Lecture 37 - Infertility Flashcards
______ refers to the probability of achieving a pregnancy in one menstrual cycle, while _______ refers to the probability of achieving a live birth in one menstrual cycle.
Fecundability
Fecundity
Infertility is defined as either One year of unprotected intercourse without conception in couples with a female partner < _____ years old
OR
_____ months of the same with a female partner > _____ years old.
35
6 months
35
Of Subserosal, Intramural, and Submucosal uterine fibroids, which are most likely to cause infertility?
Submucosal, as they encroach on the uterine canal and cause issues with implantation.
Mullerian anomalies pose risk for infertility, and ______ uterus is of concern in early pregnancies, as this area has poor blood flow and is a poor environment for implantation.
Septate uterus
Ovulatory dysfunction refers to failure of the ovary to produce a good quality egg every month. Issues can be in any aspect of that, so with the egg, with ovulation, or with monthly consistency.
What is the greatest risk factor?
Aging is the greatest risk factor
Ovulatory dysfunction is classified by the WHO into 3 groups.
Group I –> ______gonadotropic hypogonadism (basically anything that causes a problem with _____ production from the Hypothalamus - anorexia, Kallmann syndrome, very low BMI.)
Group II –> Normogonadotropic states (PCOS, Chronic anovulation, Hyperprolactinemia)
Group III –> ______gonadotropic hypogonadism (Primary ovarian failure).
Group I –> HYPOgonadotropic hypogonadism
Group II –> Normogonadotropic state
Group III –> HYPERgonadotropic hypogonadism
Some manifestations of ______ ______ (disease) can result in congenital bilateral absence of the Vas deferens.
Cystic Fibrosis
Hysterosalpingogram is a fluoroscopic eval of the uterine cavity and fallopian tubes with an ____ based radioopaque dye. It reveals the relative shape and patency of the uterus and fallopian tubes.
Iodine based
Transvaginal ultrasound is used to visualize the _____ and _____, but not so much the uterine cavity.
How can this be modified to help visualize the Uterine cavity?
Endometrium and Myometrium
Fill the uterus with saline (Hydrosonogram).
Which is better for visualizing the uterine cavity, Hydrosonogram or Hysterosalpingogram?
Hydrosonogram
________ is the only way to visualize the entire length of the Fallopian tube and its relation to the ovaries and relative positioning in the pelvic cavity.
Laparoscopy
Evaluation of ovulation can include measuring basal body ______. There is an observable, sustained _______ (increase or decrease?) after ovulation due to progesterone.
Temperature
Increase (by a few tenths of a degree)
Measuring mid-luteal ______ levels can give you a good idea ovulation has occurred (levels will be elevated and sustained).
Progesterone
FSH and Estradiol levels can be measured as a surrogate measure for ovarian reserve (the amount of follicles in the ovaries). When do these levels need to be measured?
FSH < ____mIU/mL is normal.
FSH between ___-___ is borderline.
FSH > ____ is diminished ovarian reserve.
E2 < _____pg/mL is normal for day 3. Higher values may indicate early follicular development of incorrect day of measurement.
Early in the menstrual cycle, about day 3 of bleeding (remember day 1 of the menstrual cycle is considered the first day of bleeding.)
FSH < 10mIU/mL is normal
FSH between 10-15mIU/mL is borderline
FSH > 15 mIU/mL is low ovarian reserve
E2 < 70pg/mL is normal on day 3
Ultrasound eval of Antral follicle counts is another way to measure ovarian reserve. Antral follicles are those < ___mm, and a normal number is between ___-___ in both ovaries combined.
< 10mm
10-20
