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Flashcards in Infertility Deck (46):
0

what is primary infertility?

never conceived

1

What is secondary infertility?

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

2

What is FMS?

follicular maturation study

3

What is one part of hx that is important in infertility?

how long the couple has been trying to conceive

4

What are the prime causes of infertility?

most common = unexplained

sperm problem

ovulatory failure

tubal damage

endometriosis/cervical mucous

coital problems

other

5

what are the steps of conception?

ovulation

insemination

fertilization

transportation

implantation

6

What do you evaluate with infertility as it pertains to the cervix?

provide non-hostile environment to harbor sperm

glands that secrete mucus and crypts that hold sperm

ultrasound: used to evaluate cervical length during pregnancy to assess for cervical incompetence

7

What are you evaluating considering infertility in relation to the uterus?

assess structural anatomy

assess endometrium

assessing for structural anatomy refers to evaluating uterine shape DES exposure

echogenicity

masses - fibroids

8

What would you asses in the endometrium in relation to infertility?

echogenicity

masses - fibroids

assess endometrium

9

When would you measure the endometrium for appropriate change?

throughout the menstrual cycle

10

what happens in the first part of the menstrual cycle as it pertains to infertility?

mucosa begins to proliferate because of increasing estrogen levels

11

after ovulation progesterone is secreted by _________

corpus luteum

12

secretion of progesterone begins what

the secretory phase of the endometrial cycle

13

during the secretory phase, endometrium becomes ___________ and very __________ as result of ________ ________

thickened

very echogenic as a result of stromal edema

loos of triple line sign

14

how big does the endometrium need to be in order to achieve pregnancy?

at least 6 mm

15

if there is not enough progesterone produced in the luteal phase what kind of endometrial lining will you see by US?

thin lining

16

what is the lack of progesterone production known as what?

luteal phase deficiency

may be associated with infertility and early pregnancy loss

17

why is endometrial appearance important?

for planning for infertility treatment with embryo transfer

18

What can cause irregular endometrium?

submucosal fibroids

polyps

adhesions

synechiae (scarring)

19

what procedure do you do in order to see abnormal structures in the endometrium?

SIS (saline infusion sonography) aka sonohysterogram

further delineates anatomic structure of the endometrium

20

With infertility, what are you looking for when evaluating the Fallopian tubes?

hydrosalpinx

tubal patency

21

What do you assess in the endometrium?

evaluate thickness

echogenicity characteristics

evaluate intracavitary lesions

22

What causes a 50% reduction in pregnancy rate and doubling of spontaneous miscarriage rate?

hydrosalpinx

23

Removing what structure improves in vitro fertilization success?

Fallopian tubes

24

How do you determine tubal patency?

assessed by injecting saline into tube and looking for spillage of fluid into cul-de-sac or by using contrast to evaluate for spillage.

25

where do sonographers look for spillage of saline or air?

around the ovary

into the posterior cul-de-sac

26

During the procedure to check for spillage, if none is noted and the patient complains of pain during injection, what might be the problem?

blocked Fallopian tube

27

What can obstruct the Fallopian tube?

adhesions

28

What is the normal ovary/follicle?

during follicular phase:

several antral follicles on ovary < 5mm

dominant follicle grow 1-3mm/day until reaches about 22mm

22mm follicle ruptures (will either increase or decrease in size)

Sonographic findings:

echoes within fluid left behind (corpus luteum cyst)

free fluid in peritoneal cavity

29

What are the key drugs used in ovarian induction therapy?

clomiphene citrate (clomid) oral

human menopausal gonadotropins (pergonal) injected

30

Once ovarian induction therapy is started when is ultrasound used to monitor number and size of follicles?

days 8 to 14 (follicular phase) of menstrual cycle

count and measure all follicles > 1cm in sag and trv planes

31

With ovarian induction therapy, what is the optimal mean measurement of the mature follicles?

between 16 and 20 mm

32

What is correct measurement of folllicles important?

because hCG (substitute for LH) may need to be given intramuscularly to trigger ovulation (Pergonal)

33

With ovarian induction therapy, What should the endometrium be doing?

Assess thickness and echogenicity pattern of endo cavity

normal endo response assoc with ovarian stimulation is 2-3mm to 12-14mm

sonographically:

measure endo thickness - trv uterus transvag in sag plane

measure from anterior to posterior endometrial interface

34

What is OHSS (ovarian hyperstimulation)?

syndrome that presents sonographically as enlarged ovaries with multiple cysts, abdominal ascites and pleural effusions

35

If a patient has OHSS what actions are taken?

patient will be removed from medication immediately and may be off for several months

36

What is assisted reproductive technology - ART?

in vitro fertilization (IVF) is the method of fertilizing the human oocyte outside the body

treatment plan: ovarian monitoring, needle aspiration of oocytes, incubation of oocytes, fertilization and transferring embryos into uterus

37

How is oocyte retrieval accomplished with what?

transvaginal ultrasound guidance

38

how many follicles are evaluated for IVF, 2 or 4?

4

39

How do the doctors get control of the cycle?

by using Lupron or Synarel - stops ovarian function

40

what are the complications of ART?

OHSS

Ectopic - heterotrophic pregnancies higher risk with ART patients

multiple gestations

41

What is anovulation?

failure of hypothalamus and pituitary to produce hormones to stimulate ovuation

FINISH slide 42

42

Does regular menses guarantee the ovulation of an oocyte?

no

43

What is luteal phase inadequacy?

inadequate output of progesterone in second half of cycle

creating thin endometrium

44

what shape of uterus has the highest rate of infertility?

septate

45

What are the most common factors that may cause infertility?

low sperm count

anatomic defects

disease

Fallopian tube scarring