Repro Endocrinology and Infertility

Question 1

define infertility

Answer 1

> 1 yr of unprotected sex without conception

* 6 months if >35 yrs old

Question 2

fecundability definition and average rate

Answer 2

probability of achieving pregnancy in a single menstrual cycle (about 20-25% in young couples)

Question 3

definition of fecundity

Answer 3

probability of achieving a live birth after attempting conception for a single menstrual cycle (accounts for miscarriage)

Question 4

miscarriage rate for young women and women > 40 yrs old

Answer 4

12% in young women; 26% in >40 yrs old

Question 5

OB/GYN definition of menstrual cycle

Answer 5

24-36 days give or take

Question 6

how do you calculate ovulation from menstrual cycle?

Answer 6

take cycle length and subtract 14

Question 7

describe basal body temp around ovulation…what hormone causes this effect in BBT (basal body temp)? how does this BBT relate to fertility?

Answer 7

temp increases AFTER ovulation due to progesterone; most infertile after ovulation because high BBT

Question 8

when a woman tests positive for an ovulation test, it is a signal that she will be ovulating in __-__ hrs

Answer 8

24-36

Question 9

ovulation tests are detecting what hormone?

Answer 9

LH

Question 10

which two pt groups have a higher baseline LH and are more at risk for a false-positive on an ovulation test?

Answer 10

1) . PCOS

2) . premature menopause pts

Question 11

follicle is a cyst that contains a ___

Answer 11

egg

Question 12

what are two disorders that can stop ovulation?

Answer 12

thyroid disorders and hyperprolactinemia

Question 13

estrogen has _________ feedback on pit/hypothalamus at the beginning of menses; at midcycle, estrogen begins _________ feedback

Answer 13

negative; positive (stimulates LH and FSH for LH surge)

Question 14

to evaluate FSH, LH, and estradiol levels for ovulation, blood is drawn between days __-__

Answer 14

2-4

Question 15

how do SERMs work? example of SERM

Answer 15

binds to estrogen receptor and acts as agonist or antagonist in tissues (mostly antagonist to give false sense of low estrogen levels = inc in LH/FSH)
*clomid/clomiphene

Question 16

to diagnosis someone with PCOS, you need 2 out of the following 3 criteria PLUS what else

Answer 16

1).oligoovulation/anovulation
2). evidence of elevated androgens (hirsutism)
3). polycystic ovaries
PLUS- rule out other possible conditions

Question 17

how does letrozole work?

Answer 17

it blocks aromatase (prevents conversion of androgens to estrogen), so estrogen levels dec and brain stimulates more release of LH/FSH

Question 18

letrozole works good for fertility in _____ pts

Answer 18

PCOS

Question 19

what are two drugs that require the HPO axis to be intact?

Answer 19

aromatase inhibitors and SERMS

Question 20

what medications are used to induce ovulation in women without an intact HPO axis?

Answer 20

gonadotropins LH and FSH injected

Question 21

what often happens with fertility when using gonadotropin therapy for ovulation?

Answer 21

multiple births

Question 22

what does ovarian drilling do?

Answer 22

helps pts, specifically PCOS pts, who cant ovulate on medications by destroying androgen producing tissue

Question 23

how much sperm defines fertility? what % of them have forward motility?

Answer 23

15-20 million/ml; 1/3

Question 24

three causes of abnormal sperm

Answer 24

1) . genetic- klinefelters, CFTR mutation, and microdeletion of Y chromosome
2) . hormonal- Hypo/pit dysfunction
3) . environmental toxins- smoking, radiation, heat, varicocele

Question 25

what is kleinfelters syndrome?

Answer 25

testicular failure so you cant make sperm (male version of female menopause)

Question 26

what is CFTR mutation?

Answer 26

congenital bilateral absence of vas deferens (ex cystic fibrosis

Question 27

what does microdeletion of the Y chromosome lead to?

Answer 27

men to premature testicular failure

Question 28

how does varicocele cause infertility?

Answer 28

causes body temp to testes to increase (due to dilated veins)

Question 29

two ways to evaluate a female’s tubes?

Answer 29

HSG (hysterosalpingogram) or surgery (used after HSG test OR for a pt who’s having surgery anyways)

Question 30

tubal damage can be caused from what three infections?

Answer 30

chlamydia (common cause of obstruction), gonorrhea, SIN (salpingitis isthmica nodosa)

Question 31

adhesions in tubes can be caused by what two things?

Answer 31

endometriosis and other abd/pelvic infection (ruptured appendix)

Question 32

are Fallopian tubes important in IVF therapy?

Answer 32

no, they get bypassed

Question 33

how does a saline sonogram work?

Answer 33

infuse saline in the uterus and it separates its walls (can show adhesions)

Question 34

what are four tests to evaluate uterine function for fertility?

Answer 34

HSG, US, saline sonogram, hysteroscopy

Question 35

for all fibroids inside the uterus, ______ them; for fibroids outside the uterus, _____ them if only greater than ____ cm

Answer 35

remove; remove; 4 cm

Question 36

need what test to tell the uterine structure?

Answer 36

MRI or 3D US

Question 37

if there is a septum present in the uterus, what do you do to it? what can it cause?

Answer 37

remove it; miscarriage

Question 38

what is endometriosis?

Answer 38

presence of endometrial glands and stroma in an extrauterine site

Question 39

what test do you use to diagnosis endometriosis?

Answer 39

laparoscopy

Question 40

endometrioma can interfere with ___________; considering removing it at ___ cm

Answer 40

fertility; 4

Question 41

what is important to remember about removing an endometrioma?

Answer 41

anytime you remove anything from the ovary, you remove eggs; so compare risk of removing tumor and losing eggs vs risk of keeping it there

Question 42

three noncontraceptive tx of fertility

Answer 42

1) . letrozole superovulation + intrauterine insemination
2) . IVF
3) . surgical removal/ablation of endometriosis