reproductive medicine Flashcards by Vincent Ng

what are the 3 main factors which influence fertility

healthy sperm
healthy fallopian tube
healthy menstrual cycle - ovulation + endometrium

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how common is sub-fertility?

1 in 6 women

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what are the different causes of infertility

anovulatory infertility - 30% 
malefactor - 35% 
tubal disease - 25% 
endometriosis - 5% 
unexplained 15%

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what are some pre-conception advise for women who want to get pregnant

stop smoking
no alcohol intake
BMI < 19 and > 30 can impact the fertility
age

occupational hazards
recreational drugs

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what are some pre-conception advise for men who want to get pregnant

stop smoking 
BMI > 30 will impact fertility 
3-4 units of alcohol per week 
loose-fitting underwear 
inc scrotal temp - dec fertility

occupational hazards
recreational drugs

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what vitamin should be given pre-conceptions?

folic acid - 0.4mg/day
- 5mg/day

vitamin D - 10mcg/day

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in what situation will you give 5mg of folic acid per day?

if previous children/personal/FH of neural tube defect

if DM T1/2

If BMI > 30

coeliac disease

if carrier/suffer of haemoglobinopathies eg thalassemia tract

antifolate drugs

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when will you consider a referral to reproductive medicine

when the couple has been trying for at least 1 year with sexual intercourse every 2-3 days or other reasons eg

- female age > 35 
know fertility problem 
- anovulatory cycles 
- severe endometriosis 
- previous PID 
- malignancy

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what are some anovulatory disease that can cause infertility

Brain

hypothalamic hypogondaism (due to anorexia, stress, exercise)
hyperprolactinaemia (pituitary damage or tumour)

thyroid
- hypo/hyperthyroidism

adrenal hyperplasia

ovaries
- PCOS, premature ovarian insufficiency

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what can be an indication of prolactinoma

visual field defect

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what are some of the management of subfertility

1 - clomifene - encourage ovulation
2 - gonodatrophin - used when FSH is normal and clomifene resistance PCOS
3 - laproscopic ovarian diathermy - destroy part of the ovary to release an egg
4 - insulin sensitizer - used in PCOS/weight loss more effectie
5 - surgery - treat any adhesion, tubal damage, assisted pregnancy

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what is the WHO classification of anovulatory infertility

3 different groups

Group 1 - hypothalamic pituitary failure - brain
Group 2 - hypothalamic-pituitary-ovarian dysfunction (PCOS)
Group 3 - ovarian failure (premature ovarian insufficiency)

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what is a primary ovarian failure

the patient was never able to conceive ever

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what is a secondary ovarian failure

the patient previously conceived but not able anymore

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what are some causes to primary ovarian failure

premature ovarian failure 
genetic 
turner's syndrome 
autoimmune 
iatrogenic - surgery/chemo

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what are some causes to secondary ovarian failure

PCOS
excessive weight loss or exercise
hypopituitarism - tumour, surgery, trauma
hyperprolactinaemia

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what is the effect of prolactin in the body

acts on the breast for lactation

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what is the effect of prolactin in the hypothalamus

prolactin causes -ve feedback on the thalamus

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what are the diagnostic criteria of premature ovarian failure

oligo/amenorrhoea for >4 m

elevated FSH > 25 IU/L > 4 wks apart

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what is the mean menopausal age in the UK?

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what age is considered to be pre-term menopause

<40

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what age is considered to be premature menopause

40-45

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how common is POI

1% of women < 40

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what is the classical hormonal pictures of POI

oestrogen and inhibin are both low

FSH is elevated

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what is the main P/C of POI?

amenorrhoea/oligomenorrhoea difficulty conceiving menopausal symptoms

what are the managements of POI?

as there are only a few ovum left and so oocyte donation is the only viable way to get pregnancy not other proven ways to increase the responsiveness of the oocytes

what is nidation

it is the process which the cilia is wafting the ovum/embryo down to the endometrium

what are some causes to tubal damages?

infection - chlamydia endometriosis surgery - adhesion

what are some examples of surgical damages that can cause tubal damages?

TOP - adhesion and retention of the conception material

what can be done to improve the chance of pregnancy in women who have endometriosis

surgery to remove extra-endometrial material

what are some investigations that can be done to check for tubal patency

hysterosalpingogram - radioactive dye injected into the endometrium and X-ray taken to see patency Hysterosalpingo-contrast-ultrasonography - alternative to HSG and no radiation since USS laparoscopy with dye - gold standard, can diagnose pathology and treatment

what are the risk/SE of HSG and Hysterosalpingo-contrast-ultrasonography

can be uncomfortable can cause spasm of the fallopian tube - false +ve but general good specificity and sensitivity

what is the risk of laparoscopy with dye in detecting tubal defect

general anaesthesia risks and surgical risks

what are included in the semen analysis

``` volume total sperm count concentration of sperm vitality progressive motility total motility normal morphology ```

what are some causes to male factor infertility

``` idiopathic (most common) genetic hypogonadism testies trauma/surgery/developmental abnor obstructive anabolic induced previous chemo/radio ```

what is the treatment for male factor infertility if sperm present in the ejaculation

ICSI

what is the treatment for male factor infertility if sperm absent in the ejaculation

sperm donor or surgical retrieval of sperm

what is ART

assisted reproductive technolgies

what does ART include

any fertility treatments in which sperm and oocytes are handled with the aim for pregnancy IVF, ICSI, IUI, PGD, egg donation and surrogacy

what does IUI stand for?

Intra-uterine injection

what does IVF stand for?

in-vitro fertilisation

what does ICSI stand for?

Intra-cytoplasmic sperm injection

what does PGD stand for?

pre-implantation genetic diagnosis

what is the best mode of ART for male factor infertility

ICSI

what is the best mode of ART for tubal damage

IVF

what are the indications of IVF

``` tubal damage endometriosis anovulation male factor subfertility reduced fertility with inc maternal age ```

what are depending factors of successful IVF

``` duration of subfertility age elevated FSH previous pregnancy previous failed IVF presence of hydrosalpinx and intramural fibroids smoking and inc BMI ```

what is the procedure of IVF

1) FSH given to stimulate he releases of eggss 2) HCG given to help mature egss 3) needle guide aspiration 4) sperm collected and place in the same ditch as eggs for fertilisation - Day 0 5) Day 1 - check to see if fertilisation has taken place or not 6) leave to mature further until Day 5 7) selected embryo is re-inserted back into the endometrium + luteal support by progesterone 8) pregnancy test 2 weeks after

how many embryos are given in a single circle of IVF

max 2

what do you do with the already fertilised embryo

can freeze them for later

what is the difference between IVF and ICSI

IVF simply place the sperms near egss ICSI insert sperms directly into eggs

what single test should be performed before ICSI being carried out?

karyotype for CF

what is IUI

intra-uterine insemination - placing sperms inside the womb of women

when is IUI considered

usually lesbian couple

what are some side effect of ART

egg collection - intra-peritoneal haemorrhage and pelvic infection pregnancy complications - inc multiple pregnancies, rate of ectopic pregnancy are also higher genetic - chromosomal and gene abnor associated with inc risk in ICSI mental wellbeing superovulation - multiple pregnancies and ovarian hyper-stimulation

what is ovarian hyperstimulation syndrome

complications of ovulation induction or superovulation leading to vEGF over-expression

what are some of the symptoms of ovarian hyperstimulation syndrome

``` abdo pain bloating N+V inc ovarian sizes ascites ```

what is the classical picture of OHSS

inc ovarian size fluid shift from intra to extracellular compartment to abdo and pleural spaces intravascular fluid depletion - hypercoagulopathy, haemoconcentration

RF for OHSS

PCOS low BMI previous OHSS

management of OHSS

symptomatic relief prevention of haemoconcentration and thromboembolism maintenance of cardiorespiratory function paracentesis for ascite consider heparin for thrombophylaxis

reproductive medicine Flashcards

(60 cards)