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infertility Flashcards

(75 cards)

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1
Q

define infertility

A

inability of heterosexual couples to acheieve a clinical pregnancy within 12 months od beginning regular unprotected sexual intercourse

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2
Q

define primary and secondary infertiliy

A

primary - no previous pregnancies

secondary- at least one previous pregnancy

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3
Q

incidence of infertility in the popoulation

A

1 in 7 couples at some point

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4
Q

in a normal fertile couple what are the percentage changes of getting pregnant after:
1 month
6 months
1 year
2years

A

1 month- 30%

6 months- 60%

1 year- 84%

2 years- 92%

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5
Q

factors affecting fertility 5

A

age
-mostly female issue
-some evidence of male age influence

previous pregnancy

duration of sub-fertility
- if over 3 years chance of conception only 1-3% per cycle

timing of intercourse

weight

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6
Q

how does timing of intercourse affect fertility

A

sperms needs to be deposited BEFORE ovulation
-as progesterone affects cervical mucus

2-3 times a week

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7
Q

how does weight affect fertility

A

less likely if BMI <18.5 or > 30

other weight related pregnancy problems important also
- increased risk of miscarriage
-GDM
-PIH (pregnancy induced hypertension)
-DVT

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8
Q

state the holy triad of reproductive physiology

A

sperm

egg

meet and implant

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9
Q

how can causes of infertility be classified
-percentage chance for each

A

male - 30%

ovulatory - 25%

unexplaiend 25%

tubal 15%

endometrosis 5%

*-often combined

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10
Q

management prinicples of infetility 4

A

both partenrs should be involved throughout

inital health promotion

history, exam, investigations

treatment

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11
Q

health promotion domains for inferility 6

A

smoking

alcohol

recreational drugs

obesity
-takes longer to conceive
-males >30MBI also reduced fertility

low BMIs (<19) with oligo-amenorrhoea

folic acid helps avoid NTDs (neural tube defects)

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12
Q

how does smoking affect fertility 2

A

reduces female ferility (even passive)

reduces male sperm quality

*-refer for smoking cessation

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13
Q

alcohol consumption for males and females trying to conceive

A

female -1-2 units once or twice a week

male - 3-4 units a day is OK (but intoxication affects sperm quality)

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14
Q

which recreational drugs in partiuclar affect infertility

A

esp body building supplkemtns for male s

-decreases sperm activity and takes months to recover

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15
Q

regarding semen analysis
-when is the sample collected

A

after 2-5 days of abstienece

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16
Q

what laboratory factors are used in semen analysis 3

A

concentration

total motility

normal forms

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17
Q

regarding semen analysis
-what is the minimum concentration

A

> 15mill/ml

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18
Q

regarding semen analysis
-what is the minimum total motility

A

> 40%

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19
Q

regarding semen analysis
-what is the minimum normal forms
*-what is included in assessing normal forms

A

≥4%

-count, motiltiy, morphology

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20
Q

other factors assessed in semen analysis 3

A

volume – ≥1.5ml
progressive motility - >32%
vitality – 58%

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21
Q

what can cause an abnormal semen analysis result 3

A

low (or absent) sperm numbers

low motility

poor quality

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22
Q

terminology for semen abnormalities
azoospermia

A

absent sperm

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23
Q

terminology for semen abnormalities
oligospermia

A

very few sperm

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24
Q

terminology for semen abnormalities
asthenospermia

A

very immotile sperm

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25
terminology for semen abnormalities teratospermia
abnormal morphology
26
how can causes of male subfertility be classified 3
defects in: -sperm transportation -sperm production -hypogonadotrophism (rare)
27
what is assessed in a subfertile male 5
seminal analysis history testicular examination FSH karyotype if severe oligo or azoospermia -? CF carrier; Y deletions
28
regarding semen analysis -when is the sample collected
after 2-5 days of abstinence -analysed in dedicated lab with strict regulations
29
how can causes of azoospermia be split
obstructive non obstructive
30
basic pathophys of obstructive azoospermia
normal spermatogenesis inability to leave in ejaculate
31
causes of obstructive azoospermia 2
blockage in epididymis or vas deferens congenital absence of vas deferens (TEST CF)
32
basic pathophys of non obstrutive azoospermia
testicular failure (high FSH) -small testicular volumes
33
testing for non obstrutive azoospermia
biopsy - ?any spermatogenesis karyotype for ?XXY (klinefelters) Y microdeltions
34
other than obstrutive and non obsturtive azoospermia what is a third type -how can it be caused
RARE =failure to stimjalte speramtogensis =hypogonadotorphic hypogonadism -low FSH
35
male subfertility management options 2
IVF with intracytoplasmic sperm injection (ICSI) -resuls are better than IVF -better for obstrutive than non obstructive azoospermia donor insemination -if ICSI not feasible eg. if no quality sperm extracted
36
how can female infertility be split
ovulatory tubal
37
when does ovulation occur in the cycle -what is released
day 21 -progesterone
38
regarding women infertility -define group 1
women with primary or secondary amenorrheoea -low levels of endogenous gonadotorpins -negilibile endogenous oestrogen activity
39
regarding women infertility -define group 2
anovulatoin associated with a variety of menstural disorders (including amenorrhea) -exhibit distinct endogenous oestorgen activity whose urinary and serum gonadotropins are in the normal range
40
regarding women infertility -define group 3
primary or seocndary ammenorhea due to primary ovarian failure with low endogenous oestrogen acitivyt and pathologically high gonandotooin levels
41
summaries the groups of infertile women 3
1- primary or secondary amenorrhoea -low gonadotropins, no (v low) oestrogen 2- anovulation due to menstrual disorders -normalgonadotorpins, normal oestrogen 3-primary or secondary amenorrhea due to primary ovarian failure - high gonadotropins, low oestrogen
42
regarding hypothalamic pituitraty fialure resulting in infertility in women (group 1) -what can affect the hypothalamic part 3
weight stress exercise craniopharyngioma kallmans syndrome
43
regarding hypothalamic pituitraty fialure resulting in infertility in women (group 1) -what can affect the pituitary part 1
adenoma
44
what are the lab findings in gorup 1 infertility in women 4 -what investigation could be useful in this group
decreased FSH decreased LH decreased E2 normal or increasted PRL (prolactin) -MRI check for spcare occupying lesion
45
management of group 1 infertile women 2 -medical managemnt 2
increase BMI and exercise in moderation -treat the cause medical management -GnRH agonist -given in pump - pulsatile release- mimic normality -limited aviablaibly -advantages include mono-ovulation and increased live birth success ;gonadotropins (FSH/LH) -problems with ovairna hyperstimulation -multiple ovulation -multiple pregnancy
46
cuases of group 2 (hypothalamic-pituitary dysfunction) infertility in women 5
85% anovulatory suibferitlity -mainly PCOS/PCO others: -hyperprolactinaemia -hypothyroid -hyperthyroid -adrenal insufficiency
47
how is hyeprporlactinaemia treated as a cuase of infertility
dopamine agnoist -cabergoline or bromocriptine
48
hormoen levels in PCOS (group 2 inferiltity) 4
reversed FSH/LH ratio - Normally this ratio is about 1:1 – meaning the FSH and LH levels in the blood are similar. FSH and LH are often both in the range of about 4-8 in young fertile women. In women with polycystic ovaries the LH to FSH ratio is often higher – for example 2:1, or even 3:1 E2 normal prolactin normal free andogen index (FAI) increased
49
what is the most common form of anovulatory infertiltiy
polycycstic ovarian syndrome (PCOS)
50
prevalence of PCOS
20% of woemn
51
what criteria is used for PCOS diagnosis -how many elements of this criteria are need for diagnosis
rotterdam criteria - 2 of 3
52
state the cirteria for PCOS diagnosis (rotterdam criteria) 3
clinical or biochemical evidence oligomenorrhoea/amenorrhoea ultrasound feature of PCO
53
state the cirteria for PCOS diagnosis (rotterdam criteria) 3
clinical or biochemical evidence oligomenorrhoea/amenorrhoea ultrasound feature of PCOS
54
what is the ultrasound finding in PCOS
string of pearls
55
how does PCOS affect feritltiy
ovulatory function oocyte quality endometrial receptivity *? secondary to obestiy, metabolic and inflammatory distrubance s
56
mainstay of PCOS managemtn
weight loss -even if normal BMI - 10% weight loss- increased ovulation to approx 80%
57
define ovarian drilling as a treatment for PCOS infertility
Ovarian drilling involves laparoscopic surgery. The surgeon punctures multiple holes in the ovaries using diathermy or laser therapy. This can improve the woman’s hormonal profile and result in regular ovulation and fertility. -as effective as GnRH for PCOS -80% ovulation -14% miscarraige -use after failed medical management
58
first line medical PCOS fertiltiy managemnt
letrozole
59
MOA of letrozole for PCOS infertilityh
armoatase inhibitor -block ostreogen biosynthesis -> blocks negative feedback -> increased FHS-> ovulation stimulation
60
previous first line PCOS feritlity medical mangemtn
clomiphene
61
MOA of clomiphene for PCOS feritlity
SERM -selective oestrogen receptor modulator -blocjs E2 receptor at pituitary blocks negfative geedback-> increased fSH-> ovulation stimulation
62
why is letrozole preferred over clomiphene for fertiltiyu management 4
increased ovulation and pregnancy rates has a decreased risk of multiple preganncy decreased risk of ovarian cancer decreased risk of ovarian hyperstimulation
63
when is IVF used in PCOS feritliy managemnt
stimulation after GnRH analoauge down reulafion of pituitary with FSH injections to stimulate ovulation
64
define ovarina hyperstimulatoin
ovaries over respond to gonadotrophin injfections -ssytemic diseas resulting from release of vasoactive products from hyperstimulated ovaries 1% risk but 5% risk in PCOS
65
severe manifestiaatiosn of ovarian hyeprsitmulation 4
thrombosis renal dysfunction liver dysfunction adult respiratory distress syndrome
66
lab findings in group 3 (ovarian fialure/ insuffiences) infertility in women 2
increased FHS decreased E2
67
lab findings in group 3 (ovarian fialure/ insuffiences) infertility in women 2
cuaincreased FHS decreased E2
68
causes of group 3 (ovarian fialure/insuffifences) inferitlity in women 9
Idiopatihic Chemo/XRT Surgical removal of ovaries Autoimmune Chromosomal Turners (45XO)/ Turners mosaic Pure gonadal dysgenesis Androgen insensitivity (46XY) Fragile X
69
most common group 3 (ovarian fialure/insuffieincey) cuase
premature ovarian insuffiiency (POI) can concieve with no treatment but pregnancy rates v low
70
other options for managemnt of group 3 (ovarian fialure/insuffieincey) than conseravitely 5
IVF emrbyo donation adoption fostering accepting childlessness
71
how are a womens fallopian tubes assessed for dysfunction in infertility 3
hysterosalpingogram (HSG) -X-ray with radio-opaque dye into the uterus laparosocpy and dye test -consider risks assoc w laparscopy -allows assessment of pelvis hysterosalpingo-contras ultrasonography (Hy-Co-Sy) -assess tubal and uterine pathology
72
elegibiltiy in scotland for assissted conception services 5
-female must be less than 43 yo by time treatment is completed AND less than 42 years by time screening is completed female BMI 18.5-30 both partners non smoking for at least 3 months before being placed on waiting lists at least one partner have no biliogcla child neither you or partner have been sterilied cohabitng stable relationship for greater than 2 years
73
what infections are tested for at cervical screening for assisted conception services 5
rubella HIV \ hep c hep B chlamydia
74
techniques for assisted conception services
intrauterine insemination ± ovulation inducion IVF- sperm feritlzies egg on its own intracystosplasmic sperm injection -singe sperm injected into mature egg
75
rates of live birth rate for assisted conception serivecs
~25% for each cycle

Obs & Gyn (23 decks)

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