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Phase 1b - Endocrinology > Infertility > Flashcards

Infertility Flashcards

-> Reproductive function: Describe the function and regulation of the male and female reproductive systems. -> Reproductive disorders: Summarise the pathology and pathophysiology of the male and female reproductive systems. -> Reproductive disorders: Describe the clinical features and treatment options of reproductive disorders. (71 cards)

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1
Q

What is inferility?

A
  • A disease of the reproductive system defined by the failure to achieve a clinical pregnancy after >12 months of regular unprotected sexual intercourse
    • Regular intercourse: every 2-3 days
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2
Q

What is primary infertility?

A
  • When patient did not have a live birth previously
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3
Q

What is secondary infertility?

A
  • When patient had a live birth more than 12 months previously
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4
Q

How common is infertility?

A

Affects 1 in 7 couples

Half of these will then conceive in the next 12 months

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5
Q

What are the psychological distresses of infertility (5)?

A
  • No biological child
  • Impact on couples wellbeing
  • Impact on larger family
  • Investigations
  • Treatments (failure)
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6
Q

What is the cost to society due to infertility (4)?

A
  • Fewer births
  • Less tax income
  • Investigation costs
  • Treatment costs
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7
Q

What are the male infertility causes divided into (3)?

A
  • Pre-testicular
  • Testicular
  • Post-testicular
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8
Q

What are the main pre-testicular non-endocrinological causes of infertility (2C / 3AE)?

A
  • Congenital: Kleinfelters - 47XXY / Y chromosome deletion
  • Acquired endocrinopathies: HPG / T / PRL issues
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9
Q

What are the main post-testicular causes of male infertility (4)?

A
  • Congenital (Absence of vas deferens in patients with cystic fibrosis)
  • Obstructive azoospermia
  • Erectile dysfunction (Retrograde ejaculation / Mechanical impairement / Psychological)
  • Iatrogenic (Vasectomy)
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10
Q

What are the 3 main types of erectile dysfunction?

A
  • Retrograde ejaculation
  • Mechanical impairment
  • Psychological
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11
Q

What is retrograde ejaculation?

A
  • The semen within the urethra travels back into the bladder
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12
Q

What is the function of the vas deferens?

A
  • Transports mature sperm from the epididymis to the urethra in preparation for ejaculation
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13
Q

What are the main testicular non-endocrinical causes of infertility (7)?

A
  • Congenital
  • Cryptorchidism
  • Infection (STDs)
  • Immunological (Antisperm antibodies)
  • Vascular (varicoele)
  • Trauma / Surgery
  • Toxins (Chemotherapy / DXT / Drugs / Smoking)
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14
Q

What is cryptorchidism?

A
  • Undescended testis
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15
Q

What are the five main types of female infertility causes?

A
  • Ovarian causes: Anovulation / Corpus luteum insufficiency
  • Tubal causes: Infection / Endometriosis / Trauma
  • Uterine causes: Congenital malformations / Infection / Inflammation / Scarring (adhesions) / Fibroids
  • Cervical causes (ineffective sperm penetration due to chronic cervicitis) and antisperm ABs
  • Pelvic causes: Endometriosis / Infection / Inflammation / Immunological (antisperm Ab)
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16
Q

Which hormone is mainly secreted by the corpus lutuem?

A
  • Progesterone
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17
Q

What is the main cause of infertility in females?

A
  • Ovarian causes (anovulation, and a corpus luteum insufficiency)
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18
Q

What is endometriosis?

A
  • A condition resulting from the appearance of functioning endometrial tissue outside the uterus and causing pelvic pain
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19
Q

What are the symptoms of endometriosis (4)?

A
  • Menstrual pain
  • Menstrual irregularities
  • Deep dyspareunia (Pain during sexual intercourse)
  • Infertility
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20
Q

Why do individuals with endometriosis experience menstrual pain?

A
  • Endometrial tissue responds to oestrogen in a cyclic manner
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21
Q

What are the treatments for endometriosis (3)?

A
  • Hormonal (continuous OCP, progesterone)
  • Laparscopic ablation (removal of endometrial tissue)
  • Hysterectomy / Bilateral salpingo-oophorectomy
    • Moves ovaries and tubes
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22
Q

What are fibroids?

A
  • Benign tumours of the myometrium that respond to oestrogen
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23
Q

What are the symptoms of fibroids (5)?

A
  • Asymptomatic usually
  • Increased menstrual pain
  • Menstrual irregularities
  • Deep dyspareunia
  • Infertility
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24
Q

What are the treatments available for fibroids (2)?

A
  • Hormonal
    • ​Continuous OCP
    • Progesterone
    • Continuous GnRH agonist
  • Hysterectomy
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25
What are the 2 endocrine male infertility causes?
* Hypogonadotrophic hypogonadism * Hypergonadotrophic hypogonadism
26
What are the causes of male hypogonadotrophic hypogonadism (4)?
* **Congenital Hypogonadotrophic Hypogonadism:** Anosmic (Kallmann Syndrome) or Normosmic * **Acquired Hypogonadotrophic Hypogonadism:** Low BMI / XS exercise / Stress * **Hyperprolactinaemia** * **Hypopituitarism:** Tumour / Infiltration / Apoplexy / Surgery / Radiation
27
What is the hormone profile of male hypogonadotrophic hypogonadism?
* ↓LH * ↓FSH * ↓T
28
What are the causes of male hypergonadotrophic hypogonadism (2)?
* **Congenital Primary Hypogonadism:** Klinefelters (47XXY) * **Acquired Primary Hypogonadism:** Cryptorchidism / Trauma / Chemo / Radiation
29
What is the hormone profile of male hypergonadotrophic hypogonadism?
* ↑LH * ↑FSH * ↓T
30
What are the symptoms of testosterone deficiency (9)?
* **Sexual dysfunction** (Reduced libido) * **Erectile dysfunction** (Loss of early morning erections) * **Decreased facial hair growth** * **Increased fat & Decreased muscle mass** * **Decreased spermatogenesis** * **Decreased energy levels** - General wellbeing & Fatigue * **Mood disturbance** * **Decreased bone health** -Via conversion to oestrogen * **Gynaecomastia**
31
What type of hypogonadism is Kallmann syndrome?
Hypogonadotrophic hypogonadism / Congenital secondary hypogonadism ## Footnote Affects both male & female
32
What is the hormone profile of Kallmann's Syndrome?
* ↓GnRH * ↓LH * ↓FSH * ↓T
33
What are the clinical features of Kallman syndrome (4)?
* **Anosmia** * **Cryptorchidism** * **Infertility** * **Failure of puberty:** * Male: Lack of testicle development / Micropenis * Female: Primary amenorrhea
34
How does Kallmann syndrome cause male infertility?
* There is **failure of migration of GnRH neurones with olfactory fibres to the hypothalamus**, therfore leading to a **hypogonaodtrophic hypogonadism** as there is a **failure to secrete GnRH**
35
What testicular volume range is associated with a better prognosis in patients with Kallmann syndrome?
* \> 6ml
36
What are the causes of hyperprolactinaemia (7)?
* **Prolactinoma** (micro/macro) * **Pituitary** **stalk** **compression** * **Pregnancy** & breast feeding * **Medication** (dopamine antagonists, including anti-emetics and antipsychotics) * **Oestrogens** (OCP) * **PCOS** * **Hypothyroidism**
37
What is the hormone profile of hyperprolactinaemia?
* ↓GnRH * ↓LH * ↓FSH * ↓T * ↑PRL
38
What effect does prolactin have on kisspeptin neurones?
1. **Inhibits kisspeptin neurones** 2. Thus **decreases pulsatile action of GnRH secretion** from hypothalamic neurones 3. This causes a **downstream inhibition on LH and FSH release** from the anterior pituitary gonaodtrophs, as well as testosterone release from the testes
39
What is the available treatment for individuals with hyperprolactinaemia (3)?
* Dopamine agonists (cabergoline) * Transsphenoidal surgery * Sellar radiotherapy
40
What agonists can be prescribed to treat hyperprolactinaemia?
* **Dopamine agonists** (cabergoline) * Dopamine inhibits prolactin release from lacotrophs
41
What type of hypogonadism is Klinefelters syndrome?
* **Hypergonadotrophic hypogonadism / Congenital primary hypogonadism**, there is an **insufficient secretion of testosterone** from the testes ## Footnote Affects only males
42
What is the hormone profile of Klinefelters syndrome?
* ↑LH * ↑FSH * ↓T
43
What are the clinical features of Klinefelters syndrome (11)?
* **Tall** stature * **Decreased facial hair** * **Breast** development * **Female-type pubic hair** pattern * **Small penis and testes** * **Infertility** * **Mildly impaired IQ** * **Narrow shoulders** * **Reduced chest hair** * **Wide hips** * **Low bone density**
44
What is the normal testicular volume for a male?
* 50ml
45
What happens to testicular volume in a patient with Klinefelter's syndrome?
Low testicular volume (1.5ml)
46
What impact does Klinefelters syndrome have on LH and FSH levels?
* **Dysregulation of negative feedback system**, stimulating **increased** secretion of **LH and FSH** due to low testosterone
47
What are the 2 endocrine female infertility causes?
* Hypogonadotrophic hypogonadism * Hypergonadotrophic hypogonadism
48
What are the causes of female hypogonadotrophic hypogonadism (4)?
* **Congenital Hypogonadotrophic Hypogonadism:** Anosmic (Kallmann Syndrome) or Normosmic * **Acquired Hypogonadotrophic Hypogonadism:** Low BMI / XS exercise / Stress * **Hyperprolactinaemia** * **Hypopituitarism:** Tumour / Infiltration / Apoplexy / Surgery / Radiation
49
What is the hormone profile of female hypogonadotrophic hypogonadism?
* ↓LH * ↓FSH * ↓E2 (Oestrogen)
50
What are the causes of female hypergonadotrophic hypogonadism (2)?
* **Congenital Primary Hypogonadism:** Premature Ovarian Insufficiency (POI) from Turner's (47XXY) * **Acquired Primary Hypogonadism:** Premature Ovarian Insufficiency (POI) from radiation or chemo / Surgery / Trauma * **Polycystic Ovarian Syndrome (PCOS)**
51
What is the hormone profile of hypergonadotrpohic hypogonadism?
* ↑LH * ↑FSH * ↓E2 (Oestrogen)
52
What is ammenorrhoea?
* No periods for at least 3-6 months or up to 3 periods a year
53
What is primary amenorrhoea?
* The **absence of menarche by age 16**
54
What is secondary ammenorrhoa?
* **Irregular periods**, anovulatory for first 18 months * Periods **START but cease for 3-6 month minimum**
55
What is oligo-menorrhoea?
* **Irregular or infrequent periods** \>35 day cycle * 4-9 cycles per year
56
What is the initial test that should be conducted for a patient presenting with female inferility?
* Pregnancy test (β-HCG)
57
What are the symptoms of menopause (9)?
* **Mood** disturbance * **Skin** dryness / **Hair** thinness * **Weight gain** * **Cessation of fertility** * **Osteoporosis** (Decreased bone mineral density) (E2 stimulates osteoblasts) * **Climacteric** (Irregular periods in years close to menopause) * **Hot flushes** / Sweating / Sleep disturbance * **Sexual dysfunction** (Vaginal dryness / Decreased libido) * **Amennorhoea**
58
How are the symptoms of menopause managed?
* **Oestrogen replacement** * Oestrogen stimulates the endometrium * **Add progesterone** (if endometrium is intact) * Prevents risk of **Endometrial hyperplasia / Cancer**
59
What is the hormone profile in a patient with premature ovarian insufficiency (POI)?
* ↑LH * ↑FSH * ↓E2 (Oestrogen)
60
What are the causes of premature ovarian insufficiency (POI) (3)?
* **Autoimmune** * **Genetic** * Fragile X syndrome * Turner's syndrome * **Cancer therapy** * Radiotherapy * Chemotherapy
61
What are the symptoms of premature ovarian insufficiency (POI) (11)?
* **Mood** disturbance * **Skin** dryness / **Hair** thinness * **Weight gain** * **Infertility** * **Osteoporosis** (Decreased bone mineral density) (E2 stimulates osteoblasts) * **Climacteric** (Irregular periods in years close to menopause) * **Hot flushes** / Sweating / Sleep disturbance * **Sexual dysfunction** (Vaginal dryness / Decreased libido) * **Amennorhoea** * **Sleep disturbances** * **High FSH** \> 25iU/L (x2 at least 4wks apart) | Same Symptoms as Menopause
62
How are the symptoms of premature ovarian insufficiency (POI) managed?
* **Oestrogen replacement** * Oestrogen stimulates the endometrium * **Add progesterone** (if endometrium is intact) * Prevents risk of **Endometrial hyperplasia / Cancer**
63
What is the hormone pattern in a female patient with anorexia nervosa-induced amenorrhoea?
* There is **hypogonadotrophic hypogonadism** * **Low FSH/LH and low oestradiol** * There is **low leptin** which feedback on kisspeptin neurones to reduce pulsatility
64
What is the hormone profile of Polycystic Ovarian Syndrome (PCOS)?
* ↑LH * ↑FSH * ↓E2 (Oestrogen)
65
What are the symptoms of PCOS (4)?
* **Increased insulin resistance** (impaired glucose homeostasis, T2DM, gestational DM) * **Hirsutism** * **Increased endometrial cancer risk** * **Infertility** (irregular menses)
66
What criteria is used to diagnose a patient with PCOS?
Rotterdam PCOS diagnostic criteria (2 of 3)
67
What are the three Rotterdam PCOS Diagnostic Criteria?
* **Oligo or anovulation** * **Clinical/biochemical hyperandrogenism** * Clinical (Acne, hirsutism, alopecia) * **Polycystic ovaries (US)** (\>20 follicles)
68
How is PCOS manageed?
* **Increased insulin resistance** (impaired glucose homeostasis, T2DM, gestational DM) * Metformin & Lifestyle & Diet * **Hirsutism** * Anti-Androgens * **Increased endometrial cancer risk** * Progesterone courses * **Infertility** (irregular menses) * Metformin & IVF or OCP
69
What drug can be prescribed as an anti-androgen?
* **Spironolactone**
70
What are the clinical features in a patient with Turner's syndrome (45X0) (14)?
* Short stature * Low hairline * Shield chest * Wide spaced nipples * Short 4th metacarpal * Small fingernails * Brown nevi * Characteristic facies * Webbed neck * Coarctication of aorta * Poor breast development * Elbow deformity * Underdeveloped reproductive tract * Amenorrhoea
71
The initial test to a female patient presenting with infertility is a pregnancy test (β-hCG). What does β-hCG stand for?
Human Chorionic Gonadotrophin (hCG)

Phase 1b - Endocrinology (19 decks)

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