Lecture 7- Infertility Flashcards Preview

ObGyn Lecture > Lecture 7- Infertility > Flashcards

Flashcards in Lecture 7- Infertility Deck (72):
1

What is fecundability and fecundity?

-chances of becoming pregnant off of that one cycle.
-probability of pregnancy resulting in live birth from one menstrual cycle
- both decrease over time

2

What are examples of elective infertility?

Tubal ligation
Vasectomy

3

What is the definition of infertility?

Failure to achieve IUP > 12 months

4

What are some causes of unexpected infertility?

Wars, diagnosis of cancer, chemo

5

When will you bring down the infertility to less than 6 months?

> 35 y/o
history of oligo/amenorrhea
unknown uterine/pelvic factors
hx prior infertility

6

How many couples experience difficultly with conception?

15% of couples

7

What's primary infertility?

Never fathered a child/ never been pregnant

8

What is secondary infertility in a female?

Has been pregnant before but now can't get pregnant

9

What are three etiologies of female infertility?

Presence of ovulation cycles
HPG dysfunction and ovulatory dysfunction
Anatomic dysfunction

10

What are two different types of HPG dysfunction and ovulatory dysfunction?

Oligo-ovulation (not ovulating every cycle)
Amenorrhea

11

What are some things that can cause oligo-ovulation problems?

HPG dysfunction: thyroid
Pituitary: hyperprolactinemia
PCOS

12

What are some causes of Amenorrhea?

Pregnancy
Hyperandrogenism
stress related hypothalamic dysfunction
Premature ovarian failure

13

What does basal body temperature allow you to determine?

Time of ovulation; biphasic curve (due to rise with progesterone levels after LH surge)

14

When is LH present in the urine?

1 day before ovulation

15

What is the normal range for serum progesterone?

6-25

16

What progesterone levels are considered low?

3-5 ng/mL

17

Elevated prolactin- what should you look at if she isn't pregnant?

Pituitary- look for prolactin secreting tumor

18

What hormone stimulates prolactin?

Thyroid releasing hormone

19

What shuts down prolactin secretion?

Dopamine

20

What are some things in the uterus that can lead to infertility?

Fibroids, leiomyoma, anomalous structure, polyps

21

What are some things in the fallopain tubes/ peritoneum that can cause infertility?

Obstruction/ adhesions
PID
Appendicitis
Endometriosis
Priory surgery

22

With anatomic dysfunction what imaging diagnostics would be helpful?

TVUS (trans vaginal US)

23

What is cryptochidism?

Undescended testicle

24

WHat is hypospadias?

Urethral opening is lower down than normal

25

How many semen samples do you need for a proper analysis?

2 or 3 over 2 week period

26

How many days before giving a semen sample should males be abstient?

2-3 days

27

How much is normal volume of ejaculate volume?

1.5 mL

28

How many million sperm should you have per mL?

15 million

29

What percentage of the sperm should be mobile?

>40%

30

In primary hypogonadism what lab levels are abnormal in males?

Low testosterone
or elevated FSH, LH

31

In males if there is low testosterone what should be checked?

Prolactin

32

What day of the cycle do you want to draw FSH and estradiol?

cycle day 3

33

What day do you want to draw serum progesterone?

Day 20, 21

34

When do you start clomiphene citrate?

Cycle days 3-5 (follicular phase)

35

When will ovulation occur after first dose of clomiphene citrate?

5-12 days after last dose

36

What are some side effects of clomiphene citrate?

hot flashes, HA, nausea, 10% risk of multi-gestation pregnancy

37

What type of drug is clomiphene citrate?

SERM, competes with estrogen

38

how long is daily progesterone supplement given?

From oocyte retrieval through first 10 weeks

39

What is a female with Male pattern distribution related to excess terminal hair? (coarse hair)

Hirsuitism

40

What is Masculinization of a female d/t increased testosterone?

Virlization

41

What are some ways that virilization manifests?

Clitoral hypertrophy
Hirsuitism
Deepening voice
Remodeled muscle mass
breast atrophy
male pattern baldness

42

What are common ddx for virilization?

PCOS
CAH
idiopathic (diagnosis of exclusion)

43

What is treatment for hyperandrogenic disorders?

Supress or block action at receptor site

44

What is the carrier protein that binds to testosterone?

SHBG (sex hormone binding globulin)

45

Where is SHBG produced?

In the liver

46

What stimulates SHBG production?

Estrogen

47

Where are there testosterone receptors?

Hair follicles
Sebaceous glands
Genital skin

48

What is constitutional hirsutism

increased of testosterone at target cells, not necessarily the increase in testosterone overall

49

Individuals with PCOS who have acanthrosis nigricans often have what?

Insulin resistance

50

In pCOS is estrone or estradiol present at higher levels?

Estrone

51

What two blood levels are increased or upper limits of normal in PCOS?

Androstenedione and testosterone

52

In PCOS what will TG levels be at?

150 mg/dL

53

In PCOS what levels will HDL be at?

<50 mg/dL

54

In PCOS, fasting blood glucose is greater than what?

>100 md/dL

55

On an US from someone with PCOS what will be seen?

1 or 2 ovaries w/ greater than o12 follicles (2-9 mm in diameter) see a lot of immature follicles

56

In PCOS are there any variation in FSH or LH?

No, so there is no trigger for final development, ovulation of ovums

57

What medication in PCOS helps decrease insulin resistance?

Metformin

58

If a person has had sudden symptoms of rapid onset acne, hirsuitism, amenorrhea, virilzation what should you suspect?

Sertoli-Leydig tumor

59

The deficiency of _________ is the most common cause of adrenal hyperplasia.

21-hydroxylase deficiency

60

What accumulates when 21-hydroxylase is deficient?

Progesterone
17 alpha hydroxyprogesterone (17-OH_progesterone)

61

What happens with the most severe form of 21-hydroxylase deficiency?

Female infant is virilized (ambiguous genitalia) and can suffer from life threatening salt wasting

62

When 21-hydroxylase deficiency manifests at puberty what may precede thelarche?

Adrenarche

63

What is treatment for CAH aimed at restoring?

Normal cortisol levels, usually supplement gluccocorticods like prednisone

64

Can medical therapy for adrenal and ovarian disorders resolve hirsutism?

No, can only supress new hair growth

65

What is a result of Cushing syndrome?

Adrenal excess as a result of adrenal neoplasm or an ACTH_producing tumor

66

What is the name for hirustism where there is no explanation for the cause of the disorder?

Constitutional hirsutism

67

Women with constitutional hirsutism have a greater activity of 5 alpha reductase and therefore more...

Free testosterone

68

What is the most commonly used androgen blocker for constitutional hirsuitism?

Spironolactone

69

What is when some drugs with androgen activity are implicated in hirsutism and virilization?

Iatrogenic androgen excess

70

What is an attenuated androgen used for the suppression of pelvic endometriosis and can lead to iatrogenic androgen excess and hirsutism, acne, deepening of the voice?

Danazol

71

For semen analysis, rapid progressive motility should be ...

> 32%

72

For semen analysis, normal morphology should be ...

>4%