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Block 8 - Endo & Repro > Infertility > Flashcards

Flashcards in Infertility Deck (26):
1

What is the normal conception rate?

monthly 25%

2

What is primary vs. secondary infertility?

primary: inability of couple to conceive after 1 year of sex w no contraception (or 6 mos if >35)
secondary: female has conceived before (even if miscarriage/termination)

3

What is the overall chance of infertility?

15%

4

How can antral follicles be used to work up infertility?

normal around 5/ovary = prelim to an egg

5

What is the most common cause of ovarian dysfunction?

PCOS

6

What are the causes of anovulation?

PCOS, hypo hypo, premature ovarian failure

7

How can mid-luteal progesterone help work up infertility?

>3 ng/ml means ovulation

8

What is ovarian reserve testing and when is it used?

if female >35: day 3 FSH and estradiol (high is bad), AMH and inhibin B (should be measurable - low is bad), antral follicle counts

9

What factors can indicate tubal dysfunction?

hx of pelvic inf or pain (dysmenorrhea), prior surgery, family hx of endometriosis

10

How can tubal factors be tested?

HSG
laparoscopy in operating room = gold standard

11

What factors can indicate uterine dysfunction?

hx of D&C, recurrent miscarriage, IUD, prior pregnancy outcome

12

What tests can be used to work up uterine dysfunction?

HSG, ultrasound, hysterosonogram, endometrial biopsy to diagnose luteal phase defect

13

What factors can suggest cervical obstacles in infertility?

prior abnormal pap or cervical inf, mid cycle mucus quality

14

What testing can be done to work up cervical obstacles?

pap, post coital test - mucus quality, cultures for gonorrhea and chlamydia

15

In addition to regular menstrual cycles, what other tests can be done to work up ovarian fxn?

TSH, prolactin*, testosterone and DHEA-S if signs of elevated androgens
fasting glucose and insulin levels

16

What are normal values for male sperm:
volume
count
motility
morphology
WBCs?

2-4 ml
>20 million sperm/ml
50-60% motile
WHO normal >50%, strict normal = 6-14%
<1 million wbc/ml

17

What other tests can be done to work up male infertility?

endocrine (FSH, LH, testosterone, prolactin) - look for azoospermia, moderate oligospermia
genetic eval w karyotype - azoospermia not due to blockage, severe oligospermia - Y chromosome microdeletions?

18

When is the best time for:
semen analysis
imaging
ovulation predictor kit
biopsy
lab work?

after 2-3 days abstinence
cycle day 6-10
shortest menstrual cycle and subtract 18
10-12 days after ovulation
cycle day 3

19

What are the treatment options for ovulation induction in PCOS?

oral clomiphene citrate - blocks estrogen feedback at hypothalamus, low multiple gestation, inexpensive
injectable FSH - greater response, multiple gestations, risk of hyperstimulation, expensive

20

What are the treatment options for hypo hypo?

clomiphene citrate ineffective due to axis problem
gonadotropins best option

21

What is the best treatment for ovarian failure?

donor egg/embryo

22

What is the best treatment for tubal/pelvic problems?

usually surgery, IVF

23

What are the treatment options for cervical problems?

treat abnormal pap or positive culture, consider IUI = intra-uterine insemination

24

What are the treatment options for male infertility?

hormonal treatment, IUI for mild (>5 mil total motile), IVF/ICSI for severe oligospermia (5 mil), donor sperm

25

What pts will be unable to conceive w/o therapy?

complete tubal occlusion, premature ovarian failure, hypo hypo, azospermia

26

What pts will conceive eventually even with no therapy?

mild endometriosis, oligospermia, unexplained