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Year 2 Endocrine > Management of infertility > Flashcards

Management of infertility Flashcards

1
Q

What is infertility?

A

Failure to achieve a clinical pregnancy despite 12 months of regular unprotected sex in couple who have never had a child before.

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2
Q

Why does weight cause issues?

A

Increases rate of miscarriage by 2/3x
Increased erectile dysfunction
Decreases success rate with fertility treatment.
Decreases fertility and sperm motility

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3
Q

What vaccine is given prior to attempts at conception?

A

MMR vaccine, must have been on contraception for 4 weeks prior.

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4
Q

Why is the MMR vaccine given?

A

As rubella causes serious issues in the foetus.

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5
Q

What does rubella increase the risk of in pregnancy?

A

Microcephaly
Patent ductus arteriousus
Cataracts
Rash

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6
Q

What types of ovulary disorders are there?

A

Type I
Type II
Type III
Other

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7
Q

What is a type I ovulatory disorder?

A

Hypothalamic

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8
Q

How does a type I hypothalamic disorder present?

A

Low FSH LH Oestrogen
Normal Prolactin
-ve Progesteron challenge
Amenorrhea

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9
Q

What is a type II ovulatory disorder?

A

Hypothalamic Pituitary dysfunction

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10
Q

What is a type III ovulatory disorder?

A

Ovarian failure

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11
Q

What is the mainstay of treatment in a type III ovulatory disorder?

A

Combined contraceptive pill
HRT
Egg preservation
Counselling

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12
Q

What are the other causes of infertility?

A

Hyperprolactinaemia

Hypothyroidism

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13
Q

What is the main type I ovulatory disorder?

A

Hypogonadotrophic hypogonadism

Failure to release adequate GnRH from hypothalamus

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14
Q

What are some causes of type I ovulatory disorders ?

A 
Stress
Excessive exercise 
Anorexia
Pituitary tumour
Head trauma
Steroid and opiates
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15
Q

What must be done before treatment of a type I ovulatory disorder?

A 
Stabilise weight
Reduce alcohol and smoking
Folic acid 
Rubella vaccine
Semen analysis
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16
Q

What two options are there for the treatment of a type 1 ovulatory disorder?

A

Pulsatile GnRH

Gonadotrophin injections

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17
Q

What is the GnRH pump?

A

Induces ovulation by inducing the correct levels of LH and FSH.

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18
Q

Are there any risks associated with the pulsatile GnRH pump?

A

Low multiple pregnancy risk

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19
Q

What are the gonadotrophin injections?

A

LH and FSH administered daily

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20
Q

Are there any risks associated with the gonadotrophin injections?

A

High multiple pregnancy risk

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21
Q

What do both the gonadotropin injections and the pulsatile GnRH pump require?

A

USS monitoring of the follicles.

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22
Q

What is the most common type II ovulatory disorder?

A

Polycystic ovarian syndrome

PCOS

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23
Q

How does PCOS present biochemically?

A

Normal gonadotrophins / excess LH
Normal oestrogen
Increased free testosterone

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24
Q

How does PCOS present clinically?

A

Oligo/Amenorrhea

Insulin resistance

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25
Q

What is the mainstay of treatment for PCOS?

A

Clomifene
+ metformin for insulin resistance and improved sensitivity
+Gonadotrophin injections

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26
Q

What are the risks associated with PCOS treatment?

A

Multiple pregnancy risk

27
Q

What are the three hallmarks associated with PCOS?

A

Hyperandrogenism
Hirsutism
Cystic ovaries on USS- Pearl necklace

28
Q

What are some of the risks associated with multiple pregnancy to the mother?

A 
Hyperemesis
Anaemia
Pre eclampsia 
Gestational diabetes
Post partum haemorrhage
Post natal depression
29
Q

What are some of the risks associated with multiple pregnancy to the foetus’s?

A

Low birth weight
Increased miscarriage
Increased risk of disability
Increased risk of perinatal death

30
Q

What is pre eclampsia?

A

The onset of hypertension during pregnancy resulting in seizures low platelet counts and oedema.

31
Q

What is twin twin transfusion syndrome?

A

Unbalanced vascular communication resulting in one receiving more blood and nutrients than the other.
Significant cause of perinatal mortality. 80-100% fatality

32
Q

What is the treatment for twin twin transfusion syndrome?

A

Laser division of the vessels

33
Q

What are the risks associated with prematurity?

A

Increased risk of respiratory distress syndrome
Reduced IQ
Increased risk of ADHD speech issues etc

34
Q

What is premature ovarian failure?

A

Halt of periods before 40

35
Q

What are some causes of premature ovarian failure?

A

Turners
Idiopathic
Chemotherapy
Radiotherapy

36
Q

What are some clinical signs of premature ovarian failure?

A

Flushes
Night sweats
Atrophic vaginitis

37
Q

Hoe does premature ovarian failure present biochemically?

A

High FSH and LH

Low oestrogen

38
Q

What are some infective causes of tubal diseases?

A

Pelvis inflammatory - STI TB

Trans peritoneal appendicitis

39
Q

What are some non infective causes of tubal damage?

A 
Endometriosis
Surgical 
Fibrosis
Fibroids
Polyps
40
Q

What are some signs of a pelvis infection?

A 
Abdominal pain
Vaginal discharge
Menorrhagea
Infertility 
Ectopic pregnancy
41
Q

What is endometriosis?

A

Endometrial glands located outside the uterine cavity

42
Q

How does endometriosis present?

A 
Dysmenorrhea
Painful defecation
Chronic pelvic pain
Chocolate cysts on ovary
Infertility
43
Q

What are the types of fibroids?

A

Pedunculated
Subserous
Submucous
Intramural

44
Q

Of the different types of fibroids which ones are generally operated on?

A

Submucos and intramural

45
Q

What surgical treatment can be used for PCOS

A

Laparascopic Ovarian Diathermy

Literally drilling holes in the ovaries

46
Q

What are the risks associated with laparoscopic ovarian diathermy?

A

Risk of ovarian destruction or adhesions

47
Q

What are the types of male infertility?

A

Post Testicular
Testicular
Pre Testicular
Non ob

48
Q

Name some causes of post testicular infertility?

A

CF
Vasectomy
Duct Obstruction
Accessory gland infection

49
Q

How does post testicular infertility present biochemically?

A

Testosterone FSH and LH levels are all normal

50
Q

What is the management of someone with post testicular infertility usually?

A

USS guided surgical removal of sperm

51
Q

Name some causes of testicular infertility?

A 
Klinefelters immotile cilia syndrome
Heat
Irradiation
Drugs
Chemotherapy 
Testicular torsion
52
Q

How does testicular infertility clinically present?

A

Low sperm count

53
Q

What is the main cause of pre testicular infertility?

A

Hypogonadism

54
Q

How does pre testicular infertility present both clinically and biochemically?

A

Low FSH LH and Testosterone

Erectile dysfunction

55
Q

What are some common causes of a non obstructive infertility?

A

Chemotherapy
Radiation
Klinefelters

56
Q

How does non obstructive infertility present biochemically ?

A

FSH and LH is high

Testosterone is Low

57
Q

How does non obstructive infertility present clinically?

A

Low testicular volume
Reduced secondary sexual characteristics
Vas deferens is present

58
Q

List some factors that increase infertility

A 
Precocious pregnancy
Smoking
>2 cups of coffee
Recreational drugs
BMI over 30
Over 30
59
Q

What is anovulatory infertility?

A

Where the ovaries don’t release an oocyte during the menstrual cycle.

60
Q

What are the physiological causes of anovulatory infertility?

A

Pre puberty
Pregnancy
Lactation
Menopause

61
Q

What are some gynaecological causes of anovulatory infertility?

A

Hypothalamic- anorexia bulimia excessive exercise
Endocrine- Hyperprolactinaemia tumours Sheehan
Ovarian- PCOS premature ovarian failure

62
Q

List some other causes of anovulatory infertility?

A

Systematic- chronic renal failure

Endocrine- testosterone secreting tumours

63
Q

What is Sheehans syndrome?

A

Hypoxic damage to the pituitary during childbirth caused by severe haemorrhage, leading to the failure of the pituitary gland.

Year 2 Endocrine (21 decks)

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