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cOGtext > Subfertility > Flashcards

Subfertility Flashcards

1
Q

infertility is defined as failure to achieve a clinical pregnancy after how long?

A

12 months

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2
Q

define primary infertility

A

infertility occurring in a couple who have never previously conceived

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3
Q

define secondary infertility

A

infertility occurring in a couple who have previously conceived

NB this includes pregnancies that did not result in a live birth e.g ectopic/miscarriage

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4
Q

where does spermatogenesis occur?

A

the seminiferous tubules

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5
Q

where in the male reproductive system does storage and maturation of sperm occur?

A

epididymis

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6
Q

spermatozoa pass from the ______ to the ____ ______ to the _______ where it joins the ____ _______ to form the _______ _____

A

from the epididymis to the vas deferens to the bladder where it joins the seminal vesicle to form the ejaculatory duct

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7
Q

what is the function of the bulbourethral gland?

A

produces and releases fluid which lubricates the urethra and neutralises any acidity prior to ejaculation

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8
Q

what is the function of the seminal vesicle?

A

produces and releases the majority of seminal fluid (this contains fructose, prostaglandins and fibrinogens)

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9
Q

GnRH stimulates the ____ pituitary to release which two hormones?

A

anterior pituitary

  1. LH
  2. FSH
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10
Q

LH stimulates testosterone secretion from what cells?

A

Leydig cells

L for LH
L for Leydig

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11
Q

inhibin is released from what cells in males?

A

sertoli cells

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12
Q

causes for male factor infertility can be broken down into three categories, what are they?

A

idiopathic
obstructive
non-obstructive

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13
Q

give an example of an obstructive cause of male infertility

A

cystic fibrosis (obstruction/absence of vas deferens)

vasectomy

testicular tumour

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14
Q

what would LH, FSH and testosterone levels be like in obstructive male infertility

A

NORMAL

no endocrinological issue, only obstruction

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15
Q

give an example of a non-obstructive cause of male factor infertility

A

cryptorchidism

klinefelter’s

Y chromosome microdeletion

robertsonian translocation

infection eg mumps, STIs

testicular tumour (can alter testosterone levels)

endocrine e.g pituitary tumours, hypothalamic disorders, thyroid disorders, diabetes, congenital adrenal hyperplasia

globozoospermia

sexual abuse

steroid abuse

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16
Q

what is the karyotype in klinefelter’s syndrome?

A

47 XXY

extra X chromosome

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17
Q

what is the phenotype of klinefelter’s syndrome?

A
  • slight developmental delay
  • reduced facial hair
  • poor muscle tone
  • gynaecomastia
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18
Q

LH, FSH and testosterone levels will be high/low in pituitary and hypothalamic disorders

A

low

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19
Q

define cryptorchidism

A

one or both testes being undescended into the dependant part of the scrotal sac

NB testes usually descended ~6-9 months

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20
Q

why does cryptorchidism cause male factor infertility

A

undescended testes will not be at the ideal temperature for spermatogenesis (2-4 degrees C)

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21
Q

which babies are most at risk of cryptorchidism?

A
  • premature babies (<37 weeks)
  • low birth weight
  • small for gestatinal age
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22
Q

what will LH, FSH and testosterone levels be like in non-obstructive infertility?

A

high LH and FSH

low testosterone

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23
Q

female factor infertility can be split into two categories, what are these?

A

anovulatory

tubal

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24
Q

conditions causing anovulatory infertility may originate in which three areas?

A

hypothalamus
pituitary gland
ovary

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25
Q

give an example of a hypothalamic cause of female factor infertility?

A

anorexia
bulimia
excessive exercise

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26
Q

give an example of a pituitary cause of female factor infertility

A

hyperprolactinaemia (high prolactin suppresses LH/FSH)

sheehan syndrome (post-partum hypopituitarism)

pituitary adenomas (cause anovulation)

27
Q

give an example of an ovarian cause for female factor infertility

A

PCOS

premature ovarian failure

28
Q

what triad of symptoms are present in PCOS?

A

anovulation
polycystic ovaries on USS
hyperandrogenism

29
Q

what are features of hyperandrogenism?

A

weight gain
acne
hair loss
anovulation

30
Q

why do people with PCOS not release an egg at the time of ovulation?

A

overproduction of oestrogen by the ovary to compensate for high testosterone levels

NB testosterone can also impair ovum quality

31
Q

LH will be high/low, in PCOS

A

high

32
Q

failure of the ovary to produce oestrogen and healthy ova earlier than normal is called…

A

premature ovarian failure

33
Q

how does premature ovarian failure present?

A

hot flushes
night sweats
atrophic vaginitis
oligo/amenorrhoea

34
Q

LH will be high/low, FSH will be high/low and oestradiol will be high/low in premature ovarian failure

A

high LH
high FSH
low oestradiol

35
Q

give an infective cause of tubal disease

A
  • pelvic inflammatory disease (PID)
  • transperitoneal spread of infection eg appendicitis
  • iatrogenic e.g after IUD insertion
36
Q

give a non-infective cause of tubal disease

A
  • endometriosis
  • salpingitis isthmica nodosa (scarring of the fallopian tube)
  • uterine polyps
  • fibroids
37
Q

what previous infections should be asked about in an infertility history?

A 
previous:
STIs
pelvic inflammation
mumps
epididymo-orchitis
38
Q

what environmental risk factors should be asked about in an infertility history?

A

previous:
radiotherapy exposure
pesticide exposure
excessive heat on the testes

39
Q

first line investigations for infertility in women

A
  • swab for chlamydia
  • smear test (only if due)
  • transvaginal USS
  • midluteal progesterone (used to confirm ovulation)
  • serum progesterone (if irregular menstrual cycles)
  • serum LH/FSH (if irregular menstrual cycles)
40
Q

first line investigations for infertility in men

A

semen sample for semen analysis

endocrine profile

41
Q

first line investigation for tubal patency in patients with possible tubal disease or previous pelvic pathology

A

laparoscopy

42
Q

first line investigation for tubal patency in patients with no known risk factors for tubal/pelvic disease

A

hysterosalpingogram

43
Q

name a second-line investigation for infertility in a female

A

chromosome analysis eg if amenorrhoeic

hysteroscopy if suspected endometrial pathology

44
Q

name a second-line investigation for infertility in a male

A

scrotal ultrasound if abnormality detected on scrotal USS

45
Q

nationally eligible patients are offered up to __ cycles of assisted conception treatment

A

3

46
Q

BMI of the female partner must be above ___ and below ___

A

above 18.5 and below 30

47
Q

fresh cycles of treatment must be initiated by the date of the female partner’s __th birthday

A

40

48
Q

what supplement should be taken in women conceiving through assisted conception methods before and during pregnancy?

A

folic acid

49
Q

couples must have been co-habiting in a stable relationship for a minimum of __ years

A

2

50
Q

what type of ACT is this?

directly placing the sperm inside the uterus to facilitate fertilisation at the time of ovulation

A

intrauterine insemination (IUI)

51
Q

when would someone not be a candidate for IUI?

A

not ovulating
tubal disease
low quality sperm

52
Q

which ACT is best for couples with sexual dysfunction disorders such as erectile dysfunction?

A

intrauterine insemination (IUI)

53
Q

what type of ACT is this?

a number of sperm are placed into a petri dish with an oocyte. the successful sperm fertilises the ovum, creating a zygote.

A

IVF

54
Q

what type of ACT is this?

one sperm cell is immobilised and injected directly into the cytoplasm of the oocyte.

A

intra-cytoplasmic sperm injection (ICSI)

55
Q

what ACT is best for patients with severe male factor infertility?

A

ICSI as it bypasses stages of the sperm travelling to the ovum, undergoing capacitation etc

56
Q

which ACT is best for tubal disease?

A

IVF

57
Q

which ACT is best for unexplained infertility?

A

IVF

58
Q

unexplained infertility is infertility that lasts >_ years without a known cause

A

2

59
Q

1st and 2nd line ACT options for patients with anovulatory infertility

A
  1. ovulation induction

2. IVF

60
Q

how is ovulation induction done (hint: there are 3 steps)

A
  1. GnRH injection to induce follicular development and thicken the uterus for implantation. it also stops the LH surge which prevents the egg being released too early
  2. USS to assess the ovary and endometrium to plan timing of step 3
  3. HCG injection to stimulate the final stage of maturation of the oocytes
61
Q

embryo transfer occurs on day __

A

5

NB normally only 1 embryo is transferred

62
Q

what causes ovarian hyperstimulation syndrome?

A

medications used for ovarian stimulation such as GnRH and HCG injections cause large numbers of follicles to grow -> HIGH oestradiol levels -> release of inflammatory markers -> fluid shift from within the blood vessels to the third compartment

63
Q

name a symptom of ovarian hyperstimulation syndrome

A 
abdominal distension (due to third spacing of fluid)
nausea and vomiting

cOGtext (11 decks)

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