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Endocrinology > Reproduction > Flashcards

Flashcards in Reproduction Deck (37):
1

What is the length of a regular menstrual cycle?

28-35 days

2

What s the definition of oligomenorrhoea?

cycle>35 days

3

What is amenorrhoea?

absent menstruation

4

What is the HPO axis?

Hyp: GnHR+
Pit: LH+,FSH+
Ovaries: eostradiol and progesterone

nb, negative feedback

5

What are the 2 phases of the menstrual cycle?

follicular (1-14)
Luteal (14-28)

6

What triggers ovulation?

Surge in LH (36hrs before ovulation)

7

When do eostradiol levels peak?

before ovulation

8

When do progesterone levels peak? where are the produced?

after ovulation
produced by corpus luteum

9

How is ovulation assessed in regular cycles?

midluteal serum progesterone (>30nmol/L) x2 samples
Day 21

10

How is ovulation assessed in irregular cycles?

probably anovulatory
need further hormone investigation

11

When is the early follicular phase and what is assessed here?

2-5 days
serum FSH, LH, eostradiol
Serum PRL, TSH
Free androgen index

12

What is the progesterone challenge test?

menstrual bleed in response to 5 day course progesterone
indicates normal eostrogen levels

13

What radiological investigations can be done to assess ovulation?

TVUS of ovaries
MRI pit fossa
DEXA scan

14

What other types of tests can be used to assess ovulation?

karyotyping
visual field
autoantibodies

15

What happens in hypothalamic pituitary failure?

Hypogonadotrophic hypogonadism
low levels gonadotrophins
oestrogen deficiency
normal PRL
Amenorrhoea

16

What can cause hypothalamic pituitary failure?

stress
exercise
anorexia
brian tumours
head trauma
Kallman's syndrome
drugs (steroids, opiates)

17

How do you manage hypothalamic anovulation?

Stabilise weight (BMI>19)
pulsatile GnRH if hypog hypog (administer every 90 mins, IV or SC pump worn continuously)
Gonadotrophin daily injections (FSH+LH)
US monitoring for follicle tracking

18

What is hypothalamic pituitary dysfunction?

Normal gonadotrophins
Normal oestragen
Anovulation (oligo/amenorrhoea)
PCOS

19

How is polycystic ovary syndrome diagnosed?

2+ of: oligo/amenorrhoea
polycystic ovaries (USS)
-12/more 2-9mm follicles
-increased ovarian volume >10ml
-uni/bilateral
Clinical +/- biochemicalsigns hyperandrogenism (acne/hirsutism)

20

What is the significance of insuin resistance in PCOS?

hyperinsulinaemia as normal pancreatic reserves compensate
insulin is cogonadotrophin to LH (inc LH, alther LH:FSH)
Insulin lowers SHBG levels, inc testoterone, hyperandrogensim

21

What are the symptoms of PCOS?

subfertility
oligo/amenorrhoea
hirsutism
obesity
acne
alopecia

22

How is PCOS pre treated?

weight loss (BMI

23

How is ovulation induced in PCOS?

*Clomifene citrate (50-100mg tab days 2-6)
Gntrophin therapy (daily injections)
Laparoscopic ovarian diathermy (risk destruction)

24

How can metformin be used to induce ovulation in PCOS?

improves insulin resistance
restores menstruation and ovulation

25

What happens in ovarian failure?

High gonadotrophins
Low oestragen

26

What can cause ovarian failure?

Premature menopause
Turner's syndrome
Autoimmune
pelvic radiotherapy
chemo

27

How is premature ovarian failure defined?

menopause before 40yrs
amenorrhoea
raised FSH >30 x2 samples
Low eostradiol

28

How can premature ovarian failure be treated?

HRT*
assisted conception
cryopreservation

29

How is reduced overain reserved diagnosed?

raised FSH
low Anti Mullerian Hormone (AMH)
reduced antral follicle count on USS

30

What are the risks of stimulating ovulation?

ovarian hyperstimulation
multiple pregnancy
Cancer

31

What are the complications with multiple pregnancy?

miscarriage
HT/preeclampsia
Gestational diabetes
Low birth weight
prematurity
stillbirth

32

What is the definition of infertility?

failure to achieve pregnancy in 12 months unprotected sex with no other reason

33

What is the difference between primary and secondary infertility?

P:never conceived before
S: conceived before (not necessarily successful)

34

What decreases chance of conception?

F >35yrs
No previous pregnancy
More than 3 years trying
intercourse incorrectly timed
F BMI 30
Smoking
Caffeine
Alcohol

35

What are the female causes of infertility?

ovulation failure
endometriosis
tubal damage

36

How does anorexia affect fertility?

low FSH, LH and oestradiol

37

What can cause tubal disease?

Infective (STD, TB, transperitioneal spread, following procedure)
Noninfective (endometriosis, surgical,fibroids, polyps)