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Infertility Flashcards

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1
Q

List some factors that are increasing the demand for assisted conception therapy (ACT)

A

Increasing parental age
Increasing chlamydia
Male factor infertility
Improved success rates of ACT

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2
Q

List the main indications for ACT

A 
Male factors
Unexplained infertility
Endometriosis
Tubal disease
Ovulatory disorder
Single parents/same sex couples
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3
Q

At what age does fertility start to decrease?

A

27

Significantly so at 37

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4
Q

What should females limit their alcohol limit to per week to improve fertility?

A

4 units a week

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5
Q

What is the optimal weight for males + females to improve fertility?

A

BMI 19-29

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6
Q

What medical interventions should be assessed before ACT to improve fertility?

A

Folic acid
Check rubella immunity
Cervical smear
Blood-borne viruses screen

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7
Q

Which drug class in particular can cause male infertility/azoospermia?

A

Steroids (if abused)

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8
Q

How long should a female wait before trying to conceive after being vaccinated against rubella?

A

3 months

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9
Q

List all the assisted conception treatments available

A 
Donor insemination
Intra-uterine insemination (IUI)
In vitro fertilisation (IVF)
Intra-cytoplasmic sperm injection (ICSI)
Surrogacy
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10
Q

What does intra-uterine insemination involve?

A

Sperm are injected into the uterine cavity around the time of ovulation

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11
Q

What does in vitro fertilisation involve?

A

Sperm and egg fertilise outside body and implanted into uterus

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12
Q

How is the normal menstrual cycle down-regulated in preparation for IVF?

A

Synthetic GnRH agonist administered as spray/injection

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13
Q

How is the ovary stimulated to cause follicular development?

A

Synthetic GH injection

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14
Q

What are the risks to GH injection?

A

Allergy

Ovarian hyperstimulation syndrome

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15
Q

How long must a male be abstinent before providing a sperm sample?

A

72 hours

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16
Q

What does intra-cytoplasmic sperm injection involve?

A

Injecting sperm into egg outside the body (i.e. no fertilisation)

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17
Q

What determines our gender?

A

Chromosomes (XY or XX)
Sex hormones secreted
External + internal genitalia
Psychological factor

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18
Q

Which chromosome has the sex-defining region?

A

Y-chromosome

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19
Q

Which 2 hormones/factors contribute to the development of the internal genital tract in the male?

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A

Testosterone

Mullerian inhibiting factor

20
Q

There are 2 primitive genital tracts: Wolffian and Mullerian ducts. Which duct contributes to male and female genital tracts respectively?

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A 
Males = Wolffian
Females = Mullerian
21
Q

Without stimulation by testosterone + Mullerian inhibiting factor, what develops in the male?

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A

Internal genital tract resembling that of a female

22
Q

The testes develop in the abdominal cavity but descend into the scrotal sac before birth. Why?

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A

Lower temperature outside the body facilitates spermatogenesis

23
Q

What is cryptorchidism?

Study These Flashcards
A

Undescended testes, resulting in reduced sperm count and increased risk of testicular cancer

24
Q

What does testicular descent depend on?

Study These Flashcards
A

Androgenic drive

25
Where does spermatogenesis occur?
Seminiferous tubules
26
Where is testosterone secreted from?
Leydig cells
27
List the function of Sertoli cells
``` Form blood-testis barrier (protection) Provide nutrients for developing cells Phagocytosis Secrete seminiferous tubule fluid Secrete androgen-binding globulin Regulate FSH levels through inhibin ```
28
Where does LH act in the male?
Leydig cells - regulate testosterone levels
29
Where does FSH act in males?
Sertoli cells - enhances spermatogenesis
30
What are the 3 main categories of causes of male infertility?
Idiopathic (most common cause) Obstructive Non-obstructive
31
List some obstructive causes of male infertility
Cystic fibrosis (vas deferens defect) Vasectomy Infection
32
List some non-obstructive causes of male infertility
``` Cryptorchidism Infection Radiation (chemo/radiotherapy) Testicular tumour Genetic: Klinefelter's Semen structure abnormality Systemic/endocrine disorders ```
33
List some pituitary causes of male infertility
Tumours Acromegaly Cushing's disease Hyperprolactinaemia
34
List some hypothalamic causes of male infertility
Tumour Increased exercise Kallmann's syndrome Anorexia
35
Which drug when abused is notorious for causing male infertility?
Steroids
36
What would be assessed on genital examination in a male with infertility?
``` Testicular volume (normal = 12-25ml) Presence of vas deferens + epidydimis Penis Urethral orifice Presence of swellings/varicocele ```
37
What 5 domains are assessed on semen analysis?
``` Volume Density (number of sperm) Motility (how many are moving) Progression (how well they move) Morphology ```
38
What extrinsic factors may cause abnormality in semen analysis?
``` Completeness of sample Period of abstinence from sex Conditions during transport Time delay Health of the man ```
39
How would testicular volume, secondary sexual characteristics, endocrine hormones and structure of vas deferens be affected in obstructive male infertility?
All normal | Vas deferens may be absent
40
How would testicular volume, secondary sexual characteristics, endocrine hormones and structure of vas deferens be affected in non-obstructive male infertility?
Low testicular volume Reduced secondary sexual characteristics High endocrine hormones Vas deferens present
41
List some lifestyle improvements that can help male infertility
``` Frequent sex, 2-3x a week Avoid lubricants (toxic to sperm) Less than 4 units of alcohol a week Stop smoking BMI less than 30 Avoid tight underwear, saunas/hot baths ```
42
When is ICSI indicated over IUI?
IUI - low sperm count | ICSI - very low sperm count
43
What is the success (pregnancy) rate of IUI and ICSI?
``` IUI = 15% ICSI = 30% ```
44
When is surgical sperm aspiration indicated?
Azoospermia (very low sperm count)
45
What is the success (pregnancy) rate of surgical sperm aspiration?
95% in obstructive | 50% in non-obstructive
46
If IUI, ICSI and sperm aspiration fail, what is the next option?
Donor sperm

1) Export to anki- obs and gynae (32 decks)

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