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Flashcards in Infertility Deck (92)
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1

Why is infertility increasing?

older women
rise in increase in chlamydia infections
increase in obesity
increasing male factor infertility
increasing awareness of treatments

2

What is the definition of infertility?

- failure to get pregnant
- after 12 months or more
- regular unprotected sexual intercourse
- couple have never had a child

3

Describe the difference between Primary and Secondary Infertility

Primary = couple have never conceived

Secondary = couple have previously conceived, BUT pregnancy may not have been successful
=> e.g. miscarriage or ectopic pregnancy

4

What factors can increase the likelihood of getting pregnant?

• Woman aged < 30
• Previous pregnancy  
• < 3 years trying to conceive  
• Intercourse around time of ovulation 
• BMI 18.5 – 30
• Both partners non-smokers  
• Caffeine intake < 2 cups of coffee daily  
• No use of recreational drugs

5

At what maternal age does the steep decline of fertility start?

Around the age of 35

6

Males account for 1/3 of infertility, whilst females account for the other 2/3 of infertility. TRUE/FALSE?

FALSE
1/3 male
1/3 female
1/3 combined

7

In what physiological situations would cause anovulatory infertility (no egg release)

- before puberty
- pregnancy
- lactation (breastfeeding)
- menopause

8

What gynaecological conditions can cause anovulatory infertility?

Hypothalmic Disorders:
=> anorexia/bulimia, excessive exercise

Pituitary Disorders:
=> hyperprolactinaemia, tumours, Sheehan syndrome

Ovarian Disorders:
=> PCOS, premature ovarian failure

9

What systematic disorder is known to cause anovulatory infertility?

chronic renal failure

10

What drugs can cause anovulation and therefore infertility?

Depo-provera (injection)
Nexplanon (implant)
Oral Contraceptive Pill

11

Can anorexia cause anovulation?

Yes
Causes low FSH, LH and Oestradiol

12

What are the clinical features of anorexia?

low BMI (below 18.5)
loss of hair
low pulse and BP
anaemia

13

How does Polycystic Ovary syndrome usually present?

- obesity
- hirsutism or acne
- cycle abnormalities and infertility

14

What endocrine abnormalities are present in Polycystic Ovary Syndrome?

high free androgens
high LH
impaired glucose tolerance

15

What is the diagnostic criteria for Polycystic Ovary Syndrome?

2 out of 3 of:
- chronic anovulation
- polycystic ovaries
- hyperandrogenism

16

What are the possible causes of premature ovarian failure?

- idiopathic
- genetic (Turner’s syndrome, fragile X)
- chemotherapy/radiotherapy
- oophorectomy (ovary removal)

17

How does premature ovarian failure present clinically?

hot flushes
night sweats
atrophic vaginitis

18

Describe the hormonal effects of premature ovarian failure?

high FSH
high LH
low oestradiol

19

What are the possible infective causes of tubal disease?

- Pelvic inflammatory disease
=> chlamydia, gonorrhoea = most common

-Transperitoneal spread:
=> appendicitis, intra-abdominal abscess

- Following a procedure:
=> IUCD insertion, hysteroscopy, HSG

20

What are the most common causes of tubal disease that are not from an infection?

- endometriosis
- surgical (sterilisation, ectopic pregnancies)
- fibroids/polyps
- congenital

21

What is a Hydrosalpinx?

Distended fallopian tube

22

What condition is characterised by the presence of endometrial glands outside uterine cavity?

Endometriosis

23

What symptoms are experienced in endometriosis?

- dysmenorrhoea (cramps)
- dysparenuia (pain during sex)
- menorrhagia (heavy bleeding)
- painful defaecation
- chronic pelvic pain

24

What coital disorders can contribute to male factor infertility?

Erectile dysfunction
Ejaculatory Failure

25

What genetic conditions can cause male factor infertility?

Kleinfelter Syndrome (XXY)
Y chromosome deletion
Immotile Cilia (e.g. CF)

26

Testicular torsions and varicoceles can cause what subtype of male factor infertility?

Vascular

27

What drugs can cause a decrease in male sperm count?

- Alcohol, Tobacco, Marijuana, Cocaine
- Testosterone Supplements
- Specific chemo drugs
- Long term use of certain antibiotics

28

What drugs can cause hormone imbalance?

Marijuana
Testosterone supplements
Anabolic Steroids
Opiates
Spironolactone
Drugs for schizophrenia/ tri-cyclic antidepressants

29

What drugs can cause decreased sex drive?

Excessive alcohol
SSRIs
Opiates
Spironolactone
Beta Blockers
Lithium

30

What drugs can cause erectile dysfunction?

Excessive alcohol, Tobacco, Cocaine
Spironolactone and other diuretics
Beta-blockers
Alpha-Blockers
Schizophrenia/ Tri-cyclic antidepressants
Lithium