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Endocrinology > Infertility > Flashcards

Infertility Flashcards

1
Q

Infertility

A

A disease of the reproductive system defined by the failure to achieve a clinical pregnancy after ≥12 months of regular unprotected sexual intercourse

Primary - no previous live births
Secondary - live birth more than a year prior

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2
Q

Most common cause of infertility

A

30% female
30% male
30% both
10% unknown

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3
Q

Infertility causes pre-testicular

A

Congenital & Acquired Endocrinopathies
Klinefelters 47XXY
Y chromosome deletion
HPG, T, PRL

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4
Q

Infertility causes testicular

A

(Congenital)

Cryptorchidism

Infection
STDs

Immunological
Antisperm Abs

Vascular
Varicocoele

Trauma/Surgery

Toxins
Chemo/DXT/Drugs/Smoking

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5
Q

Infertility causes post-testicular

A

Congenital
Absence of vas deferens in CF

Obstructive Azoospermia

Erectile Dysfunction
Retrograde Ejaculation Mechanical
Impairment Psychological

Iatrogenic
Vasectomy

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6
Q

Cryptorchidism

A

Undescended testis (in inguinal canal)

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7
Q

Infertility causes pelvic

A

Endometriosis
Adhesions

5%

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8
Q

Infertility causes tubal

A

Tubopathy due:

  • Infection
  • Endometriosis
  • Trauma

30%

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9
Q

Infertility causes ovarian

A
  • Anovulation (Endo)
  • Corpus luteum insufficiency

40%

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10
Q

Infertility causes uterine

A
  • Chronic endometritis (TB)
  • Fibroid
  • Adhesions (Synechiae)
  • Congenital malformation

10%

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11
Q

Infertility causes cervical

A

Ineffective sperm penetration due:

  • Chronic cervicitis
  • Immunological (antisperm Ab)

5%

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12
Q

Endometriosis

A

Presence of functioning endometrial tissue outside the uterus

  • 5% of women
  • Responds to oestrogen
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13
Q

Endometriosis symptoms

A

↑ Menstrual pain
Menstrual irregularities
Deep dyspareunia
Infertility

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14
Q

Endometriosis treatments

A

Hormonal (eg continuous OCP, prog)
Laparascopic ablation
Hysterectomy
Bilateral Salpingo-oophorectomy

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15
Q

Fibroids

A

Benign tumours of the myometrium

  • 1-20% of pre-menopausal women (increases w age)
  • Responds to oestrogen
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16
Q

Fibroids symptoms

A 
Usually asymptomatic
↑ Menstrual pain
Menstrual irregularities
Deep dyspareunia
Infertility
17
Q

Fibroids treatment

A

Hormonal (eg continuous OCP, prog, continuous GnRH agonists)

Hysterectomy

18
Q

Male infertility in hypothalamus

A

Congenital Hypogonadotrophic Hypogonadism
-Anosmic (Kallmann Syndrome) or Normosmic

Acquired Hypogonadotrophic Hypogonadism
-Low BMI, XS exercise, Stress

Hyperprolactinaemia

Decreased GnRH, LH, FSH, T

19
Q

Male infertility in anterior pituitary

A

Hypopituitarism
-Tumour, Infiltration, Apoplexy, Surgery, Radiation

Decreased LH, FSH, T

20
Q

Male infertility in gonads

A

Congenital Primary Hypogonadism
-Klinefelters (47XXY)

Acquired Primary Hypogonadism
-Cryptorchidism, Trauma, Chemo, Radiation

Increased LH and FSH, decreased T

21
Q

Kallmann Syndrome

A

Failure of migration of GnRH neurons with olfactory fibres

Anosmia 
Cryptorchidism
Failure of puberty
-Lack of testicle dvlpt
-Micropenis
-Primary amenorrhoea
Infertility
22
Q

Klinefelters Syndrome

A 
Tall
Decreased facial hair 
Breast development 
Mildly impaired IQ
Narrow shoulder 
Wide hips
23
Q

Male Infertility: Initial History, Examination & Investigation

A

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

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

Investigation: semen analysis, blood test, urine test, scrotal ultrasound , MRI pituitary

24
Q

Male Infertility: Treatment

A

Optimise BMI
Smoking cessation
Alcohol reduction/cessation

Dopamine agonist for hyperPRL

Gonadotrophin treatment for fertility (will also increase testosterone)

Testosterone
(for symptoms if no fertility required – as this requires gonadotrophins)

Surgery
(eg. Micro Testicular Sperm Extraction (micro TESE))

25
Q

Menarche

A

Menstrual Cycles

  • 28-day cycle (24-35 days).
  • ±2 days each month.

Primary Amenorrhoea
- Later than 16yrs is regarded as abnormal.

Secondary Amenorrhoea

  • Common for Periods to be irregular / anovulatory for first 18months.
  • Periods start but then stop for at at least 3-6 months

Amenorrhoea - Absence of Periods

  • No periods for at least 3-6 months.
  • or up to 3 periods per year.

Oligo-menorrhoea - Few Periods

  • Irregular or Infrequent periods >35day cycles
  • or 4-9 cycles per year.
26
Q

Premature Ovarian Insufficiency

A

Same Symptoms as per Menopause
Previously called ‘Premature Ovarian Failure’ POF
Conception can happen in 20%.
Diagnosis High FSH >25 iU/L (x2 at least 4wks apart)

Causes
Autoimmune
Genetic eg Fragile X Syndrome / Turner’s Syndrome
Cancer therapy Radio- / Chemo-therapy in the past

27
Q

Female infertility in hypothalamus

A

Congenital Hypogonadotrophic Hypogonadism
-Anosmic (Kallmann Syndrome) or Normosmic

Acquired Hypogonadotrophic Hypogonadism
-Low BMI, XS exercise, Stress

Hyperprolactinaemia

Decreased GnRH, LH, FSH, estrogen

28
Q

Female infertility in anterior pituitary

A

Hypopituitarism
-Tumour, Infilatration, Apoplexy, Surgery, Radiation

Decreased LH, FSH, estrogen

29
Q

Female infertility in gonads

A

Polycystic Ovarian Syndrome (PCOS)

Acquired Primary Hypogonadism

  • Premature Ovarian Insufficiency (POI)
  • Surgery, Trauma, Chemo, Radiation

Congenital Primary Hypogonadism

  • Turners (45X0)
  • Premature Ovarian Insufficiency (POI)

Increase LH:FSH, LH, FSH
Decreased estrogen

30
Q

Polycystic Ovarian Syndrome: Diagnosis

A

Rotterdam PCOS Diagnostic Criteria (2 out of 3)

Oligo or Anovulation
Clinical +/- Biochemical Hyperandrogenism
Polycystic Ovaries (US)

1 and 2 worst metabolic risk combo

31
Q

Polycystic Ovarian Syndrome: Treatments

A 
Infertility - Clomiphene, IVF
Irregular menses - oral contraceptive pill, metformin
Insulin resistance - metformin, diet 
Hirsutism - wax, laser, anti androgens 
Endometrial cancer risk - progesterone
32
Q

Turners Syndrome (45 X0)

A 
Short stature
Low hairline
Webbed neck
Shield chest
Elbow deformity 
Coarctation of aorta
Poor brest development
33
Q

Female Infertility: Initial History, Examination & Investigation

A

History: 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

Examination: including BMI, sexual characteristics, hyperandrogenism signs, pelvic examination, other endocrine signs, syndromic features, anosmia

Investigation: Blood (LH, FSH, PRL), pregnancy test, urine test, ultrasound (transvaginal), MRI pituitary

Endocrinology (13 decks)

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