorchidism, trauma, chemo, radiation

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19
Q

What is Kallmann syndrome and what does it present as?

A

Failure of migration of GnRH neurones with the olfactory fibres (from olfactory placode to hypothalamus)

Anosmia
Cryptorchidism
Failure of puberty e.g. micropenis, primary amenorrhoea
Infertility

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20
Q

What does hyperprolactinaemia inhibit and cause?

A

Kisspeptin neurones causing low GnRH/LH/FSH/T/Oest

Oligo/amenorrhoea
Low libido
Infertility
Osteoporosis

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21
Q

What is the chromosomal abnormality in Klinefelter syndrome?

A

XXY sex chromosome in men

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22
Q

What are the symptoms of Klinefelter syndrome?

Study These Flashcards
A 
Tall stature
Little facial hair
Breast development
Female-type pubic hair development
Mildly impaired IQ
Narrow shoulders
Wide hips
Small penis and testes
Low bone density
Infertility
23
Q

What investigations can you undertake with infertile men?

Study These Flashcards
A 
Semen analysis (volume, sperm conc., motility)
LH/FSH/PRL blood test
Morning fasting testosterone
Sex hormone binding globulin test
Karyotyping
Pituitary/thyroid profile
Urine test
MRI for pituitary
Scrotal ultrasound
24
Q

What are 3 lifestyle treatments for male infertility?

Study These Flashcards
A

optimise BMI
Smoking cessation
Alcohol reduction

25
What are specific treatments for male infertility?
Dopamine agonist for hyperprolactinaemia Gonadotrophin treatment for fertility Testosterone if no fertility is required Surgery
26
List all the categories causes of female infertility
``` Tubal causes Uterine causes Cervical causes Ovarian causes Pelvic causes Idiopathic ```
27
What are some tubal causes of female infertility?
Infection Endometriosis Trauma
28
What are some uterine causes of female infertility?
Chronic endometritis (Tb) Fibroid Adhesions Congenital malformation
29
What are some cervical causes of female infertility?
Ineffective sperm penetration: - Chronic cervicitis - Immunological (antisperm Ab)
30
What are some ovarian causes of female infertility?
Anovulation | Corpus luteum insufficiency
31
What are some pelvic causes of female infertility?
Endometriosis | Adhesions
32
What is amenorrhoea?
No periods for at least 3-6 months Or Up to 3 periods a year
33
What is primary amenorrhoea?
Later than 16 years old regarded as abnormal
34
What is secondary amenorrhoea?
Periods start but then stop for 3-6 months
35
What is oligomenorrhoea?
Irregular or infrequent periods > 35 day cycles Or Up to 4-9 cycles per year max
36
What is premature ovarian insufficiency (POI)?
Early menopause previously called premature ovarian failure (POF). Conception can still occur in 20%
37
What is the diagnosis of premature ovarian insufficiency (POI)?
High FSH > 25 iU/L (x2 at least 4 weeks apart)
38
What are the causes of premature ovarian insufficiency (POI)?
Autoimmune Genetic e.g. fragile X syndrome, Turner's syndrome Cancer therapy (radio/chemo in past)
39
What causes low GnRH, hypogonadotrophism and hypogonadism in women?
Congenital hypogonadotrophic hypogonadism - Anosmic (Kallmann syndrome) or normosmic Acquired hypogonadotrophic hypogonadism - Low BMI, XS exercise, stress Hyperprolactinaemia
40
What causes hypogonadotrophism and hypogonadism in women?
Hypopituitarism e.g. tumour, apoplexy, surgery, radiation
41
What causes hypergonadotrophism and hypogonadism in women?
Polycystic ovarian syndrome (PCOS) Acquired primary hypogonadism: - POI - surgery, trauma, radiation, chemo Congenital primary hypogonadism: - Turner's syndrome - POI
42
What is the epidemiology of PCOS?
Affects 5-15% of women of reproductive age Frequent family history Most common endocrine disorder in women and cause of infertility of women
43
How do you diagnose PCOS and explain it
Exclude other reproductive disorders then... ``` Rotterdam PCOS diagnostic criteria (2/3) - Oligomenorrhoea/anovulation - Clinical signs of (with/out biochemical) hyperandrogenism - Polycystic ovaries ```
44
Which combination of diagnostic criteria gives the worst metabolic risk?
Oligomenorrhoea/anovulation | Clinical signs of (with/out biochemical) hyperandrogenism
45
How is PCOS treated?
Patient is asked which symptoms they want to get rid of and tailored treatment plan is drawn up
46
If a PCOS patient wishes to remove oligo/amenorrhoea and thus infertility as a symptom what can they take?
Oligo/amenorrhoea: - Oral contraceptive pill - Metformin Infertility: - Clomiohene - Letrozole - IVF
47
If a PCOS patient wishes to remove impaired glucose homeostasis (T2DM) as a symptom what can they do?
Metformin | Diet + lifestyle
48
If a PCOS patient wishes to remove hirsutism as a symptom what can they take?
Anti-androgens e.g. spironolactone | Creams, waxing, laser
49
If a PCOS patient wishes to remove an increased endometrial cancer risk as a symptom what can they take?
Oral contraceptive pill | Progesterone courses
50
What are the symptoms of Turner's syndrome?
``` Short stature Low hairline Shield chest Wide spaced nipples Small fingernails Brown nevi Webbed neck Coarctation of aorta Poor breast development Elbow deformity Underdeveloped reproductive tract Amenorrhoea ```
51
What are the blood tests that can be done to investigate female infertility?
``` LH, FSH, PRL Oestradiol, androgens Mid-luteal progesterone Sex hormone binding globulin (SHBG) Albumin, iron studies Pituitary/thyroid profile Karyotyping ```
52
What are some microbiological tests that can be done to investigate female infertility?
Urine test | Chlamydia swab
53
What are some imaging techniques that can be done to investigate female infertility?
Transvaginal ultrasound Hysterosalpingogram MRI pituitary if hypogonadotrophism or hyperprolactinaemia

ENDOCRINOLOGY 2 (12 decks)

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