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Flashcards in Management of Infertility Deck (40):
1

What is the definition of infertility

Failure to conceive despite regular unprotected sexual intercourse over 12 months in absence of known reproductive pathology

2

Why is infertility classed as a disease

It causes considerable psychological distress

3

What are some factors that influence fertility

Female age
Duration of infertility
Previous pregnancy
Cause of infertility

4

What are some reasons for the incidence of infertility increasing

Older women
rise in increase in chlamydia infections
increase in obesity
increasing awareness of treatments
change in expectations
increasing male factor infertility

5

What should be involved in the examination of a female in the infertility clinic

BMI
BP
Urinalysis
General examination
Pelvic examination

6

What should be involved in the examination of a male in the infertility clinic

BMI
BP
Urinalysis
General examination
Urogenital examination

7

What type of drug can cause an increase in prolactin

Antidepressents

8

What types of drugs can cause a problem with Ovulation

NSAID

9

What investigations are required for the female

Endocervical swab for chlamydia
Cervical smear if due
Blood for rubella immunity
Midluteal progesterone level

10

What 3 things can Rubella syndrome cause to the newborn

Microcephaly (small head)
PDA (heart abnormalities)
Cataracts
Rash at birth
Low birth weight

11

What type of vaccine is the Rubella vaccine

Live

12

What is the treatment for chlamydia

Azithromycin tablet 1g

13

What are some short-term affects of pelvic inflammatory disease

Tub-ovarian abscess
Peritonitis
Fitz-Hugh-Curtis Syndrome

14

What are some long-term affects of pelvic inflammatory disease

Chronic pelvic pain
Infertility
Ectopic pregnancy

15

What is the treatment for an ovarian abscess

Surgically drain the abscess and prescribe broad spectrum Antibiotics for 2 weeks

16

What is a strong suggestion of ovulation

Regular menstruation

17

What can we measure to confirm ovulation in someone with regular cycles

Midluteal serum progesteron

18

What are the 3 groups of ovulatory disorders

Group 1 - Hypothalamic
Group 2 - Hypothalamic Pituitary dysfunction
Group 3 - Ovarian Failure

19

What are some of the causes of Hypothalamic ovulatory disorders

Stress
Excessive exercise
Anorexia
Kallman's syndrome
Isolated gonadotrophin deficiency

20

What is the most common type of ovulatory disorders

Hypothalamic pituitary dysfunction including PCOS

21

What are some symptoms of PCOS

Hirsutism
Acne/ oily skin
Increase in testosterone levels
Oligomennorhoea
Central obesity

22

What is seen on US to confirm Polycystic ovary

More than 12 follicles between 2-8 mm in diameter in a single plane

23

Patients must have 2 of what to make a diagnosis of PCOS

Irregular menstrual cycle, hirsuitism, acne, sub fertility, alopecia, obesity
Biochemical- in days 2-5
Elevated serum LH
LH/FSH >2
Normal estradiol
Low progesterone
Normal or mildly elevated prolactin
Raised testosterone

24

What are the first line drugs used to induce ovulation

Antioestrogens e.g. Clomifene citrate or tamoxifen
Aromatase inhibitors e.g. Letrozole

25

How should Clomifene citrate be taken

Day 2-6 of cycle (1 tablet for 5 days)

26

What is the advantage of using Tamoxifen to Clomifene citrate

The oestrogen effect on endometrium

27

How do Aromatase inhibitors work

They inhibits ovarian aromatase enzyme

28

What are some second line treatments for inducing ovulation

Clomifene citrate + metformin (to improve sensitivity)
Gonadotrophin therapy (daily injections)
Laparoscopic ovarian diathermy

29

What do we look for when examining sperm

Volume >1.5ml
count >15x 10^6/ml
Progressive motility and >4% normal morphology

30

What is the most common cause of male infertility

Idiopathic

31

What are some obstructive causes of male infertility

Vasectomy
Infection
Congenital absence of vas deferens (Cystic Fibrosis)

32

What are some of the non-obstructive causes of male infertility

Undescended testis
Orchitis
Torsion/trauma
Chromosomal (Kleinfelter's syndrome 47XXY)

33

What are some other causes of male infertility

Hormone - hypothyroidism, hypogonadism, hypogonadotrophic, testicular cancer
Chemo, radio, erectile dysfunction, immunological

34

What are the treatment options for male infertility

Surgery to obstructed vas deferins
Intrauterine insemination
Intracytoplasmic sperm injection (ICSI)
Donor insemination

35

What are the most common causes of tubal disease

Infective:
Pelvic inflammatory disease inc. chlamydia or gonorrhoea

36

What are some non-infective causes of the tubal disease

Endometriosis
Surgical
Fibriods
Polyps
Congenital

37

What are the treatment options for tubal disease

Tubal surgery (reversal of sterilisation)
IVF

38

How are eggs collected for IVF treatment

Ultrasound guided

39

How big is a blastocyst and at what stage does this form

More than 125 cells - blastocyst

40

What are some general factors for improving the likelihood of pregnancy

Sex 2-3 times per week
Low alcohol intake
Between 19-29 BMI
No smoking
Folic acid
Rubella immunity
Cervical smears up to date