Infertility

Question 0

Secondary infertility is…

Answer 0

Conceived at least once and not again for at least one year

Question 1

Primary infertility is…

Answer 1

Never conceived

Question 2

Prime causes of infertility from greatest to least…

Answer 2

Unexplained
Sperm problems
Ovulatory failure
Tubal damage
Endometriosis/cervical mucous 
Coital problems
Other

Question 3

5 steps of conception…

Answer 3

Ovulation
Insemination
Fertilization
Transportation
Implantation

Question 4

The cervix needs to provide a __________ environment to harbor sperm.

Answer 4

Non hostile

Question 5

In the cervix, the glands need to secrete __________ and crypts need to hold __________.

Answer 5

Mucus

Sperm

Question 6

How is ultrasound used to evaluate the cervix?

Answer 6

Cervical length to assess for cervical incompetence

Question 7

2 main objectives in evaluating the uterus…

Answer 7

Assess structural anatomy

Assess endometrium

Question 8

In evaluating the uterus, assessing for structural anatomy refers to…

Answer 8

Evaluating uterine shape (unicollis, bicornuate, etc.)

DES treatments - T shaped uterus

Question 9

Evaluate the uterus for…

Answer 9

Echogenicity

Masses - fibroids

Assess endometrium - thickness, echogenicity, lesions

Question 10

Why measure the endometrium?

Answer 10

Make sure it changes appropriately throughout the menstrual cycle

Question 11

In the first half of the menstural cycle, mucosa begins to…

Answer 11

Proliferate because of increasing estrogen levels

Question 12

Proliferative endo =

Answer 12

Triphasic endo - 3 stripes

Question 13

After ovulation, what is secreted and by what?

Answer 13

Progesterone by the corpus luteum

Question 14

Secretion of progesterone begins in what phase?

Answer 14

Secretory phase of endometrial cycle

Question 15

What happens to the endometrium during the secretory phase and why? What is lost?

Answer 15

Endo becomes thickened and very echogenic as a result of stromal edema

Loss of the triple line sign

Question 16

How thick does the endometrium have to be to achieve pregnancy?

Answer 16

At least 6 mm thick

Question 17

What happens to the endometrium if not enough progesterone is produced during the luteal phase?

Answer 17

A thin endometrial lining by US

Question 18

Lack of progesterone production is known as?

Answer 18

Luteal phase deficiency

Question 19

Luteal phase deficiency (lack of progesterone) is associated with?

Answer 19

Infertility and early pregnancy loss

Question 20

Why is endometrial appearance important for planning infertility treatments?

Answer 20

For embryo transfer

Question 21

4 things that can make an endometrium irregular…

Answer 21

Submucosal fibroids
Polyps
Adhesions
Synechiae - scar tissue from d&c’s

Question 22

What can be used in situations to further delineate anatomic structures of irregular endometriums?

Answer 22

Saline infusion sonography

Question 23

When evaluating the fallopian tubes what accounts for 50% reduction in pregnancy rate and doubling spontaneous miscarriage rate?

Answer 23

Hydrosalpinx

Question 24

What improves in vitro fertilization success?

Answer 24

Tube removal

Question 25

How is tubal patency assessed?

Answer 25

By injecting saline into the tube and looking for spillage of fluid into the cul de sac or around the ovary or by using contrast to evaluate for spillage

Question 26

If spillage is seen from the fallopian tubes, ________ is inferred.

Answer 26

Patency

Question 27

If no spillage from the fallopian tubes is noted and patient complains of pain during injection, tube may be _______.

Answer 27

Blocked

Question 28

What can obstruct a fallopian tube?

Answer 28

Adhesions

Question 29

During follicular phase several antral follicles on the ovary measure?

Answer 29

Less than 5 mm

Question 30

What hormone creates the dominant follicle?

Answer 30

FSH

Question 31

What is the dominant follicle growth rate?

Answer 31

Approximately 1 to 3 mm/day until it reaches 22 mm

Question 32

At what size do the dominant follicles rupture?

Answer 32

22 mm

Question 33

Rupture of a follicle is associated with?

Answer 33

Increased or decreased size

Question 34

Sonographic ovulation findings?

Answer 34

Eh ones within fluid left behind (corpus luteum) Free fluid in peritoneal cavity

Question 35

Key drugs in ovarian induction therapy?

Answer 35

``` Clomiphene citrate (clomid) oral Human menopausal gonadotropins (pergonal) injected ```

Question 36

Once therapy is started, US is used to monitor the number and size of follicles in what days?

Answer 36

8-14 (follicular phase of menstrual cycle)

Question 37

What size follicles get counted by the sonographer after ovarian induction therapy?

Answer 37

Greater than 1 cm in long and trans

Question 38

Measurement of an optimal mature follicle?

Answer 38

16-20 mm

Question 39

During ovarian induction therapy, what is US correlated with?

Answer 39

Serum estradiol levels

Question 40

Why is correct measurement of the follicle important?

Answer 40

HCG may need to be given to trigger ovulation - pergonal

Question 41

Monitor endometrium for what 2 things?

Answer 41

Thickness 2-3 mm to 12-14 mm Echogenicity

Question 42

What is OHSS?

Answer 42

Syndrome that presents sonographically as enlarged ovaries with multiple cysts, ABD ascites, pleural effusions If this is seen patient will be removed from meds immediately

Question 43

What is IVF?

Answer 43

Method of fertilizing human oocytes outside the body

Question 44

During IVF, what happens to the mature oocytes?

Answer 44

They are collected and mixed in a dish with a sample of sperm Resulting embryos see placed back in the uterus

Question 45

Treatment plan for IVF is...

Answer 45

``` Ovarian monitoring Needle aspiration of oocytes Incubation of oocytes Fertilization Transferring embryos into uterus ```

Question 46

With IVF, how many follicles are evaluated before triggering ovulation?

Answer 46

4

Question 47

Oocytes are retrieved with what kind of US guidance?

Answer 47

TV's

Question 48

What is intrauterine insemination?

Answer 48

Technique used to treat male factor infertility Catheter containing sperm placed into uterine fundus

Question 49

What is TDI?

Answer 49

Therapeutic donor insemination or artificial insemination

Question 50

What is GIFT?

Answer 50

Gamete intrafallopian transfer - sperm and egg injected into the fimbrated end of tube

Question 51

What is ZIFT?

Answer 51

Zygote intrfallopian transfer - trans cervical placement of zygote into fallopian tubes

Question 52

Complications of assitive reproductive technology (ART)?

Answer 52

OHSS Ectopic Multiple gestation

Question 53

Factors of ART?

Answer 53

``` Central/ovulatory Male Cervical Uterine Tubal/peritoneal ```

Question 54

What is an anovulation?

Answer 54

Failure of hypothalamus and pituitary to produce hormones stimulating ovulation

Question 55

What happens when ovulation fails?

Answer 55

LUF - luteinized unruptured follicle syndrome - enlarges but fails to rupture and release the oocyte

Question 56

Central/ovulatory factors...

Answer 56

BEST predictor of ovulation is basal body temperature - spike of .6-.8° Regular menses does not guarantee ovulation

Question 57

Male factors...

Answer 57

Enough sperm to penetrate and fertilize ovum Sperm count Sperm motility - #1 test

Question 58

Cervical/mucus factors...

Answer 58

Cervical mucus must allow transportation of sperm into uterus If mucus is poor (high viscosity), it'll act as a barrier

Question 59

2 types of mucus changes?

Answer 59

Pre ovulatory - clear & copious Post ovulatory - mucus becomes tacky & sparse

Question 60

What checks mucus consistency?

Answer 60

Spin barkeit and ferning

Question 61

What evaluated sperm mucus interaction?

Answer 61

Post coital test - PCT

Question 62

Endometrial/uterine factors...

Answer 62

Fertilized ovum must be able to implant within endometrial lining Luteal phase inadequacy

Question 63

Tubal/peritoneal factors...

Answer 63

Oviducts must allow transport of sperm to ovum Passage of fertilized ovum to uterus Adhesions cause issues Distal fallopian tube - MOST COMMON BLOCKAGE Laparoscopy - gold star for evaluating