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Gwen - Reproductive Medicine (Obs, Gyn, Breast) > Infertility > Flashcards

Infertility Flashcards

(44 cards)

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1
Q

What is the definition of infertility?

A

No conception after one year of regular unprotected intercourse with no known cause

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2
Q

ARE EGGS AVAILABLE

ARE SPERM AVAILABLE

CAN THEY MEET

A

ARE EGGS AVAILABLE

ARE SPERM AVAILABLE

CAN THEY MEET

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3
Q

What are female causes of infertilifty?

A
  • Ovulatory dysfunction
  • Diminishing ovarian reserve
  • Tubal factors
  • Endometriosis
  • Uterine factor
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4
Q

What can cause anovulation in a woman?

A
  • Premature ovarian failure
  • Turner’s syndrome
  • Surgery/Chemo
  • PCOS
  • Excessive weight loss or exercise
  • Hypopituitarism
  • Kallman’s syndrome
  • Hyperprolactinaemia
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5
Q

What are problems in sperm production that can occur in a man?

A
  • Genetic
  • Failure of testes to descend
  • Infection
  • Torsion
  • Varicocele
  • Drugs
  • Radiation damage
  • Heat
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6
Q

What problems can occur with erection and ejaculation that can lead to problems with infertility?

A
  • Prostate surgery
  • Damage to nerves
  • Ejaculation problems
  • Timing of intercourse
  • Medication
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7
Q

What are causes of blockage of sperm transport which can cause infertility?

A
  • Vasectomy
  • Prostate problems
  • Absence of vas deferens
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8
Q

What are the main things you would want to establish in a couple that are having problems conceiving?

A
  • Are Eggs Available?
  • Is Ovulation happening?
  • Are sperm available?
  • Are the tubes ok?
  • Is the uterine cavity normal?
  • Are there any other factors?
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9
Q

How would you determine if eggs are available in a woman who is struggling to conceive?

A
  • Determine Age
  • Ovarian reserve - Blood test and scan
    • FSH - D1-5 of cycle - <10 iu/L
    • AMH - 5.0-25.0 pmol/L
  • Scan - Antral follicular count
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10
Q

What would you be assessing when scanning a woman to see if there were eggs present?

A

Antral follicular count

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11
Q

What should FSH be when measuring baseline hormonal profile at day 1-5 of the cycle?

A

< 10 iu/L

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12
Q

How would you confirm ovulation was occuring?

A
  • Mid-luteal phase progesterone levels
  • LH ovulation kits
  • Cervical mucus
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13
Q

How would you measure mid-luteal phase progesterone levels?

A

Measure 7 days before period is meant to start (day 21-28 of cycle)

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14
Q

What progesterone level indicate ovulation when mid-luteal phase progesterone levels are taken?

A

> 30 nmol/L

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15
Q

If there was no evident ovulation, what would you do?

A

Determine hormonal profile

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16
Q

What investigations would you consider doing to determine hormonal profile?

A

Taken D1-5 of menstrual cycle

  • FSH
  • LH
  • Testosterone
  • Prolactin
  • Thyroid Profile
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17
Q

If a woman had high FSH and LH, what might this suggest as to the cause of anovulation?

A
  • Hypergonadotrophic gonadism
  • Ovarian cause
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18
Q

What might a high prolactin indicate as a cause of infertility?

19
Q

What might a low FSH/LH indicate as a cause of infertility?

Study These Flashcards
A

Hypogonadotrophic hypogonadism

  • Hypothalamic/pituitary cause
20
Q

What might normal FSH/LH indicate as a cause of infertility?

Study These Flashcards
A

Normogonadotrophic normogonadism

  • Ovarian dysfunction
  • PCOS
21
Q

What is normozoospermia?

Study These Flashcards
A

Normal ejaculate

22
Q

What is Oligozoospermia?

Study These Flashcards
A

Reduced sperm count

23
Q

What is asthenozoospermia?

Study These Flashcards
A

Reduced sperm motility

24
Q

What is teratozoospermia?

Study These Flashcards
A

Reduced sperm morphology

25
What is azoospermia?
No sperm in ejaculate
26
What is aspermia?
No sperm
27
How would you investigate if a mans sperm is the cause of infertility?
Computerised semen analysis
28
What FSH levels mean in men?
If raised = testis problem Normal FSH - blockage Reduced FSH - pituitary problem
29
How would you check if a womans "tubes" are ok?
* **Hysterpsalpingogram/HyCoSy** - if no pelvic infection of gynae problem * **Laparoscopic dye test** - if pelvic infection or gynae problem
30
If a woman was not ovulating due to PCOS, how would you manage them?
* **Weight loss/gain** * **Clomifine dictrate** * **Gonadotrophins** * **Consider metformin** * **Laproscopic ovarian drilling**
31
How does clomifene citrate work?
**Anti-oestrogen** - increases endogenous FSH via negative feedback to the pituitary. Therefore stimulates release of egg from ovary.
32
When are gonadotrophins used in treating infertility in PCOS?
For clomifene resistant PCOS
33
What is laparoscopic ovarian drilling?
Small holes are drilled into each ovary using needlepoint diathermy with the aim of reducing LH and restoring feedback mechanisms
34
What interventions are used for tubal disease in an attempt to restore fertility?
* **Surgical** - Tubal catheterisation * **IVF**
35
What techniques can be used to manage infertility in endometriosis?
* **Ablation/resection of spots** * **Adhesiolysis** * **Cystectomy**
36
What are indications for IVF?
* **Tubal disease** * **Male factor subfertility** * **Endometriosis** * **Anovulation not responding to clomifene** * **Subfertility due to maternal age** * **Unexplained subfertility**
37
What are examples of sources of eggs used for IVF?
* **Own eggs** * **Donor eggs**
38
What does success of IVF depend on?
* **Age** * **Duration of subfertility** * **Previous pregnancy** * **Smoking** * **Low BMI**
39
What are the risks of IVF therapy?
* **Ovarian hyperstimulation syndrome** * **Multiple pregnancy** * **Medication side effects**
40
What criteria are used to determine if semen is normal?
WHO criteria 2009 * **Volume \> 1.5 ml** * **Concentration \> 15x106/ml** * **Progressive motility \>32%** * **Total motility \> 40%** * **Normal forms \>4%**
41
What are causes of male infertility?
* **Anabolic steroid abuse** * **Alcohol abuse** * **Haemochromatosis** * **Drug-induced hyperprolactinaemia** * **Kleinfelter's syndrome** * **Pituitary tumours** * **Hypothalamic tumours** * **Kallman's syndrome**
42
What investigations might you consider doing in a man with infertility?
* **Bloods** - LH, FSH, fasting glucose, iron studies, testosterone, LFTs * **Other** - Urinary steroid, tox screen for cannabis
43
Define primary infertility
Unprotected sex \>1 year + no history of pregnancy
44
Define secondary infertility
Unprotected sex \>1 uear + history of pregnancy

Gwen - Reproductive Medicine (Obs, Gyn, Breast) (49 decks)

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