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Aneesha Flashcards BRS 2 > Infertility > Flashcards

Infertility Flashcards

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1
Q

what is infertility?

A

a disease of the reproductive system defined by the failure to achieve a clinical pregnancy after 12+ months of regular (every 2-3 days) unprotected sexual intercourse

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2
Q

what is primary infertility?

A

infertility with no previous live birth

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3
Q

Does male factor, female factor or a combination account for most cases of infertility?

A
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4
Q

what is secondary infertility?

A

infertility with a live birth 12+ months previously

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5
Q

what is the prevalence of infertility?

A

affects 1 in 7 couples
But ~ half of these will then conceive in the next 12 months (ie at 24months ~ 7% of couples)

55% seek help - positive association with socioeconomic status

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6
Q

what are the psychological impacts of infertility?

A

no biological child, impact on wellbeing of couple, larger family, investigations and treatments (often failing)

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7
Q

what are the societal costs of infertility?

A

less births, less tax income, investigation and treatment costs.

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8
Q

what are the male pre-testicular causes of infertility?

A

congenital and acquired endocrinopathies e.g Klinefelters, HPG, T, PRL issues

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9
Q

what are the testicular causes of male infertility?

A

congenital
cryptorchidism
infection - STDs
immunological - antisperm ABs
vascular - varicocoele
trauma/surgery
toxins - chemo, dxt, drugs, smoking

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10
Q

what are the post testicular causes of male infertility?

A

congenital - abscence of vas deferens in CF
obstructive azoospermia
erectile dysfunction - retrograde ejaculation, mechanical impairment, psychological
latrogenic - vasectomy

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11
Q

what is cryptorchidism?

A

undescended testes - 90% in inguinal canal, as normal pathway of descent is through inguinal canal

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12
Q

what are the types of causes of female infertility?

A

pelvic (5%)- endomteriosis, adhesions,
ovarian (40%)- anovulation, Corpus luteum insufficiency
tubal (30%)-Tubopathy due:
-Infection
-Endometriosis
-Trauma

uterine (10%)-Unfavourable endometrium due:
-Congenital malformations
-Infection/Inflammation/Scarring (adhesions)
-Fibroids

cervical (5%) Ineffective sperm penetration due:
-Infection/Inflammation
-Immunological (antisperm Ab)

and unexplained (10%)

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13
Q

what is endometriosis?

A

presence of functioning endometrial tissue outside the uterus

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14
Q

what is the prevalence of endometriosis in women?

A

5%

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15
Q

what are the symptoms of endometriosis?

A

menstrual pain and irregularity, deep dyspareunia, infertility

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16
Q

what are fibroids?

A

benign tumours of the myometrium

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17
Q

what is the prevalence of fibroids in women?

A

1-20% pre-menopausal women

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18
Q

are fibroids or endometriosis responsive to oestrogen?

A

both

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19
Q

what are the symptoms of fibroids?

A

usually asymptomatic
menstrual pain, irregularities
deep dyspareunia
infertility

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20
Q

what are the blood results for a hypothalamic cause of endocrine male infertility?

A

low LH/FSH
low testosterone

low GnRH (not measurable)

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21
Q

what are the blood results for pituitary causes of endocrine male infertility?

A

low LH/FSH
low testosterone

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22
Q

what are the blood results for gonad causes for endocrine male infertility?

A

high LH/FSH
low testosterone

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23
Q

Endocrine Male Infertility at different levels of HPG axis

A
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24
Q

what is Kallman’s syndrome?

A

failure of migration of GnRH neurons along with olfactory neurons to hypothalamus from olfactory placode (during first 10wks of development)
This leads to anosmia and reproductive features

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25
what are the reproductive features of Kallmann's?
Failure of puberty Infertility
26
what are the blood test results for someone with Kallmann's?
low LH/FSH low testosterone
27
how is hyperprolactinemia treated?
cabergoline | or pit surgery/radiotherapy
28
what is the karyotype for Klinefelter syndrome?
47XXY
29
what is the karyotype for Turner syndrome?
45X0
30
what are the features of Klinefelters syndrome?
tall stature decreased facial/chest hair mildly impaired IQ narrow shoulders Slight breast deveolpment female pattern pubic hair wide hips small penis/testes low bone density INFERTILITY
31
how would you approach a male history for infertility?
duration previous children pubertal milestones, associated symptoms (eg. T deficiency, PRL symptoms, CHH features) medications/drugs
32
how would you approach examining a male presenting with infertility?
BMI, sexual characteristics, testicular volume, anosmia
33
what are the 3 main investigations for males presenting with infertility?
semen analysis blood tests imaging
34
what is semen analysis?
measures volume (1.5ml normal), sperm concentration-15 million/ml (Azospermia = No sperm, Oligospermia = Reduced sperm) and total mobility of a sperm sample (40%)
35
what are the main blood tests for a male presenting with infertility?
LH, FSH, PRL Morning Fasting Testosterone Karyotyping
36
what are the imaging methods used for males presenting with infertility?
Scrotal US/Doppler (for varicocoele/obstruction, testicular volume) MRI Pituitary (if low LH/FSH or high PRL)
37
what are the typical lifestyle treatments for general male inferility?
optimise BMI smoking cessation alcohol cessation/ reduction
38
what are specific treatments for male hyperPRL?
dopamine agonist - cabergoline
39
What type of surgery can be used to treat male infertiliy?
Micro TESE (microtesticular sperm extraction)
40
how is testosterone prescribed to males not desiring fertility?
daily gel 3 weekly IM injections 3 monthly IM injections implants/oral preparations less common
41
what to prescribe to males desiring fertility?
``` hCG injections (act on LH receptors) if no response after 6mnth, add FSH injections ```
42
what treatments are used for males wanting fertility?
gonadotrophin treatment | NO TESTOSTERONE - -ve feedback on LH/FSH
43
when is testosterone prescribed to males presenting with infertility?
if fertility is not desired, only for symptomatic relief
44
What blood results would you see in premature ovarian insufficiency? How is POI diagnosed?
High FSH/ LH, low oestradiol Diagnosis High FSH >25 iU/L (x2 at least 4wks apart)
45
Can conception occur in premature ovarian insufficieny?
Yes, in 20%
46
what is primary amenorrhoea?
menses not started after 16 years old
47
what is secondary amenorrhoea?
periods start at puberty but stop for at least 3-6mnths
48
what is amenorrhoea?
no periods for at least 3-6mnths | or up to 3 periods/yr
49
what is oligomenorrhoea?
irregular/infrequent periods, >35day cycles | or 4/9 cycles/yr
50
what is early menopause?
menopause occurring in a female under 45
51
how is early menopause diagnosed?
high FSH (>25iU/L) twice at least 4wk apart
52
what are the odds for conception in a female with early menopause?
20%
53
Causes of premture ovarian insufficiency?
Autoimmune Genetic eg Turner’s Syndrome Cancer therapy Radio- / Chemo-therapy in the past
54
What blood results would you see in Anorexia Nervosa-Induced Amenorrhoea?
Low FSH/LH/ oestradiol
55
how does hypothalamic causes of infertility in women show in a blood test?
low LH/FSH low E2 hypogonadotrophic hypogonadism
56
what are the female congenital causes of hypogonadotropic hypogonadism?
anosmic (kallmann's syndrome) or normosmic
57
what are the acquired female causes of hypogonadotrophic hypogonadism?
low BMI stress excessive exercise hyperprolactinemia
58
what are the blood results for pituitary causes of female infertility?
low LH/FSH low E2
59
what are the causes of female hypogonadotropic infertility? (pituitary causes)
hypopituitarism- tumour infiltration apoplexy surgery radiation
60
what are the acquired gonadal causes of female primary hypogonadism?
``` early menopause/primary ovarian insufficiency surgery trauma chemo radiation polycystic ovarian syndrome (PCOS) ```
61
what are the congenital causes of female primary hypogonadism?
turners syndrome | early menopause/premature ovarian insufficiency
62
what are the blood results for PCOS?
high LH/FSH | low or normal E2
63
what are the blood results for female primary hypogonadism?
high LH/FSH | low E2
64
what is PCOS' burden of disease?
affects 5-15% women of reproductive age | most common endocrine disorder in women, most common cause of infertility
65
how is PCOS diagnosed?
exclude other reproductive disorders | Rotterdam criteria - 2/3
66
what is the Rotterdam PCOS diagnostic criteria?
oligo or anovulation clinical+/- biochemical hyperandrogenism polycystic ovaries on utrasound
67
how is oligo/anovulation assessed for the rotterdam criteria of PCOS?
by menstrual frequency - oligomenorrhoea (<8-9 cycles a year)
68
how is clinical hyperandrogenism for the rotterdam PCOS criteria assessed?
clinical - acne, hirsutism, alopecia
69
how is biochemical hyperandrogenism for the rotterdam PCOS criteria assessed?
raised androgens on blood test (e.g testosterone)
70
why are polycystic ovaries on ultrasound not diagnostic for PCOS?
30% of women have polycystic ovaries so isn't confirmational
71
how does Clomiphene act for female fertility?
oestradiol receptor antagonist reduces negative feedback of oestrogen on hypothalamus/pituitary gland therefore increases LH/FSH FSH stimulates follicle growth
72
what treatments for PCOS aim to restore ovulation?
weight loss letrozole (aromatase inhibitor) clomiphene (oestradiol receptor modulator) FSH stimulation
73
how does letrozole act for female infertility?
inhibits aromatase (test-oest) therefore reduces negative feedback of oestrogen on LH/FSH therefore increases serum LH/FSH leading to stimulation of follicle growth
74
what are the treatments for PCOS?
75
what are the physical features of Turner's syndrome?
short stature low hairline shield chest webbed neck poor breast development, wide spaced nipples elbow deformity brown nevi short 4th metacarpal small fingernails
76
what are the internal features of Turner's syndrome?
coarctation of aorta underdeveloped reproductive tract amenorrhoea
77
what are the main history points for a female presenting with infertility?
duration, previous children, pubertal milestones, menstrual History, medications/drugs
78
what are the examinations to consider for females presenting with infertility?
BMI, sexual characteristics, hyperandrogenism signs, anosmia
79
what are the main types of investigations for females presenting with infertility?
blood tests pregnancy test imaging
80
what are the blood tests for a female presenting with infertility?
``` LH/FSH/PRL oestradiol, androgens follicular phase 17-OHP, mid-luteal progesterone sex hormone binding globulin albumin, iron studies pit/thyroid study karyotyping ```
81
what are the imaging methods used for a female presenting with infertility?
Ultrasound (transvaginal) hysterosalpingogram MRI pit

Aneesha Flashcards BRS 2 (47 decks)

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