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Women's Health > Lecture 5: Infertility > Flashcards

Lecture 5: Infertility Flashcards

1
Q

Define infertility

A
  • Inability to conceive after 1y of unprotected intercourse of reasonable frequency in women < 35y
  • Inability after 6m for women > 35y

Primary = no prior para. Secondary = multips

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2
Q

What conditions tend to result in infertility?

A
  • Oligo/amenorrhea
  • Uterine/tubal/peritoneal disease
  • Stage 3/4 endometriosis
  • Known/suspected male infertility (varicocele)
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3
Q

What is the MCC of infertility?

A

Ovulatory issues

Male is 2nd highest, so evaluate both partners!

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4
Q

What is conization?

A

Cone biopsy of cervix, which can affect cervical anatomy and decrease mucus quality

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5
Q

What typically can cause recurrent pregnancy loss?

A
  • Monosomy X (Turner syndrome) for spontaneous miscarriage
  • APS
  • Uterine abnormalities
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6
Q

What is the MCC of premature ovarian failure < 40y?

A

Turners

Monosomy X, aka gonadal dysgenesis

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7
Q

What is mittelschmerz?

A

Midcycle pelvic pain associated with ovulation

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8
Q

What are molimina symptoms?

A
  • Breast tenderness
  • Acne
  • Food cravings
  • Mood changes
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9
Q

How does basal body temperature change with ovulation?

A

Basal temp increase by 0.4-0.8F is strongly predictive of ovulation

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10
Q

How do ovulation predictor kits work?

A

Measuring urinary LH, since LH surge precipitates ovulation

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11
Q

Why is FSH good to check ovarian reserve?

A
  • The less eggs you have, the less inhibin you secrete.
  • The less inhibin, the more FSH
  • FSH > 10 IU/L is associated with diminished ovarian reserve
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12
Q

What does increased antimullerian hormone mean for follicle count?

A

More follicles

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13
Q

What is the initial treatment for anovulatory infertile women?

A

Clomiphene citrate (clomid)

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14
Q

What does letrozole do?

A

Aromatase inhibitor, which inhibits the production of estrogen and increases FSH

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15
Q

What is ovarian hyperstimulation syndrome?

A

Excessive exogenous gonadotropin therapy resulting in ovarian enlargement

Supportive tx

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16
Q

Describe intrauterine insemination (IUI)

A
  1. wash/concentrate sperm
  2. Insert catheter into endometrial cavity and inject sperm
17
Q

Describe in vitro fertilization (IVF)

A
  • Direct injection of mature oocytes into endometrial cavity via sonographic evidence.
18
Q

What is a hyserosalpingogram used to image? (HSG)

A

Uterine cavity and tubal imaging via radio-opaque dye

19
Q

What is chromopertubation?

A

Injection of methylene blue thru cervical canal during laparoscopy to evaluate tubal patency

20
Q

Tx for tubal occlusion

A
  • Tubal cannulation
  • Tubal reconstruction
  • Tubal resection followed by IVF
21
Q

Tx for endometriosis

A
  • Surgical treatment
  • IVF
  • GnRH
22
Q

Tx for pelvic adhesions

A
  • Surgical removal
  • IVF
23
Q

How do fibroids affect infertility?

A
  • Obstruction of tubes or distortion of uterus
24
Q

What is Asherman’s syndrome?

A
  • Intrauterine adhesions
  • Hx of D&C
25
Dx and Tx of Asherman's syndrome
* Dx: HSG or hysteroscopy * Tx: Hysteroscopic lysis of adhesions
26
Why is an endometrial biopsy performed?
Thought to be more informative than just a serum progesterone level. | **No longer routine**
27
What does high estrogen do to cervical mucus?
Thin and slippery | It wants the sperm to go up
28
How long does it take sperm to mature?
90d, so anything 3 months prior could be the culprit for male infertility | Sperm matures best at slightly below body temp
29
How is semen analysis performed?
* Dont jack off for 2-3 days * Sterile cup collection
30
How do you treat antisperm antibodies?
Corticosteroids | You will see a**gglutination on semen analysis**
31
Tx of oligospermia
IUI | If you cant make enough, then we concentrate it and inject it
32
Causes of azoospermia
* Congenital absence of vas deferens (CF) * Severe infection * Vasectomy | Tx with donor or epididymal aspiration
33
What is asthenospermia and causes and tx?
* Decreased sperm motility * Prolonged abstinence * Antisperm antibodies * Infection * Varicocele * Tx with intracytoplastic sperm injection or IUI
34
What is teratospermia and Tx?
* Abnormal morphology * Tx with IVF
35
What might low FSH & low testosterone suggest in a male? Tx?
* Kallmann syndrome: anosmia + hypogonadotropic hypogonadism * Idiopathic hypogonadotropic hypogonadism * Tx with gonadotropins!
36
What might elevated FSH with low testosterone suggest?
Testicular failure resulting in oligospermia. | Testicles get stimulated but they aint working
37
What are the genetic causes of poor semen analysis?
* Klinefelter syndrome (XXY) * Microdeletion of Y chromosome * CF

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