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Endocrinology BRS 2 > Infertility > Flashcards

Infertility Flashcards

1
Q

Explain the difference between primary and secondary infertility.

A

Primary infertility- Not had a live birth previously.
Secondary Infertility- Have had a live birth over 12 months ago.

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2
Q

How can infertility causes in MEN be classified.

A

-Pre testicular
-Testicular
-Post testicular

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3
Q

What is the name for undescended testis in men.

A

Cryptorchidism

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4
Q

What are the six main issues/causes that can lead to female infertility, giving 1 example of each.

A

-Pelvic causes (endometriosis)
-Ovarian causes (Corpus luteum insufficiency)
-Tubal Causes (infection/trauma)
-Uterine causes (Infection/ inflammation/ scarring)
-Cervical causes (Infection/inflammation)
-Unexplained

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5
Q

What is endometriosis?

A

The presence of functioning endometrial tissue outside the uterus.

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6
Q

Symptoms of endometriosis.

A

-Increased menstrual pain
-Pain during sexual intercourse (dyspareunia)
-infertility

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7
Q

Does endometriosis respond to oestrogen?

A

YES

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8
Q

Describe the order of the Hypothalamic-Pituitary-Gonadal (HPG) Axis.

A

1.KISSPEPTIN NEURONS stimulate the hypothalamus to release gonadotrophin releasing hormone.

2.GnRH enters the HYPOPHYSEAL PORTAL CIRCULATION & stimulates the gonadotrophs into releasing LH & FSH.

3.LH & FSH enter the systemic circulation

4.LH and FSH stimulate the gonads to release Testosterone/Oestrogen.

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9
Q

Which conditions affect the hypothalamus to reduce GnRH.

A

-Congenital Hypogonadotropic hypogonadism. (Kallmann Syndrome)
-Acquired Hypogonadotropic Hypogonadism.
-Hyperprolactinaemia

HYPOgonadotrophic Hypogonadism

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10
Q

Which conditions affect the Anterior Pituitary Gland to reduce LH & FSH.

A

-Hypopituitarism

HYPOgonadotrophic hypogonadism.

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11
Q

Which conditions affect the Anterior Pituitary Gland to reduce LH & FSH.

A

-Hypopituitarism

HYPOgonadotrophic hypogonadism.

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12
Q

What is anosmia.

A

Loss of smell.

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13
Q

What is Kallmann syndrome.

A

Congenital disease, failure of migration of GnRH neurons in development causing unmeasurable GnRH.

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14
Q

What are reproductive features of Kallmann.

A

-Failure of puberty
-Infertility

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15
Q

What pre testicular causes of infertility are there in men?

A

-Klinefelters 47XXY
-Y chromosome deletion
-HPG Axis issues, testosterone and prolactin issues

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16
Q

What is cryptorchidism?

A

In cryptorchidism the testes don’t descend. (Usually stuck in inguinal canal)

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17
Q

What pattern of LH, FSH and T would you see in primary testicular failure? e.g Klinefelters

A

-LH up
-FSH up
-T down

18
Q

What

A
18
Q

What pattern of LH, FSH and T would you see in hyperprolactinaemia?

A

-LH down
-FSH up
-T down

19
Q

What diseases are there that affect the hypothalamus to cause hypogonadism?

A

-Congenital hypogonadotrophic hypogonadism e.g anosmic (Kallmann syndrome) or normosmic.

-Acquired hypogonadotrophic hypogonadism e.g low BMI/ stress

-Hyperprolactinaemia

20
Q

What do diseases that cause hypogonadism by affecting the hypothalamus do to:
-GnRH
-LH + FSH
-Testosterone

A

-GnRH down
-LH and FSH down (hypogonadotrophic)
-Test down (hypogonadism)

21
Q

What diseases/ conditions are there that affect the pituitary to cause hypogonadism?

A
  • Tumour
  • Infiltration (e.g. of sarcoid/TB)
  • Apoplexy- sudden loss of blood supply
  • Surgery
  • Radiation
22
Q

What do diseases that affect the pituitary to cause hypogonadism do to:
-LH
-FSH
-Testosterone

A

-LH and FSH down
-Test down

23
Q

What diseases are there that affect the gonads to cause hypogonadism?

A
  • Congenital primary hypogonadism e.g. Klinefelters (47XXY)
  • Acquired primary hypogonadism e.g. cryptorchidism, trauma, chemo, radiation
24
Q

What causes Kallmans syndrome

A
  • Within first 10 weeks of conception, GnRH neurones migrate from the olfactory placode in the primitive nose to the thalamus along with olfactory fibres
  • Failure of this migration causes Kallmann’s
25
Q

What does kallmans do to:
-GnRH
-FSH + LH
-Testosterone

A

Low GnRH, low FSH and LH, low T

26
Q

Symptoms for Kallmans syndrome

A
  • Anosmia (loss of smell)
  • Cyptorchidism (undescended testes)
  • Failure of puberty- lack of testicle development, micropenis, primary amennorhoea
  • Infertility
27
Q

What is Klinefelter’s syndrome?

A

Where males have XXY

28
Q

What does klinefelter’s do to LH, FSH and T

A

Higher LH and FSH, low T (hypergonadotrophic hypogonadism)

29
Q

Symptoms for Klinefelter’s

A
  • Tall stature
  • Narrow shoulders
  • Wide hips
  • Breast development
  • Low bone density
  • Less facial hair
  • Reduced chest hair
  • Female-type pubic hair pattern
  • Small penis and testes
  • Infertility (accounts for up to 3% of cases)
  • Mildly impaired IQ
30
Q

What are the main investigations to diagnose male infertility?

A

-Semen analysis
-Blood tests
-Urine + chlamydia swabbing
-Imaging (MRI pituitary if low LH/FSH or high PRL)

31
Q

What treatment do you use for hyper PRL?

A

Dopamine agonist

32
Q

What ovarian causes of of infertility are there?

A
  • Anovulation- access controlling ovarian hormones is defective
  • Corpus luteum insufficiency (not enough progesterone to support early pregnancy stages)
33
Q

What tubal causes of female infertility are there?

A

-Infection
-Trauma
-Endometriosis

34
Q

What is endometriosis and how do you treat it?

A

Presence of functioning endometrial tissue outside the uterus.

Treated by:
- Hormonal (e.g. continuous OCP, progesterone)
- Laparoscopic ablation
- Hysterectomy (removal of womb)
- Bilateral Salpingo-oophorectomy (take out tubes and ovaries where endometriosis is)

35
Q

What are fibroids?

A
  • Benign tumours of myometrium
  • Responds to oestrogen
36
Q

What diseases are there that affect the gonads in females to cause hypogonadism?

A
  • Congenital primary hypogonadism e.g. Turners (45X0), premature ovarian insufficiency (POI)
  • Acquired primary hypogonadism e.g. POI, trauma, chemo, radiation, surgery
  • Polycystic ovaries syndrome (PCOS)
37
Q

How do we diagnose PCOS?

A

Exclude other reproductive disorders then use Rotterdam PCOS diagnostic criteria (need 2 out of 3 criteria):
- Oligo or anovulation:
- Clinical and/or biochemical hyperandrogenism
-Polycystic ovaries on ultrasound

38
Q

How do we treat infertility in people with PCOS

A
  • Clomiphene
  • Letrozole
  • IVF
39
Q

What drug can we give in PCOS for irregular periods and insulin resistance?

A

Metformin

40
Q

What does metformin do?

A

Helps control blood sugar

41
Q

How does Turner’s Syndrome affect FSH, LH and E2?

A

Increased FSH and LH but lower E2 (hypergonadotrophic hypogonadism)

Endocrinology BRS 2 (12 decks)

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