Infertility

Question 0

What is secondary infertility?

Answer 0

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

Question 1

what is primary infertility?

Answer 1

never conceived

Question 2

What is FMS?

Answer 2

follicular maturation study

Question 3

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

Answer 3

how long the couple has been trying to conceive

Question 4

What are the prime causes of infertility?

Answer 4

most common = unexplained

sperm problem

ovulatory failure

tubal damage

endometriosis/cervical mucous

coital problems

other

Question 5

what are the steps of conception?

Answer 5

ovulation

insemination

fertilization

transportation

implantation

Question 6

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

Answer 6

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

Question 7

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

Answer 7

assess structural anatomy

assess endometrium

assessing for structural anatomy refers to evaluating uterine shape DES exposure

echogenicity

masses - fibroids

Question 8

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

Answer 8

echogenicity

masses - fibroids

assess endometrium

Question 9

When would you measure the endometrium for appropriate change?

Answer 9

throughout the menstrual cycle

Question 10

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

Answer 10

mucosa begins to proliferate because of increasing estrogen levels

Question 11

after ovulation progesterone is secreted by _________

Answer 11

corpus luteum

Question 12

secretion of progesterone begins what

Answer 12

the secretory phase of the endometrial cycle

Question 13

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

Answer 13

thickened

very echogenic as a result of stromal edema

loos of triple line sign

Question 14

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

Answer 14

at least 6 mm

Question 15

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

Answer 15

thin lining

Question 16

what is the lack of progesterone production known as what?

Answer 16

luteal phase deficiency

may be associated with infertility and early pregnancy loss

Question 17

why is endometrial appearance important?

Answer 17

for planning for infertility treatment with embryo transfer

Question 18

What can cause irregular endometrium?

Answer 18

submucosal fibroids

polyps

adhesions

synechiae (scarring)

Question 19

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

Answer 19

SIS (saline infusion sonography) aka sonohysterogram

further delineates anatomic structure of the endometrium

Question 20

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

Answer 20

hydrosalpinx

tubal patency

Question 21

What do you assess in the endometrium?

Answer 21

evaluate thickness

echogenicity characteristics

evaluate intracavitary lesions

Question 22

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

Answer 22

hydrosalpinx

Question 23

Removing what structure improves in vitro fertilization success?

Answer 23

Fallopian tubes

Question 24

How do you determine tubal patency?

Answer 24

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

Question 25

where do sonographers look for spillage of saline or air?

Answer 25

around the ovary into the posterior cul-de-sac

Question 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?

Answer 26

blocked Fallopian tube

Question 27

What can obstruct the Fallopian tube?

Answer 27

adhesions

Question 28

What is the normal ovary/follicle?

Answer 28

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

Question 29

What are the key drugs used in ovarian induction therapy?

Answer 29

clomiphene citrate (clomid) oral human menopausal gonadotropins (pergonal) injected

Question 30

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

Answer 30

days 8 to 14 (follicular phase) of menstrual cycle count and measure all follicles > 1cm in sag and trv planes

Question 31

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

Answer 31

between 16 and 20 mm

Question 32

What is correct measurement of folllicles important?

Answer 32

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

Question 33

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

Answer 33

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

Question 34

What is OHSS (ovarian hyperstimulation)?

Answer 34

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

Question 35

If a patient has OHSS what actions are taken?

Answer 35

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

Question 36

What is assisted reproductive technology - ART?

Answer 36

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

Question 37

How is oocyte retrieval accomplished with what?

Answer 37

transvaginal ultrasound guidance

Question 38

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

Answer 38

4

Question 39

How do the doctors get control of the cycle?

Answer 39

by using Lupron or Synarel - stops ovarian function

Question 40

what are the complications of ART?

Answer 40

OHSS Ectopic - heterotrophic pregnancies higher risk with ART patients multiple gestations

Question 41

What is anovulation?

Answer 41

failure of hypothalamus and pituitary to produce hormones to stimulate ovuation FINISH slide 42

Question 42

Does regular menses guarantee the ovulation of an oocyte?

Answer 42

no

Question 43

What is luteal phase inadequacy?

Answer 43

inadequate output of progesterone in second half of cycle creating thin endometrium

Question 44

what shape of uterus has the highest rate of infertility?

Answer 44

septate

Question 45

What are the most common factors that may cause infertility?

Answer 45

low sperm count anatomic defects disease Fallopian tube scarring