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Charis & Ellie VS Reproduction > Infertility > Flashcards

Infertility Flashcards

(68 cards)

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1
Q

What is infertility?

A

Inability to conceive after 12 months regular intercourse without contraceotion

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2
Q

What is primary infertility?

A

Couple hasn’t conceived before

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3
Q

Secondary infertility?

A

Couple have conceived together in the past (even if it hasn’t resulted in a live birth)

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4
Q

Definition of oligomenorrhoea?

A

Cycles >35 days

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5
Q

Amennorhoea?

A

Absent menstruation

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6
Q

What triggers menstruation?

A

LH surge

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7
Q

What follows ovulation?

A

Progesterone peaks

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8
Q

How do you confirm ovulation?

A

Midluteal serum progesterone (>30nmol/L)
Day 21 (28 cycle)
Adjust for cycle length

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9
Q

Investigations if amenorrhoeic/cycle longer than 42 days?

A
  • Follicular phase bloods- LH, FSH, E2
  • Testosterone, SHBG, FAI
  • Prolactin
  • Diagnostic semen analysis
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10
Q

Semen analysis looks at?

A

Sperm conc- 16 million per ml
Progressive motility - 30%
Sperm morphology - 4% normal

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11
Q

What should sperm conc be (units)?

A

16 million per ml

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12
Q

Initial info to get at infertility consultation?

A
  • Patients seen as couple
  • Establish length of relationship
  • length of time trying to get pregnant
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13
Q

What to ask about female in infertility consultation?

A

History
Exam/USS: pelvic anatomy- uterus & ovaries, transvaginal US
Investigation

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14
Q

What to look into for the male in an infertility consultation?

A

History
Diagnostic semen analysis
Examination
Investigations

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15
Q

Abnormal findings in infertility investigations?

A
  • Congenital uterine abnormalities
  • Fibroids
  • Endometrial polyp
  • Hydrosalpinx
  • PCOS
  • Ovarian cyst
  • Tubal patency
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16
Q

Types of ovarian cysts?

A

Simple
Dermoid
Cancer
Endometrioma

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17
Q

Investigations of tubal patency?

A

Hysterosalpingogram (HSG)

Diagnostic laparoscopy and hydrotubation

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18
Q

When would you do a diagnostic laparoscopy?

A

Possible tubal/pelvic disease
Known previous pathology
History suggestive of pathology
Prev abnormal HSG

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19
Q

When is a hysteroscopy performed?

A

-Cases where sus or known endometrial pathology (uterine septum, adhesions, polyp)

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20
Q

Lifestyle advice for infertility?

A
    1. Stop smoking
      1. BMI: 18.5-30
      2. Reduce/lessen alcohol consumption
      3. Moderate caffeine
      4. Stop recreational drugs
      5. Folic acid
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21
Q

Most common reason for ovulatory problems?

A

Polycystic ovarian syndrome (PCOS)

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22
Q

What criteria do you use for PCOS?

A

Revised Rotterdam diagnostic criteria

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23
Q

Revised Rotterdam diagnostic criteria?

A

2 of:

  • Oligo/menorrhoea
  • Polycystic ovaries
  • Clinical and/or biochem signs of hyperandrogenism (acne/hirsutism)
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24
Q

Scan appearance of polycystic ovaries?

A

12/more 2-9mm follicles
Increased ovarian volume >10ml
Unilateral/bilateral

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25
1st line for ovulation induction?
Clomifene citrate - 50-100-150 mg tab, days 2-6 - 70-80% ovulate, 30-40% conceive Alternatively Letrozole (Tamoxifen)
26
Other methods of ovarian induction?
Gonadotrophin injections | Laparoscopic ovarian diathermy
27
Details about gonadotrophin injections?
- Recombinant FS - 80% ovulate, 60-70% conceive - Risks: multiple pregnancy, overstimulation
28
Details about laparoscopic ovarian diathermy?
- 80% ovulate, risk ovarian destruction | - Mainly singleton pregnancies
29
Whats the downside of clomifene?
CLOMIFENE RESISTANCE
30
What's the craic with clomiphene resistance?
15-20% of ptnts don't ovulate on it - Wt loss - Letrozole - Adjuvant metformin
31
Approach to abnormal semen parameters?
- Examination - Check LH, FSH, Testosterine, prolactin - Karyotype, CF mutation - 50% unexplained causes
32
What does treatment mainly include for abnormal semen parameters?
-ART (assisted repro technology) Intrauterine insemination (iui) IVF Intracytoplasmic sperm injection
33
Treatment for blocked fallopian tubes?
Generally no treatment -Could try IVF, hydrosalpinx reduces IVF success by 50% -Cannulation using guidewire or microcatheter Proximal tube occlusion -Reversal of sterilisation- not on NHS
34
Eligibility criteria for assisted reproduction technology?
- Stable relationship (2y + same sex is g) - Female age <40y - Female BMI (18.5-30) - Non smokers (at least 3/12 before treatment) - No biological child - No illegal substances/abuse substance - Neither sterilized - Duration unexplained infertility 2y - Up to 3 cycles treatment
35
Biggest factor influencing infertility?
Female age
36
All terms meaning type 1 ovulation disorder?
Hypogonadal hypogonadism | Hypothalamic pituitary failure
37
The problem in type 1 ovulation disorder?
Problem with not producing enough GnRH or dysregulation in pulsatility
38
Hormones levels in hypogonadal hypogonadism?
Low LH | Low FSH
39
Causes of type 1 ovulation disorder?
- Stress - XSive exercise - Low BMI - Brain tumours - Head trauma - Kallman syndrome - Drugs (steroids, opiates)
40
What will be present in hypothalamic pituitary failure?
Amenorrhoea
41
Treatment of hypogonadal hypogonadism?
- Improvement to modifiable factors | - Ultimate treatment: pulsatile GnRH pump or FSH and LH daily injections
42
Another term for type 2 ovulation disorder?
Normogonadotrophic anovulation
43
Main cause of T2 ovulation disorder?
Polycystic ovarian syndrome
44
Hormone levels in type 2 ovulation disorder?
Normal GnRH Normal FSH Potential XS LH
45
What charcterizes type 2 ovulation disorder?
Multiple small cysts within the ovary and by XS ovarian androgen production
46
What is T2 ovulation disorder assoc with?
``` Obesity Hyperinsulinaemia Insulin resistance Increased risk of T2DM HT Hyperlipidaemia Increased CVS risk ```
47
Diagnostic criteria of normogonadotrophic anovulation?
2 or more: | -Clinical and/or biochem evidence of hyperandrogenism, oligo/anovulation, Polycystic ovaries on US
48
Treatment of T2 ovulation disorder?
Wt loss Treating acne Treating hirsutism Fertility treatment: involves ovulation induction
49
1st line fertility treatment for normogonadotrophic anovulation?
Clomifene used on days 2-6 of cycle
50
What may become 1st line ovulation induction?
Letrozole (as it requires less monitoring)
51
2nd line fertility treatment?
Gonadotrophin injections with recombinant FSH However this risks multiple pregnancy and overstimulation
52
Risks of gonadotrophin injection?
Overstimulation and multiple pregnancy
53
3rd line infertility treatment?
Laparoscopic ovarian diathermy Isn't risk of multiple pregnancies but procedure risks ovarian destruction
54
Terms for type 3 ovulation disorder?
Hypergonadotropic hypogonadism | Premature ovarian failure
55
What is characteristic of Type 3 ovulation disorder?
Premature menopause Ovarian failure before age 40 Amenorrhoea
56
Hormone levels in type 3?
LH raised FSH raised Oestrogens decreased
57
Causes of type 3 ovulation disorder?
- Turner syndrome - Other genetic conditions - AI failure - Surgery - Chemo/radio therapy
58
What can a person with T3 ovulation disorder not do?
Be stimulated to produce eggs
59
What should people with premature ovarian failure be on?
Combined HRT
60
Infertility treatment if peri-menopausal?
-Egg donor and then hormonal treatment to help them maintain a pregnancy
61
Type 4 ovarian disorder other term?
Hyperprolactinaemia
62
Whats happening in T4 ovarian disorder?
Person has elevated serum prolactin and low/normal FSH and LH Frequently due to pituitary adenoma
63
Azoospermia?
No sperm in ejaculate
64
Asthenozoospermia?
% of progressive motile sperm is below reference limit
65
Oligozoospermia?
Total number/concentration of sperm below reference limit
66
Teratozoospermia?
% of morphologically normal sperm below reference limit
67
Initial GP investigations in women for infertility?
Day 21 progesterone to establish ovulation TSH Rubella immunity checked Chlamydia screen -Ensure smear up to date -If amenorrhoeic or cycle lasts longer than 42 days they should have follicular phase bloods (LH, FSH, E2), testosterone, SHBG, FAI and prolactin checked
68
Initial GP investigations in men?
Diagnostic semen analysis If there are abormal semen parameters he male should be examined as well as LH, FSH, testosterone and checked for genetic causes

Charis & Ellie VS Reproduction (71 decks)

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