Infertility Flashcards
(35 cards)
causes of FEMALE INFERTILITY
PCOS
THYROID ISSUES
PREVIOUS SURGERY (SCARRING TO CERVIX /UTERUS)
PID
ENDOMETRIOSIS
STI
DRUGS - NSAIDs, CHEMO, ANTIPSYCHOTICS, SPIRONOLACTONE
Causes of MALE INFERTILITY
SPERM ISSUES - LACK OF, POOR MOVEMENT, ABNORMAL, CANCER, SURGERY, HIV, STIs,
EJACULATION ISSUES - HYPOGONADISM DUE TO TUMOUR OR DRUGS OR Klinefelter syndrome (XXY47)
DRUGS - SULFASALAZINE, ANABOLIC STEROIDS, CHEMO, CHINESE HERBAL MEDS: triptergium wilfordii
what is asked in a female hx of infertility onn assessment of ovulation?
The frequency and regularity of their menstrual cycles. Women with regular monthly menstrual cycles should be informed that they are likely to be ovulating.
Duration of innfertility, previous contraception, previous pregnancies, menstrual hx, med and surg hx, sexual hx, previous ix, psychological assessment.
- excess body hair, weight gian, acne? (PCOS).
Previous ectopic pregnancies/ miscarriages? menhorragia? dysmenhorragia? (thinking of endometriosis) STI’s? Medicaiton Hx?
female examinnation
weight, height, bmi, fat and hair distribution, galactorrhpea (prolactin production increase - sy also bitemporal hemanopia, menorrhagia), abdo and pelvic examination.
hirsutism is caused by?
PCOS, cushings, acromegaly, androgen-secreting tumors (ovarian or adrenal) and ovarian hyperthecosis. (ANDROGEN EXCESS)
what is the clinical mesasurement score of hirsutism?
Ferriman Gallwey score
what is the biochemical measurements used?
Biochemical measurement - Testosterone (T), Dehydroepiandrosterone sulphate (DHEAS) if is greater than 700 mcg/dL (18.9 micromol/L)
adrenal computed tomography (CT) is recommended to look for an androgen-secreting adrenal tumor, 17-OH Progesterone
give one other sign of androgenn excess
Acanthosis nigricans
what is found on pelvic examination/ what is looked for?
masses, pelvic distortion, tenderness, vaginal septum, cervical abnormalities, fibroids
sy of fibroids
pressure symptoms, period issues, infertility
what initial baseline Ix are done to the female and male partners?
Female partner: Rubella immunity, Chlamydia, TSH,
if periods are regular: Mid luteal progesterone (7 days prior to expected period);
if periods are irregular please do day 1-5 FSH, LH, PRL, TSH, testosterone. Male Partner`s semen analysis.
Blood levels of LH, FSH, Oestradiol. THEN Progesterone test in the mid luteal phase.
Transvaginal USS, Blood levels of TSH, prolactin (pituitary adenoma) and testosterone.
what ix are donne at the fertility clinic?
pelvic us, physical exam, testing for ovulation, semen analysis, tubal patency test
what blood test is done inn the mid-luteal phase?
Women who are undergoing investigations for infertility should be offered a blood test to measure serum progesterone in the mid-luteal phase of their cycle (day21 of a 28‑day cycle) to confirm ovulation even if they have regular menstrual cycles
what is the test offered to sccreen for tubal occlusion?
hysterosalpingography (HSG)
what is asked in Male hx?
Developmental - Testicular descent, Change in shaving frequency, Loss of body hair, Infections - Mumps, Sexually transmitted diseases
Surgical - Varicocelerepair, Vasectomy, Previous fertility, drugs and alcohol - sterioids, smocking, chemo, rec drugs, sexual hx - libido, frequency, any chronic illnesses
what is done in Male examination?
BMI, Hair distribution, Abdominal and inguinal examination, Genital examination: Testis, Epididymis, Vas deferens, Varicocoele, Penis
what may epididimytis indicate?
STD’s - chlamydia, gonorrhoea
what is a variococele?
is a dilatation of the pampiniform plexus of the spermatic veins in the scrotum. Most men with varicocele and presumptive infertility have abnormal semen parameters, including low sperm concentration and abnormal. Men should not be offered surgery for varicoceles as a form of fertility treatment because it does not improve pregnancy rates.
what is Klinefelter’s synodrome?
One of the most common causes of primary hypogonadism with impaired spermatogenesis and testosterone deficiency is Klinefelter syndrome, which may occur in up to 1 out of 500 to 700 phenotypic males and in up to 10 to 15 percent of infertile men with azoospermia. It is characterized by sex chromosome aneuploidy, with an extra X (XXY) chromosome being the most frequent. These patients often have very small testes and almost always have azoospermia.
what are some reasons for female infertility?
Ovulatory dysfunction = excessive exercise, underweight, PCOS
Diminishing ovarian reserve, Endometriosis,
Uterine factors
Tubal factors -fallopian tubes arent patent = infeciton, endometriosis, adhesions
what are the 3 groups of ovulatory disorders?
Group I: hypothalamic pituitary failure (hypothalamic amenorrhoea or hypogonadotrophic hypogonadism).
Group II: hypothalamic-pituitary-ovarian dysfunction (predominately polycystic ovary syndrome).
Group III: ovarian failure (POI). Offer GnRH to innduce ovulation.
what are the features of PCOS (polycystic ovary synodrome)?
Androgen excess (clinically - hirsutism, biochemically - testosterone), infrequent periods (anovulation), polycyctic ovaries (us))
mainn mx for ovulatory disorders
treta the unnderlying cause, weight loss/gain, improve bmi, ovulationn induction by - Clomifene, GnRH, general gonnadotrophins
how does clomiphene work and what are its side effects?
Clomifene exhibits its Ovulatory inductive function by blocking estrogen receptors in the anterior pituitary, leading to increased secretion of FSH.Selective estrogen receptor modulator, Monitoring - Follicle scanning in 1st cycle, 15% require dose adjustment. Side effects - Vasomotor, Visual.
