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Reproduction > Infertility > Flashcards

Infertility Flashcards

1
Q

Why does female age matter in fertility?

A

Egg count is determined at birth following which there is no new egg production

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2
Q

How does egg quality change over time?

A

Capacity to perform well in terms of nuclear and genetic material division declines with advancing age

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3
Q

Can we predict decline in fertility?

A

No

We can just advise to plan ahead

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4
Q

What are the main necessary components of successful conception?

A

Ovulation
Sperm production
Sperm to meet and fertilise the egg in patent and functioning fallopian tubes
Implantation

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5
Q

Does progesterone increase or decrease after ovulation?

A

Increase

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6
Q

Describe the hormonal control of spermatogenesis.

A

Hypothalamus releases GnRH
GnRH stimulates AP to release FSH
FSH acts on spermatogonia in seminiferous tubules
Spermatogenesis takes place

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7
Q

Describe the hormonal control of androgen release?

A

Hypothalamus releases GnRH
GnRH stimulates AP to release LH
LH acts on Leydig or interstitial cells of testes
Androgens released

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8
Q

What do androgens do?

A

Secondary male characteristics

Sustentacular cells of seminiferous tubules

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9
Q

What are some lifestyle factors associated with fertility?

A 
Age
BMI
Smoking
Alcohol
Recreational drug use
Stress
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10
Q

What are the 4 types of problems which may cause infertility in the male?

A

Problems producing hormones for sperm production
Blockage of sperm transport
Sperm production problems
Erection and ejaculation problems

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11
Q

What are some problems which could arise with erection and ejaculation?

A

Prostate surgery
Damaged nerves
Timing of intercourse
Medication

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12
Q

What are some problems which could impair sperm production?

A 
Genetic
Failure of testes to descend
Infections
Torsion
Varicoele
Drugs
Radiation
Sperm antibodies
Heat
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13
Q

What are some causes of blockage of sperm transport?

A

Infection
Prostate problems
Absence of vas deferens

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14
Q

What are the main considerations for investigating infertility?

A

Are eggs available?
Are sperm available?
Can sperm and egg meet?
Any other factors?

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15
Q

How is incidence of ovulation investigated?

A 
Basal Body Temperature
Cervical mucus
LH ovulation kits
Ovulation calendars
D21 serum progesterone
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16
Q

When is progesterone recorded for ovulation checking?

A

Day 21, assuming a 28-30 day cycle

17
Q

What is HSG?

A 
Hysterosalpingography
Used to check fallopian tube patency
Catheter through cervix
Dye instilled
X ray taken
18
Q

What are some common other tests for couples with infertility problems?

A 
Serum prolactin
Thyroid fucntion
Chlamydia screening
Pelvic US
Rubella immunity
Cervical smear
19
Q

What is first line advice for ovulation disorders?

A

Optimise body weight, healthy lifestyle, exercise

20
Q

What are medications which can be used to induce ovulation?

A

Clomiphene

Gonadotrophins

21
Q

What is a possible surgical management of ovulation disorders?

A

Laparoscopic ovarian drilling

22
Q

What are some of the ways we could manage low sperm count (azoospermia)?

A

Gonadotrophins
Surgical sperm retrieval
Intrauterine insemination
Intracytoplasmic sperm injection (ICSI)

23
Q

How can endometriosis be treated surgically?

A

Ablation or resection of spots
Ahesiolysis
Cystectomy for endometrioma

24
Q

What are some possible surgical solutions for uterine problems?

A

Removal of polyp/fibroid

Adhesiolysis for synechiae

25
Q

How is unresolved infertility managed?

A

IVF advised

26
Q

What is the regulatory authority for IVF?

A

HFEA

Human fertilisation & embryology authority

27
Q

Why may donor eggs be used for IVF?

A

Age
Poor quality
Ovarian failure
Genetic causes

28
Q

Why may a sperm donor be used for IVF?

A 
Single women 
Same sex relationship
Azoospermia
Genetic cause
Infection (HIV, HepB, HepC)
29
Q

What are the key steps in IVF?

A 
Gonadotrophin induced superovulation
Follicular monitoring
Timing ovulation
Egg collection
Insemination
Incubation
Embryo transfer
Progesterone support
30
Q

What are the different techniques for IVF?

A

Sperm just mixed into dish with egg

ICSI - sperm injected into egg

31
Q

Can embryos be stored?

A

Yes they can be frozen in nitrogen and stored for up to 10 years

32
Q

What is OHSS?

A

Ovarian hyperstimulation
Over response of ovaries
Over production of follicles
Symptoms

33
Q

Can multiple pregnancy be a risk of IVF?

A

Yes

Sometimes multiple embryos transferred

Reproduction (25 decks)

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