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Reproduction > Infertility > Flashcards

Infertility Flashcards

1
Q

When do couples receive an infertility referral?

A 
After 12 months of trying with no success or;
period irregularity
relevant PMH
testicular problems
Abnormal tests
HIV/hep B
Anxiety
After 6 months of trying in over 35s
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2
Q

What is asked in a female history?

A 
Duration of infertility
Previous contraception and fertility
Previous pregnancies and complications
Menstrual history
PMH
Sexual history
Psych assessment
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3
Q

What is looked at in a female exam?

A 
Weight, height and BMI
Fat and hair distribution 
Galactorrhoea
ABdo exam
Pelvic exam- masses, relic distortion, fixed retroversion, tenderness
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4
Q

What is asked in a male history?

A

Development- change in body hair or shaving frequency, testicular descent
Previous fertility
PMH- vasectomy, varicocele, testicular descent, chamo/radio
Occupational history
Sexual history
Previous investigations/treatment
Drugs and environment

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5
Q

What is done on a male exam?

A

Weight, height, BMI
Fat and hair distribution
Abdo and inguinal exam
Genital exam

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6
Q

What would a change in hair and fat distribution mean?

A

Problems with androgens- too much in females, too little in males

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7
Q

What baseline investigations are done for females?

A

Rubella immunity
Chlamydia
TSH
Testing for ovulation

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8
Q

Why is TSH tested for in females?

A

Subclinical hypothyroidism can cause issues with implantation

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9
Q

How is ovulation tested for in a woman w regular periods?

A

Mid luteal phase progesterone

Take sample 7 days before expected period

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10
Q

How is ovulation tested for with irregular periods?

A

Day 1-5 FSH, LH, PRL, TSH and testosterone

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11
Q

What tests are done for women at the fertility clinic?

A

Pelvic US
Physical exams
Tubal patency test- HyCoSy or laparoscopy
Test for ovulation- mid luteal progesterone or FSH and LH

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12
Q

What tests are done for males?

A

Computerised semen analysis

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13
Q

What would be considered a low sperm count?

A

<15 million sperm/ml

<39 million sperm per ejaculation

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14
Q

What is considered severe oligospermia?

A

<5 million sperm/ml

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15
Q

What are the types of ovulatory disorders?

A

Group 1- hypo-gonadotrophin, hypo-gonadic
Group 2- normo-gonadotrophic, norm-oestrogenic
Group 3- hyper-gonadotrophin, hypo-oestrogenic

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16
Q

What is the treatment of group 1 ovulatory disorders?

A

Optimise BMI

Reduce overexercise

17
Q

What is an example of a group 2 ovulatory disorder?

A

Polycystic ovary syndrome

18
Q

What is the diagnostic criteria for polycystic ovary syndrome?

A

2 of;
androgen excess
infrequent periods
US conformation

19
Q

What are the signs and symptoms of androgen excess in PCOS?

A

Hirsutism
Moderately raised testosterone
Acanthosis nigricans

20
Q

What is the treatment of PCOS?

A

Optimise BMI

Pharm- clomifene or gonadotrophins

21
Q

What is clomifene?

A

Selective oestrogen receptor modulator

22
Q

How does clomifene work?

A

Inhibits oestrogen receptos in hypothalamus, preventing negative feedback and leading to up-regulation of gonadotrophin, causing ovulation

23
Q

What is the dose and course of clomifene?

A

Start 50mg, and adjust up to 150mg as necessary

Give for up to 6 cycles

24
Q

What are the possible side effects of clomifene?

A

Ovarian hyperstimulation
Multiple pregnancy
Visual alterations
Vasomotor “flushes”

25
Q

What are the indications to give gonadotrophin in PCOS?

A

No ovulation on clomifene

Ovulation but no pregnancy on clomifene

26
Q

How many cycles can gonadotrophin be given for?

A

3-6 cycles

27
Q

What are the signs and symptoms of an androgen secreting adrenal tumour?

A

Hirsutism

Acanthosis nigricans

28
Q

What are the signs and symptoms of fibroids?

A

Pressure symptoms

Period problems

29
Q

What type of fibroids affect fertility the most?

A

Submucosal- alter implantation

30
Q

What are the common causes of female infertility?

A 
Ovulatory disorders
Androgen secreting adrenal tumour
Prolactinoma
Fibroids
Endometriosis
Tumours
Sterilisation
Unexplained
31
Q

What causes epididymitis?

A

STIs

32
Q

What are the conditions of male infertility re the vas deferens?

A

Cystic fibrosis mutations

Congenital bilateral absence

33
Q

What are the conditions of male infertility re testes?

A

Testicular maldescent

Varicocele- dilation in pam-uniform plexus of veins

34
Q

What is hypospadias?

A

Urethral meatus on penis not in usual location

35
Q

What are the causes of azoospermia?

A

Testicular- normogonadotrophic, hypogonadism, hypergonadotrophic
Post testicular- iatrogenic, congenital, infective

36
Q

What is the commonest cause of hypogonadism?

A

Klinefelter syndrome

37
Q

What investigations are done for azoospermia?

A

History and exam
FSH, LH, testosterone and prolactin
Karyotype
CF screen

38
Q

What is the management of azoospermia?

A

Surgical sperm retrieval

Reproduction (29 decks)

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