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The Endocrine System > Infertility > Flashcards

Infertility Flashcards

1
Q

A rise in which STI is contributing to infertility?

A

Chlamydia

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2
Q

What is the definition of infertility?

A

Failure to become pregnant after 12 or more months of regular unprotected sex

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3
Q

What is primary infertility?

A

Infertility in a couple who have never conceived

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4
Q

What is secondary infertility?

A

Inferility in a couple who have previously conceived

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5
Q

What are the main physiological causes for infertility?

A
  1. Pregnancy
  2. Before puberty
  3. Lactation
  4. Menopausal
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6
Q

What are the main gynaecological conditions which cause inferility?

A
  1. Hypothalmic - Anorexia/bulimia, excessive exercise
  2. Pituitary - Hyperprolactinaemia, tumours, Sheehan syndrome
  3. Ovarian - PCOS, premature ovarian failure
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7
Q

Besides physiological and gynaecological conditions, what else may cause infertility?

A
  1. Systemic disorders e.g. CKD
  2. Endocrine disorders e.g. Testosterone secreting tumours, CAH, thyroid problems
  3. Drugs e.g. Depo-provera (medroxyprogesterone), explanon, OCP
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8
Q

Anorexia is defined as a BMI of less than what?

A

18.5

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9
Q

What are the key clinical features of anorexia nervosa?

A
  1. Loss of hair
  2. Increased lanugo
  3. Low pulse
  4. Low Bp
  5. Anaemia
  6. Halitosis
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10
Q

What is lanugo?

A

Fine soft hair on the skin

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11
Q

What are the endocrine markers of anorexia nervosa?

A

Low FSH/LH/Oestradiol

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12
Q

Which condition may be brought on by a low oestradiol in anorexia nervosa?

A

Osteoporosis

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13
Q

What is the most common endocrine disorder in women?

A

PCOS

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14
Q

What are the main clinical features of PCOS?

A
  1. Obesity
  2. Hirsutism
  3. Acne
  4. Cycle abnormalities
  5. Infertility
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15
Q

What are the endocrine markers of PCOS?

A
  1. High free androgens
  2. High LH, Low FSH
  3. High oestrogen
  4. Impaired glucose tolerance
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16
Q

Which criteria are used to diagnose PCOS and what are they?

A

Rotterdam criteria

  1. Chronic anovulation
  2. Polycyctic ovaries*
  3. Hyperandrogenism (clinical or biochemical)

(2/3 are required)

*At least one ovary must have at least 12 follicles between 2-8 mm in a single plane. These can be uni or bilateral

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17
Q

What may cause premature ovarian failure?

A
  1. Idiopathic
  2. Genetic (Turner’s syndrome)
  3. Chemotherapy
  4. Radiotherapy
  5. Oophorectomy (ovary removal)
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18
Q

What are the clinical features of premature ovarian failure?

A
  1. Hot flushes
  2. Night sweats
  3. Atrophic vaginitis
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19
Q

What are the endocrine markers of prematrure ovarian failure?

A
  1. High FSH
  2. High LH
  3. Low oestradiol
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20
Q

What is a hydrosalpinx?

A

A distally blocked Fallopian tube filled with clear or serous fluid

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21
Q

What is endometriosis?

A

Presence of endometrial glands outwith the uterine cavity

22
Q

What are the main causes for endometriosis?

A
  1. Retrograde menstruation
  2. Altered immune function
  3. Abnormal cellular adhesion molecules
  4. Genetic causes
23
Q

Upon USS, what classic sign will endometriosis have on the ovaries?

A

Characteristic “chocolate” cysts

24
Q

What are the key clinical features of endometriosis?

A
  1. Dysmenorrhoea (painful menstruation)
  2. Dysparenunia (pain during sex)
  3. Menorrhagia (abnormally heavy periods)
  4. Painful defaecation
  5. Chronic pelvic pain
  6. Uterus may be fixed and retroverted
  7. Chocolate ovarian cysts
  8. Infertility
  9. Asymptomatic
25
Q

What can cause non-obstructive infertility in males?

A
  1. Chemotherapy
  2. Radiotherapy
  3. Klinefelter’s syndrome
  4. Undescended testes
  5. Idiopathic
26
Q

What are the endocrine markers for non-obstructive male inferility?

A
  1. High LH/FSH
  2. Low testosterone
27
Q

What can cause obstructive male infertility?

A
  1. Congenital absence of Vas deferens (sign of cystic fibrosis)
  2. Infection
  3. Vasectomy
28
Q

What are the endocrine markers for obstructive male infertility?

A

Normal LH/FSH/Testosterone

29
Q

How can tubal patency be established in females?

A
  1. Hysterosalpingiogram (no known risk factors or tubal pathology)
  2. Laparoscopy (known risk factors and/or tubal pathology)
  3. Hysteroscopy (suspected or knopwn endometrial pathology)
30
Q

Which biochemical tests would be carried out if a patient presented with an anovulatory cycle or infrequent periods?

A
  1. Urine HCG
  2. Prolactin
  3. TSH
  4. Testosterone and SHBG
  5. LH/FSH/Oestradiol
31
Q

When analysing semen, how many times must samples be examined and how long between samples?

A

2 times, 6 weeks apart

32
Q

Which biochemical tests would be carried out in a male had an abnormal semen analysis?

A
  1. LH/FSH
  2. Testosterone
  3. Prolactin
  4. Thyroid function
33
Q

When investigating a female for infertility, blood will be checked for immunity to what?

A

Rubella

34
Q

Which investigations would be undertaken for a female who may be infertile?

A
  1. Chlamydia swab
  2. Cervical smear (if due)
  3. Midluteal progesterone level (or 7 days prior to expected period) - >30nmol/l suggests ovulation
  4. In anovulatory - early follicular hormone profile for blood LH, FSH, E2, Testosterone, FAI, Prolactin and TSH
35
Q

What is the classic triad of symptoms associated with congenital rubella syndrome?

A
  1. Sensorineural deafness
  2. Eye abnormalities e.g. cataracts
  3. Congenital heart disease (especially pulmonary artery stenosis and patent ductus arteriosus)

Other symptoms include:

  1. Thrombocytopenic purpura
  2. Microcephaly
36
Q

Under which 3 categories does the WHO define ovulatory disorders?

A
  1. Group 1 - Hypothalmic
  2. Group 2 - Hypothalmic-pituitary dysfunction
  3. Group 3 - Ovarian failure

Hyperprolactinaemia can also cause ovulatory disorders

37
Q

Give examples of group 1 hypothalmic ovulatory disorders

A
  1. Stress
  2. Excessive exercise
  3. Anorexia nervosa
  4. Kallman’s syndrome
  5. Isolated gonadotrophin deficiency
38
Q

What are the biochemical findings for group 1 ovulatory disorders?

A
  1. Low FSH
  2. Low oestrogen
  3. Normal prolactin
  4. Negative progesterone challenge
39
Q

Give examples of group 2 hypothalmic-pituitary dysfunction

A

PCOS

40
Q

What are the biochemical findings for group 2 ovulatory disorders?

A
  1. Normogonadotrophic
  2. Normoestrogenic
  3. Increased LH to FSH ratio (normally 1:1, but can be up to 3:1)
41
Q

What are the key biochemical findings in group 3 ovulatory disorders?

A
  1. High gonadotrophins (LH and FSH)
  2. Low Oestrogen
42
Q

What is the most common cause of anovulatory infertility?

A

PCOS

43
Q

What is the first line treatment to induce ovulation?

A
  • Antioestrogens - Clomifene citrate, Tamoxifen
  • Aromatase inhibitors - Letrozole
44
Q

How is Clomifene citrate taken?

A

Between days 2 and 6 of the menstrual cycle (5 days, once daily)

45
Q

What are the second line options for induction of ovulation in those with PCOS?

A
  1. Clomifene citrate + metformin (improves sensitivity)
  2. Gonadotrophin therapy (daily injections)
  3. Laparoscopic ovarian diathermy
46
Q

If a male had severely abnormal or azoospermic samples, which tests would be undertaken?

A
  1. Endocrine profile
  2. Chromosome analysis
  3. Cystic fibrosis screen
47
Q

What are main general causes for male infertility?

A
  1. Idiopathic
  2. Obstructive causes (vasectomy, infection, congenital absecence of vas deferens)
  3. Non-obstructive causes (undescended testes, orchitis, torsion or trauma, Klinefelter’s, Y chromosome microdeletions)
  4. Hormonal (hypogonadotrophic hypogonadism, hypothyroidism, hyperprolactinaemia, testicular cancer)
  5. Others (varicocele, chemotherapy, radiotherapy, erectile dysfunction, immunological)
48
Q

How may male infertility be treated?

A
  1. Surgery to obstructed vas deferens
  2. Intrauterine insemination
  3. Intracytoplasmic sperm injection
  4. Surgical sperm aspiration from epididymis/testicle then ICSI
  5. Donor sperm
49
Q

To aid with infertility what dose of folic acid should be administered?

A
  1. 0.4mg/day preconception
  2. 5mg/day when increased risk of neural tube defects
50
Q

In order to become pregant a BMI below __ is ideal

A

In order to become pregant a BMI below 29 is ideal

(ideal range 19-29)

The Endocrine System (35 decks)

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