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Infertility Diseases Flashcards

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1
Q

what is infertility defined as

A

failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sex in a couple who have never had a child

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2
Q

what are the two types of infertility

A 
primary = never conceived
secondary = previously conceived but never carried ti term
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3
Q

what are the risk factors of infertility

A 
obesity 
chlamydia infection
old age 
smoking 
recreational drugs
high caffeine intake
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4
Q

what are the common cause of infertility in FEMALES (5)

A 
anorexia/bulimia 
endometriosis
PCOS
premature ovarian failure 
pelvic inflammatory disease
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5
Q

what hormone levels would you expect in anorexia/bulimia

A

low FSH
low LH
low oestrogen

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6
Q

what is endometriosis

A

presence of endometrial glands outside of the uterine cavity

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7
Q

what are the symptoms of endometriosis

A 
dysmenorrhoea (classically before menstruation) = painful cramps
dyspareunia = painful sex
menorrhagia = heavy period
painful defection
chronic pelvic pain
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8
Q

what are the investigations of  endometriosis

A

transvaginal US

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9
Q

what would you expect to see on US of endometriosis

A

“chocolate” cysts on ovaries

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10
Q

what are the symptoms of pelvic inflammatory disease

A 
abdominal/pelvic pain
vaginal discharge
dyspareunia = painful sex 
cervical excitation
menorrhagia & dysmenorrhoea
ectopic pregnancy
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11
Q

what basic things should be done for a FEMALE presenting with infertility

A 
test for chlamydia
cervical smear
bloods for rubella immunity 
midluteal progesterone level 
pelvic exam 
test tubal patency
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12
Q

what are the 2 methods of testing tubal patency

A

hysterosalpingogram

laparoscopy

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13
Q

when is a laparoscopy indicated

A

possible tubal/pelvic disease is suspected
previous pathology (e.g. ectopic pregnancy, ruptured appendix, endometriosis)
dysmenorrhoea
dyspareunia
previously abnormal hysterosalpingogram

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14
Q

when is a hysterosalpingogram indicated

A

no known risk factors of tubal/pelvic pathology

if laparoscopy is contraindicated

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15
Q

when would a laparoscopy be contraindicated

A

obesity
Crohn’s
previous surgery

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16
Q

when would you perform a hysteroscopy

A

suspected or known endometrial pathology e.g. uterine septum, adhesion, polyps

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17
Q

when would a pelvic US be preformed

A

if pelvic exam is abnormal

if further clarification is needed after a different test

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18
Q

what endocrine hormones are checked if hirsute

A

testosterone

SHBG

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19
Q

what endocrine hormones are checked if amenorrhoea

A 
Urine HCG
Prolactin
TSH
Testosterone and SHBG
LH, FSH and oestradiol
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20
Q

what other test is indicated if amenorrhoea

A

chromosome analysis

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21
Q

what endocrine hormones are checked if they have an anovulatory cycle or infrequent periods

A 
Urine HCG
Prolactin
TSH
Testosterone and SHBG
LH, FSH and oestradiol
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22
Q

what are the main causes of infertility in MALES

A

idiopathic (>60%)
drugs
non-obstructive
obstructive

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23
Q

give examples of non-obstructive causes of male infertility

A

47 XXY
chemo or radiotherapy
undescended testes

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24
Q

what hormone levels would you expect in a non-obstructive cause of male infertility

A

high LH
high FSH
low testosterone

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25
what symptoms would make you suspect an non-obstructive cause of male infertility
low testicular volume reduced secondary sexual characteristics vas deferens present
26
give examples of obstructive causes of male infertility
CF infection vasectomy
27
what symptoms would make you suspect an obstructive cause of male infertility
normal testicular volume normal secondary sexual characteristics vas deferens may be absent
28
what endocrine hormone levels would you expect in an obstructive cause of male infertility
normal LH normal FSH normal testosterone
29
what investigations should you do for a MALE presenting with infertility
abdominal + testicular examination | semen analysis
30
what is the next step if male examination is abnormal
scrotal US
31
how is semen analysis done
twice, 6 wks apart
32
what is the next step if semen analysis is abnormal
``` measure: LH and FSH Testosterone Prolactin Thyroid function ```
33
what is the next step if semen analysis is severly abnormal/ azoospermic
``` LH and FSH Testosterone Prolactin Thyroid function chromosome analysis screen for CF testicular biopsy ```
34
what is the treatment for male infertility
intrauterine insemination = in mild disease intracytoplasmic sperm injection donor insemination
35
what is oligomenorrhea
cycles >35 days
36
what is amenorrhea
absent menstruation
37
what are the 2 types of amenorrhea
``` primary = never had a period secondary = had periods previously ```
38
what are the 3 types of ovulatory disorders, which is most common
group 1 = hypothalamic pituitary failure group 2 = hypothalamic pituitary dysfunction (85%) group 3 = ovarian failure
39
give an example of a group 2 ovulatory disorder
PCOS
40
what are the causes of hypothalamic pituitary failure (Group 1)
``` stress excessive exercise/ low BMI/ anorexia tumour head trauma drugs ```
41
what are the symptoms of hypothalamic pituitary failure (Group 1)
amenorrhea ovulatory disorders hypogonadism
42
what investigations are done in hypothalamic pituitary failure (Group 1), what would you expect to find
hormone levels = low FSH/ LH, normal prolactin | progesterone challenge test = negative
43
what is the treatment for hypothalamic pituitary failure (Group 1)
get BM >18.5 gonadotrophin injections daily US monitoring
44
what is the treatment of  hypogonadotropic hypogonadism
pulsatile GnRH
45
what are the symptoms of | Hypothalamic Pituitary Dysfunction (group 2)
normal oestrogen levels oligo/amenorrhoea PCOS
46
what are the symptoms of PCOS
``` Amenorrhoea (10-20%) Oligomenorrhoea (80-90%) Acne Hirsutism Central Obesity Insulin resistance (50-80%) ```
47
what are the investigations of PCOS
High free androgens (Testosterone) high LH glucose tolerance test US ovaries
48
what would you expect to see on US in PCOS
polycystic ovaries: 12 or more 2-9mm follicles Increased ovarian volume >10ml Unilateral or bilateral
49
what is the treatment of PCOS
``` lifestyle change folic acid 5mg daily rubella immunity patency of tubes ovulation induction ```
50
what is the first line treatment in ovulation induction
clomifene citrate
51
what can be given instead of clomifene citrate
tamoxifen | letrozole
52
what increases sensitivity to clomifene citrate
metformin
53
what is the 2nd line treatment in ovulation induction
gonadotrophin therapy
54
what is the 3rd line treatment in ovulation
laparoscopic ovarian diathermy (drilling)
55
what are the risks of IVF treatment
ovarian hyperstimulation | multiple pregnancy
56
what is twin-twin transfusion syndrome
complication that arises in 10-15% of monochronicioc twins
57
what is the cause of twin-twin transfusion syndrome
unbalanced vascular communications within the placental bed
58
what is premature ovarian failure
menopause before 40
59
what are the causes of premature ovarian failure
turner syndrome (46X) fragile X syndrome autoimmune disease radio or chemotherapy
60
what are the symptoms of premature ovarian failure
Hot flushes night sweats atrophic vaginitis amenorrhoea
61
what hormone levels would expect in premature ovarian failure
high FSH (>30 in 2 samples) high LH low oestrogen
62
what is the treatment of premature ovarian failure
Hormone Replacement Therapy Egg or Embryo donation (assisted conception treatment) Ovary / egg / embryo cryopreservation prior to chemo Counselling Prevent osteoporosis

endocrine (mine) (12 decks)

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