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Endocrinology > Infertility > Flashcards

Infertility Flashcards

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1
Q

how many couples are affected by infertility

A

1 in 6

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2
Q

how much of the population is infertile

A

8%

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3
Q

what might be causing the rising incidence of infertility

A 
older women
increase in chlamydia infections 
increase in obesity 
increasing male infertility 
increasing awareness of treatments 
change in expectations 
social changes - same sex couples
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4
Q

what is infertility

A

failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse in a couple who have never had a child

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5
Q

what separates primary and secondary infertility

A

primary- couple have never conceived

secondary- couple previously conceived (pregnancy may not have been successful- miscarriage or eptopic pregnancy)

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6
Q

what makes infertility prognosis worse

A 
>30
long duration of infertility 
secondary infertility 
male infertility 
endometriosis
tubal factor infertility
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7
Q

what increases your chance of conception

A

Woman aged under 30 years
• Previous pregnancy
• Less than three years trying to conceive
• Intercourse occurring around ovulation
• Woman’s body mass index (BMI) 18.5 – 30m/kg2
• Both partners non-smokers
• Caffeine intake less than two cups of coffee daily
• No use of recreational drugs

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8
Q

what are the physiological causes of anovulatory infertility

A

before puberty
pregnancy
lactation
menopause

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9
Q

what conditions can cause anovulatory infertility

A

hypothalmic- anorexia/ bulimia, excessive exercise

pituitary- hyperprolactinaemia tumours, sheehan syndrome

ovarian- PCOS, premature ovarian failure

systemic disorders- chronic renal failure

endocrine disorders- testosterone secreting tumours, congenital adrenal hyperplasia, thyroid

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10
Q

what drugs can cause anovulatory infertility

A

depo-provera, explanon, OCP

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11
Q

what are the clinical features of anorexia nervosa

A 
low BMI
hair loss 
increased lanugo 
low pulse and MP (hypothyroid) 
anaemia (vit deficiency)
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12
Q

what are the endocrine markers of anorexia

A

low FSH, LH and osteradiol

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13
Q

what is the commonest endocrine disorder in women

A

polycystic ovary syndrome

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14
Q

what can exacerbate PCOS

A

weight gain

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15
Q

what are the clinical features of PCOS

A

obesity, hirsuitism/ acne, cycle abnormalities, infertility

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16
Q

what are the endocrine markers of PCOS

A

high free androgens, high LH, impaired glucose tolerance

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17
Q

how do you diagnose PCOS

A

must have 2 of:

  • chronic anovulation (no cycle)
  • polycystic ovaries
  • hyperandrogenism (clinical or biochemical)
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18
Q

what lifestyle change can help PCOS

A

weight loss

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19
Q

what is premature ovarian failure

A

loss of normal function of your ovaries before the age of 40

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20
Q

what can cause premature ovarian failure

A

idiopathic, genetic (turners, fragile X), chemotherapy, radiotherapy, oophorectomy (removal of the ovaries)

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21
Q

what are the clinical features of premature ovarian failure

A

hot flushes, night sweats, atrophic vaginitis

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22
Q

what are the endocrine markers of premature ovarian failure

A

high FSH, high LH, low oestradiol

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23
Q

what is wrong in turners

A

missing X

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24
Q

what are the infective causes of tubal disease

A

pelvic inflammatory disease: chlamydia, gonnorrhoea, anaerobes, syphilis, TB)

transperitoneal spread: appendicitis, intra-abdominal abscess

following procedure: IUCD insertion, hysteroscopy, HSG (hysterosalpingogram)

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25
what are the forms of pelvic inflammatory disease
endotetrisis, salpingitis, oophoritis, parametritis, tubo-ovarian abcess, peritonitis
26
what are the non infective causes of tubal disease
``` endometriosis surgical (sterilisation, ectopic pregnancy) fibroids polyps congenital salpingitis isthmica nodosa ```
27
what is a hydrosalpinx
distally blocked fallopian tube filled with serous or clear fluid- becomes distended
28
what are the clinical features of a hydrosalpinx due to pelvic inflammatory disease
``` abdominal/pelvic pain febrile vaginal discharge dyspareunia cervial excitation menorrhagia dysmenorrhoea infertility ectopic pregnancy ```
29
what is endometriosis
presence of endometrial glands (what lines the uterus) outside the uterine cavity
30
what causes endometriosis
retrograde menstruation, altered immune function, abnormal cellular adhesion, molecules, genetics
31
what are the clinical features of endometriosis
``` dysmenorrhoea (classicaly before menstruation ), dysparenuia, mennorrhagia, painful defaecation, chronic pelvic pain, infertility, may be asymptomatic ```
32
what can happen to the position of the uterus in endometriosis
retorverted (tilted abnormally backwards) and can be fixed
33
what can be seen on scan of endometriosis
chocolate cysts on ovary
34
what types of cells are found proliferating in endometriosis
glandular epithelium
35
what can cause male infertility
``` unexplained, undescended testes , urogenital infection, sexual factors, systemic disease, varicocele (varicous veins on testes causing them to overheat), hypogonadism, immune system factors, other causes (drugs) ```
36
what are the types of pre testicular male infertility causes
endocrine and coital disorders
37
what are the endocrine causes of male infertility
hypogonadotrophic hypogonadism, hypothyroidism, hyperprolactinaemia, diabetes
38
what are the coital disorders that can cause male infertility
erectile dysfunction, | ejaculatory failure
39
what are the types of testicular male infertility
genetic, congential, vascular, immunological
40
what are the genetic causes of male infertility
``` klinefelter syndrome (XXY), y chromosome deletion, immotile cilia syndrome ```
41
what are the congenital cause of male infertility
cyptorchidism, infective, activespermatogenic agents (heat, irradiation, drugs, chemotherapy)
42
what are the vascular causes of male infertility
torsion | varicocele
43
what are the types of post testicular causes of male infertility
obstructive: epididymal and vasal
44
what are the causes of epididymal obstructive male infertility
congenital, infective
45
what are the causes of vasal obstructive male infertility
genetic: cystic fibrosis acquired: vasectomy, ejaculatory duct obstruction, accessory gland infection, immunological, idiopathic
46
what are drugs that cause may infertility by decreasing sperm count
alcohol, tobacco, marijuana, cocaine, testosterone supplements, chemotherapy, long term use of some antibiotics
47
what are drugs that cause may infertility by creating a hormone imbalance
marijuana, testosterone supplements, anabolic steroids
48
what are drugs that cause may infertility by decreasing sex drive
excessive alcohol, SSRI antidepressants
49
what are drugs that cause may infertility by causing erectile dysfunction
excessive alcohol, tobacco, cocaine
50
what are drugs that cause may infertility by decreasing the ability of sperm to fertilise the egg
CCB's, tetracycline antibiotics
51
what are the clinical features of non obstructive male infertility
low testicular volume, reduce secondary sexual characteristics, vas deferens present
52
what are the endocrine features of non obstructive male infertility
high LH, FSH and low testosterone
53
what are the clinical features of obstructive male infertility
normal testicular volume, normal secondary sexual characteristics, vas deferens may be absent
54
what are the endocrine features of obstructive male infertility
normal LF, FSH and testosterone
55
how should you exam females to investigate infertility
BMI, general exam, assessing body hair distribution, galactorrhoea pelvic exam, assessing for uterine and ovarian abnormalities/tenderness/mobility swab for chlamydia, smear if due, bloods for rubella immunity, progesterone levels, test of tubal patency
56
how should you exam males to investigate infertility
BMI, general exam, genital exam: assess size/position of testes, penile abnormalities, presence vas deferns, presence varicoceles semen analysis (twice over 6 weeks apart)
57
why should you check rubella immunity
as if women get it when pregnant can affect the baby - cant conceive for a month after being vaccinated as its a live attenuated vaccine
58
how do you test tubal patency
laparoscopy or hysterosalpingiogram
59
when is laparoscopy contraindicated to test tubal patency
obesity, previous pelvic surgery, crohns
60
when do you do laparoscopy
possible tubal/ pelvic disease known previous pathology (ectopic pregnancy, ruptured appendix, endometriosis) history suggestive of pathology (dysmenorrhoea, dysparunia), previous abnormal HSG
61
when is a hysteroscopy
only performed in cases where suspected or known endometrial pathology (uterine septum adhesions, polyp)
62
when would a pelvic ultrasound be done
when abnormality or pelvic examination | when required for other investigations
63
what endocrine test are done if there is anovulatory cycle or infrequent periods
``` urine HCG prolactin TSH testosterone and SHBG LH FSH oestradiol ```
64
what is SHBG
sex hormone binding globulin
65
what endocrine test are done if hirsute
testosterone and SHBG
66
what tests are done in amenorrhoea
endocrine profile and chromosome analysis
67
what is hCG
Human chorionic gonadotropin is a hormone produced by the placenta after implantation
68
what are the semen parameters
volume, pH, concentration, motility, morphology, WBC
69
what tests are done is there is abnormal semen analysis
LH and FSH, testosterone, prolactin, thyroid function
70
what tests are done if there is severely abnormal semen analysis/ azoospermic (no sperm)
endocrine profile (as in abnormal semen), chromosome analysis and Y chromosome microdeletions, screen for cystic fibrosis, testicular biopsy
71
what test are done if there is an abnormal male genital exam
scrotal ultrasound
72
what causes the symptoms of menopause/ premature ovarian failure
decreased oestrogen level - hair thinning, atrophic vaginitis, hot flushes, mood swings
73
what are hormones like in premature ovarian failure
abnormally high FSH, LH will be raised these are due to low oestrogen levels
74
what hormone test can indicate ovarian failure
level of FSH more than 30 units/litre on separate occasions (normal is 2-8 units/litre)
75
true or false- oestrogen protects from ischaemic heart disease
yes
76
what is the treatment for premature ovarian failure
HRT prevents osteoporosis and coronary heart disease symptomatic control
77
why is HRT usually combined
as progesterone protected the endomterium from getting endometrial cancer whos risk is increased by oestrogen
78
how are eggs donated
donor gets stimulation injections of gonadotrophins which cause the growth of follicles donor eggs retrieved in theatres then 'matched' to recipients transferred into recipients womb

Endocrinology (46 decks)

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