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Flashcards in Infertility Deck (36)
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1

Components of female fertility history?

-Age
-Development
-Menstrual cycle
-Pregnancies
-Time trying to conceive
-Previous contraception
-Stigmata endometriosis
-Sexual patterns
-Med / surg / psych
-Family

2

Components of male fertility history?

-Age
-Past fertility
-Development
-Sexual function
-Testicular: trauma, descent, torsion
-Med / surg / psych
-Family
-Vasectomy

3

What are the broad components of infertility investigation?

-Hormones
-Genetics
-Imaging
-Screening
-Semen analysis

4

What is the reproductive age range?

15-44 years approx

5

What is infertility?

Failure of couple to conceive after 12 months of frequent, unprotected intercourse

6

What is the series of events broadly required for conception?

1)- Ovulation of competent oocyte
2) - Production of competent sperm
3) - Juxtaposition of sperm and oocyte in a patent reproductive tract and subsequent fertilisation
4) - Generation of a viable embryo
5) - Transport of embryo into uterine cavity
6) - Successful implantation of the embryo into the endometrium

7

How does progesterone secretion relate to the menstrual cycle and conception?

Secretion of progesterone by the corpus luteum dominates the luteal phase of the menstrual cycle and persists if conception occurs

8

What does progesterone do to the cervical mucous?

Acts on endocervix to convert thin, clear cervical mucous into sticky mucoid material

9

What does progesterone do to basal body temperature?

Changes thermoregulatory set point resulting in basal body temp rise

10

Which tests provide indirect evidence of ovulation and timing?

-Basal body temp
-LH urine kits

11

What is the initial evaluation for ovulation?

-Hx and PEx
-Basal body temp charting
-Ovulation predictor kits

12

What are the further evaluations for ovulation?

-Mid luteal phase progesterone level
-Ultrasonography
-Endometrial biopsy (not routine)

13

What are the initial and further evaluation investigations for the uterus?

Initial: US
Further:
-saline infusion ultrasonography
-Hysterosalpingography
-MRI
-Hysteroscopy

14

Initial evaluation of male infertility?

-Semen analysis
-Repeat if indicated
-Postcoital test (not routine)

15

When is uterus assessment particularly important in infertility work up?

Uterine abnormalities usually cause pregnancy loss. Important to assess if:
-abnormal bleeding
-pregnancy loss
-preterm delivery
-previous uterine surgery

16

What are the important characteristics of a normal hysterosalpingography (HSG)?

-Uterine cavity smooth and symmetrical (indentations / irregularities suggest leiomyomas, polyps, adhesions)
-Proximal 2/3 fallopian tube thin (~ diameter of pencil lead)
-Distal third = ampulla; dilated cf proximal portion of tube
-Free spill of dye from fimbriae outlining bowel etc in pelvic cavity

17

Causes of pelvic adhesions

-infection (PID, appendicitis)
-endometriosis
-abdominal / pelvic surgery

18

How should semen analysis be collected and performed?

-Obtained by masturbation after 2-3 days of abstinence
-Analyse within 1h
-Evaluate quantity and quality of seminal fluid, sperm concentration, sperm motility and morphology

19

What are the groups of male factor infertility aetiology?

-Hypothalamic pituitary disease causing gonadal dysfunction
-testicular disease
-post testicular defects impeding disorders of transport or ejaculation
-unexplained

20

How long does sperm production and development take?

~70 days

21

When should endocrine evaluation be undertaken in male factor infertility investigation?

Individuals with abnormal sperm concentrations or signs of androgen deficiency

22

How can primary and secondary hypogonadism be detected?

Serum FSH, LH and testosterone
-Primary: low testosterone, elevated FSH / LH
-Secondary: low testosterone, FSH and LH

23

What is the hormone pattern in exogenous steroid use?

Low LH in presence of oligospermia and normal testosterone level

24

What should be assessed in men with low serum testosterone?

Serum prolactin

25

When is genetic testing indicated for sperm?

Azoospermia or severe oligospermia

26

What are the most common genetic abnormalities producing decreased sperm count?

-CFTR (Cystic fibrosis)
-Somatic and sex Chr abnormalities
-microdeletions of Y chromosome

27

When is ovulation stimulation indicated? What must be done first

Women with anovulation or oligo-ovulation.
BUT
any identified condition a/w ovulatory disorders should be treated before initiating ovulation induction therapy (e.g. thyroid disorders, PCOS, high stress)

28

What is the medication commonly used for ovulation induction?

Clomiphene citrate:
-SERM competitively inhibits oestrogen binding to oestrogen receptors at hypothalamus and pituitary
-causes gonadotropin release from pituitary stimulating follicle development in ovaries

29

How is clomiphene administered?

Daily for 5 days in the follicular phase of the menstrual cycle starting between days 3-5

30

What are the risks of clomiphene?

-Multigestation 10% (usually twins)
-Ovarian hyper stimulation and cyst formation