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FINALS - OBS, GYNAE, BREAST > infertility > Flashcards

infertility Flashcards

(57 cards)

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1
Q

what defines infertility

A

cannot conceive after 12 months (primary no kids, secondary have a kid)

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2
Q

causes infertility

A

male factor (most common) // ovulation issue // tubal damage

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3
Q

RF infertility

A

older, extreme BMI, no previous pregnancy

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4
Q

what is primary amenorrhoea

A

no menstruation by 15 (with secondary development eg breasts) or 13 with no breast development

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5
Q

what is secondary amenorrhea

A

no period for 3-6 months with normal menses // no period for 6-12 months with oligomenorrhoea

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6
Q

causes of primary amenorrhea

A

hypogonadism eg turners // congenital malformation // CAH // kallmans

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7
Q

causes of secondary amenorrhea

A

hypothalamic eg stress, excersice // PCOD // raised prolactin // ovarian failure // sheehan // ashermans // pregnancy

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8
Q

what congenital malformations can cause amenorrhea

A

imperforated hymen, mullarian agenesis (no uterus forms)

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9
Q

how does CAH cause infertility

A

underproduction of cortisol and aldosterone and overproduction of androgens

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10
Q

what is ashermanns

A

(secondary) - adhesions in uterus

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11
Q

what is sheehans

A

(secondary) hypopituitary after obstetric bleed

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12
Q

invx amenorrhea

A

bHCG // FBC + TFT // endocrine profile (LH, prolactin, andorgen, oestrogen)

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13
Q

what would LH + FSH + oestradiol indicate in amenorrhea

A

raised LH, FSH + low oestrogen = ovarian problem (eg premature failure) // raised oestrogen = gonadal dysgensis eg turners

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14
Q

endocrine profile in secondary hypothalamic disorder eg exercise, anorexia

A

low FSH, LH, oestradiol

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15
Q

endocrine profile in secondary pituitary disorder eg sheehan, hypopituitarism

A

low FSH, LH, oestradiol

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16
Q

tubal causes infertility

A

PID

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17
Q

what is Premature ovarian insufficiency

A

ovaries stop producing oestrogen before 40

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18
Q

causes Premature ovarian insufficiency

A

idiopathic // bilateral oophorectomy // radio or chemp // mumps // autoimmune

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19
Q

symptoms Premature ovarian insufficiency

A

menopause eg flushes, night sweats // infertile // secondary amenorrhoea

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20
Q

sex hormone profile premature ovarian failure

A

raised FSH (2 readings 4-6 weeks apart!!!) // low oestradiol

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21
Q

mx Premature ovarian insufficiency

A

HRT or COCP until 51

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22
Q

symptoms PCOS

A

subfertility // oligo or amenorrhea // hirsutism, acne androgens) // obesity // acanthosis nigricans + T2DM (insulin resisitance) // obesity

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23
Q

imaging in PCOS

Study These Flashcards
A

USS - cysts on ovaries

24
Q

endocrone hormone profile PCOS

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A

raised LH // mildly raised testosterone // ShBH is low to normal // glucose tolerance

25
criteria for diagnosing PCOS
rotterdam, 2/3: amenorrhoea // clinical or biochemical signs of hyperandrogenism (hirsutism, acne, raised testosterone) // USS = cysts
26
lifestyle mx PCOS
weight loss
27
hirsutism and acne mx PCOS
COCP eg or co-cyprindiol // topical eflornithine // spironolactine, finasteride
28
inferitlity mx PCOS
clomifene or metformin // (gonadotrophins)
29
(surgical mx PCOS)
ovarian drilling
30
function LH in men
leydig cells --> testosterone
31
function FSH in males
(with testosterone) induce spermatogenesis
32
function sertoli cells males
release inhibin --> decrease FSH + LH
33
male fertility causes
CF (bilateral absent vas deferens) // cryptochorism // klinefelters (47XXY) // mumps // tumour
34
what is azoospermia
no sperm in ejaculate
35
what is oligozoospermia
Low sperm count
36
what is Teratozoospermia
decreased normal sperm
37
when should semen analysis be performed
between 3-5 days no ejaculation // if abnormal repeat 3 months
38
invx for infertility
serum analysis + serum progesterone on day 21 (7 days before period)
39
normal progesterone results
<16 - low // 16-30 = repeat // >30 = ovulation is occuring
40
lifestyle advice for ovulation
folic acid // BMI 20-25 // intercourse every 2-3 days // stop drinking and smoking
41
what causes ovulation
luteal phase - LH surge
42
what is a class 1 anovulatory disorder
hypogonadotrophic hypogonadism an-ovulation //low LH, FSH, oestrogen // hypothalamic eg exercise, AN
43
is a class 2 anovulatory disorder
normogonadotrophic normoestrogenic an-ovulation // PCOS // 80!!!
44
what is class 3 anovulatory disorder
hypergonadotrophic hypoestrogen anovulation // high LH and FSH, low oestrogen // problem with ovaries eg premature ovarian failure
45
which class of anovulatory disorders will not benefit from ovulation induction
class 3 (premature ovarian failure)
46
lifestyle advice for ovulation indcution
weight loss, exercise
47
medications for ovulation induction
Clomiphene citrate // letrozole // gonadotrophins
48
what induction is useful in PCOS (class 2)
clomiphene citrate and letrozole // gonadotrophins last line
49
what induction is useful in class 1
gonadotrophins
50
when is IVF indicated
female infertility: tubal disease // last resort if ovulation induction hasnt worked in class 1 and 2 // class 3 (premature ovarian failure)
51
when is artificial insemination used
male infertility eg CF
52
what is ovarian hyperstimualtion
SE of IVF or gonadotrophin therapy
53
mild ovarian hyperstimualtion
abdo pain and bloating
54
moderate ovarian hyperstimualtion + invx
mild N+V // USS = ascites
55
severe ovarian hyperstimualtion + invx
clinical ascites, oliguria // haemocrit >45 // hypoproteinaemia
56
critical ovarian hyperstimualtion + invx
VTE, ARDS, anuria, tense ascites, renal failure, shock
57
mx severe ovarian hyperstimualtion
fluid replacement // anticoag // ascites paracentesis

FINALS - OBS, GYNAE, BREAST (27 decks)

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