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Endo yr 2 > infertility > Flashcards

infertility Flashcards

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1
Q

definition of infertility

A

a disease of the REPRODUCTIVE SYSTEM defined by the failure to achieve A CLINICAL pregnancy after>12 months of REGULAR unprotected sexual intercourse.

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2
Q

what is considered regular intercourse

A

every 2-3 days

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3
Q

prevelance of infertility and how many achieve it after an extra year of trying

A

14% of couples but half of these will achieve after extra year

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4
Q

how many couples with infertility seek help?

A

55%

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5
Q

which couples have been shown to be more likely to seek help concerning infertility?

A

higher socioeconomic status

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6
Q

what proportion of cases is due to 1) male factor 2) female factor 3) combination of male AND female factor 4) unknown

A

1,2,3; 33% each, unknown :10%

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7
Q

what is the cost of infertility to society?

A

Less births
- Less tax income
- Investigation costs
- Treatment costs

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8
Q

what are some of the issues that trouble couples with infertility psychologically?

A

No biological child
- Impact on couples wellbeing
- Impact on larger family
- Investigations
- Treatments (often fail) (eg ivf- 20-30 % of success)– money and psych
Discouraging

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9
Q

what are the three main categories of male infertility causes?

A

pre-testicular
testicular
post-testicular

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10
Q

what are the causes of pre testicular infertility

A

congenital and acquired endocrinopathies

1) Klinefelters 47XXY (extra x chormosome)
2) HPG,
T,
PRL issues (prolactin)

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11
Q

CAUSES OF TESTICULAR INFERTILITY

A

(Congenital)

Cryptorchidism

Infection STDs

Immunological Antisperm Abs

Vascular Varicocoele

Trauma/Surgery

Toxins
Chemo/DXT/Drugs/Smoking

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12
Q

causes of post testicular infertility

A

Congenital: Absence of vas deferens in CF

Obstructive: (obstruction of spermatic cord): Azoospermia

Erectile Dysfunction:
1)Retrograde Ejaculation 2)Mechanical Impairment 3) Psychological

Iatrogenic: Vasectomy

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13
Q

what is the normal path through which testes descent?

A

inguinal canal

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14
Q

what happens in cryptorchidism?

A

undescended testes,
90% in ingiunal canal

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15
Q

what are the categories of female infertility causes?

A

cervical, uterine, tubal, ovarian, pelvic (things that can happen in multiple areas of the female reprod system)

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16
Q

what are some pelvic (general) causes of infertility

A

endometriosis
adhesions

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17
Q

tubal causes of infertility and prevalence

A

30% infection
endometriosis
trauma

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18
Q

uterine causes and prevalence

A

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

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19
Q

cervical causes and prevalence

A

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

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20
Q

ovarian causes of infertility and prevalence

A

40%
anovulation (endo)
corpus luteum insufficiency

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21
Q

rank the causes of female infertility for prevalence

A

1) ovarian 40
2) tubal 30
3) unexplained and uterine 10 each
4) pelvic and cervical 5 each

(remember it by location, from ovary to cervic physiological path) (ovary-> tube-> uterus-> cervix)

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22
Q

above what point in the fem reprod system is there sterility?

A

cervix

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23
Q

what is endometriosis?

A

presence of functioning endometrial tissue outside the uterus

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24
Q

prevalence of endiometriosis

A

5% of women

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25
what can be given to help with endometriosis?
oestrogen
26
symptoms of endometriosis
MENSTRUAL pain menstrual irregularities deep dyspareunia (pain before during or after sex) infertility
27
what are fibroids?
benign tumours of the myometrium
28
prevalence of fibroids and what factor increases their prevalence?
1-20% of premenopausal women (increases with age)
29
what do fibroids responf to and why?
oestrogen because they are mad eup of uterine tissue
30
usual presentation of fibroids
1) usually asymptomatic 2) incr menstrual pain 3) menstrual irregularities dyspareunia infertility
31
where is kisspeptin released form and where does it act on?
kisspeptin neurons in hypothalamus and acts on gnrh neurons in hypothalamus
32
which of the following are measurable in the blood? ( kisspeptin, gnrh and lh fsh)
only lh fsh
33
in what rhythm is gnrh released
pulsatile
34
what rhythm is lh and fsh released in
pulsatile
35
what rhythm is oestrogena nd testosterone release in
diurnal
36
is oestrogen produced from testosterone or test from oestrog by aromatisaiton
oestrog by testosterone (biology is sexist: way to remmebr)
37
levels of lh fsh and test in any endocrine male infertility issue caused by any part of the HPG axis above the pituitary (hypothal or pit)?
all low (hypogonadotrophic hypogonadism) (in hypothalamus issues gnrh is additionally low but it cant be measured anyways)
38
what do the terms: hypogonadotrophic hypogonadism mean and what is their significance?
hypogonadism : low test and oestrogen hypogonadotrophic : low lh fsh its not a diagnosis, just way to describe the situation
39
levels of lh fsh and test in any gonad level caused endocrine male infertility
test low, lh fsh high
40
hypothalamus level causes of endocrine male infertility?
congenital hypogonadotrophic hypogonadism (2 types-Anosmic (you cant smell) (Kallmann Syndrome) or Normosmic) Acquired Hypogonadotrophic Hypogonadism -Low BMI (anorexia nervosa: no , XS exercise, Stress Hyperprolactinaemia
41
when are these symptoms (of klinefelters syndrome) even more severe?
when 3 or more x chromosomes are present
42
pituitary level causes of endocrine male infertility
Hypopituitarism -Tumour, Infiltration (full of wbc), Apoplexy (blood flow interuption), Surgery, Radiation
43
gonad level causes of endocrine male infertility
Congenital Primary Hypogonadism -Klinefelters (47XXY) acquired primary hypogonadism Cryptorchidism, Trauma, Chemo, Radiation
44
what is kallmann syndrome?
the ANOSMIC type of CONGENITAL HYPOGONADOTROPHIC hypogonadism (at the HYPOTHALAMIC level)
45
main symptoms of kallmann syndrome?
anosmia reproductive features: failure of puberty (Short, small penis) infertility
46
what is the pathology in kallmann syndrome
failure of migration of GnRH neurons with olfactory fibres from the olfactory placode (promitive nose) to the hypothalamus
47
how does hyperprolactinaumia work?
prolactin binds on prolactin receptors on kisspeptin neurons inhibits kissp and the axis
48
symptoms of hyperprolactinaemia in both men and women
(hypogonadal symptoms) oligo or amenorrhoea low libido infertility/ osteoporosis
49
what is klinefelter syndrome?
most common sex chromosome disorder - (sex chromosome trisomy) people have an extra x chromosome
50
how common is klinefelter syndrome and how many cases get diagnosed?
1-2/ 1000 BIRTHS AND only 1/4 gets diagnosed
51
what are the symptoms in klinefelters syndrome?
tall stature mildly impaired IQ (15 POINTS DOWN ON AVERAGE) low bone density and female looking stuff: 1) female pubic pattern 2) small penis and testes 3) wide hips 4) narrow shoulders 5) little facial + chest hair (infrequent shaving)
52
key history of male infertility
duration, previous children, pubertal milestones
53
key examination of male infertility
BMI sexual characteristics testicular volume anosmia
54
key investigations for male infertility
1) semen analysis 2) blood tests 3) imaging
55
normal semen volume, sperm concentration and total motility (proportion of sperm that can move)
1.5 ml 15 million 40%
56
blood tests needed for male infertility
LH FSH PRL (prolactin) Morning fasting testosterone karyotyping
57
imaging tests in male infertility
MRI pituitary (if low fsh/ lh or high prl) SCROTAL US (ultrasound) / doppler: checks blood flow) (if variococoele/ obstruction, testicular volume)
58
male infertility lifestyle treatments
Optimise BMI Smoking cessation Alcohol reduction/cessation
59
male infertility specific treatments
Dopamine agonist for hyperPRL Gonadotrophin treatment for fertility (will also increase testosterone) Surgery (eg. Micro Testicular Sperm Extraction (micro TESE))
60
when do we give testosterone?
Testosterone (for symptoms if no fertility required – as this requires gonadotrophins)
61
what is the first thing you do to women with infertility symptoms?
ensure not pregnant or breastfeeding first
62
symptoms of premature ovarian insufficiency
same as menopause
63
conception rate in POI
20%
64
causes of POI
Autoimmune Genetic eg Turner’s Syndrome Cancer therapy Radio- / Chemo-therapy in the past
65
what is the cause of gonad level endocrine female infertility with incr lh fsh and normal or low e2?
polycystic ovarian syndrome (PCOS )
65
HOW DO anorexia and stress induced amenorrhoea work?
Anorexia: no leptin: produced by fat cells Stress: high cortisol: no periods All these are sensed by kisspeptin neurons Prevent periods bc its not safe to carry baby (if too thin or if too much stress)
66
what are the causes of gonad level endocrine female infertility with incr lh fsh and low e2?
Acquired Primary Hypogonadism -Premature Ovarian Insufficiency (POI) -Surgery, Trauma, Chemo, Radiation Congenital Primary Hypogonadism -Turners (45X0) -Premature Ovarian Insufficiency (POI)
67
what is the most common speciifc cause of infertility in women?
PCOS - 5-15%, ALSO most common endocrine disorder in women
68
PCOS diagnostic mehtod
1) exclude other causes of infertility 2) rotterdam pcos diagnostic criteria 2/3: a) oligo or anovulation (assessed by menstrual freq) b) Clinical +/- Biochemical Hyperandrogenism c) polycystic ovaries
69
PCOS symptoms
1) irregular menses/ amenorrhoea and infertility 2) incr insulin resistance and impaired glucose homeostasis (T2DM, gestational DM) 3) HIRSUTISM 4) incr risk of endometrial cancer
70
what drugs are given for PCOS to help with a mix of the symptoms?
1) OCP for lighter periods and improves risk for endometr cancer 2)ovulation induction (IVF ) for infertility 3) metformin and diet-lifestyle for insulin issues and irregular menses and weight loss 4) anti androgens and hair removal for hirsutism 5) progesterone for enfometrial cancer rik
71
what is turnners syndrome?
genetic disease cause of endocrine infertility (45 X)
72
SYMPTOMS of turners syndrome appearance
head: low hairline, certain facies (grimatses), webbed (short) neck whole body: short, brown nevi (big moles) -nipples big distance apart + poor breast dev hands: (shield chest) short fourth metacarpal small fingernails elbow deformity,
73
health/ internal symptoms of turners syndrome
amenorrhoea underdeveloped reproductive tract
74
what thing do you do differently for womens key history for infertility?
menstrual history
75
what do you do different for key for womens key examination for infertility?
hyperandrogenism signs
76
key investigations differences for infertility for women
1) OU DO PREG TEST FIRST: common and cheap 2)oestradiol, androgens, mid luteal progesterone 3)hysterosalpinogram in imaging

Endo yr 2 (11 decks)

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