Subfertility Flashcards
(31 cards)
Which drug is used for ovarian stimulation for IVF?
FSH or HCG
What is the chief inflammatory factor responsible for OHSS?
Vascular Endothelial Growth Factor (VEGF)
What is the typical percentage loss of calculated blood volume in the acute phase of severe OHSS?
20%
What is the combined incidence of moderate to severe OHSS (give a range)
3.1-8%
What are the risk factors for OHSS?
Previous history of OHSS
PCOS
high antral follicle count
Elevated anti-Mullerian hormone
When do early and late OHSS present?
Early OHSS presents typically within the first 7 days
Late OHSS presents typically 10 or more days after the HCG injection
Which laboratory markers are typical of OHSS?
Elevated haematocrit
Reduced serum osmolality
Reduced serum sodium
Which two symptoms are usually not indicative of OHSS and should prompt investigation for alternate pathologies in women undergoing IVF?
Severe abdominal pain
Fever
What are the features used to give a grade of mild OHSS?
Abdominal bloating
Mild abdominal pain
Ovarian size <8cm
What are the features used to give a grade of moderate OHSS?
Moderate abdominal pain
Nausea and vomiting
Ultrasound evidence of ascites
Ovarian size usually 8-12cm
What are the features used to give a grade of severe OHSS?
Clinical ascites +/- hydrothorax
Oliguria
Haematocrit >0.45
Hyponatraemia
Hypo-osmolality
Hyperkalaemia
Hypoproteinaemia (Alb <35)
Ovarian size usually >12cm
What are the features used to give a grade of critical OHSS?
Tense ascites
Haematocrit >0.55
WCC >25
Oligo/anuria
Thromboembolism
ARDS
How should ascites in OHSS be managed?
Transvaginal paracentesis
What condition should you be suspicious of in a woman with dizziness, loss of vision and neck pain following IVF?
Vertebral artery thrombosis (thromboses in OHSS often presents in upper limb arteries)
What obstetric conditions are more common following OHSS?
Pre-eclampsia
Preterm birth
What is the chance of a couple with unexplained subfertility conceiving with 12 months of expectant management?
74%
Generally speaking, what defines hypogonadotropic hypogonadism?
Pituitary or hypothalamic hypogonadism
What are the genetic causes of hypogonadotropic hypogonadism?
Kallmann syndrome (also causes anosmia)
Prader Willi syndrome
What happens to FSH in hypogonadotropic hypogonadism?
FSH decreases
What happens to FSH in hypergonadotropic hypogonadism?
FSH increases
What are the causes of hypergonadotropic hypogonadism?
Kleinefelters
Noonans
Cryptorchidism
Varicocele
Chemotherapy
What is the normal range for semen volume?
> = 1.5ml
What is the normal semen pH?
> =7.2
What is the minimum normal sperm concentration?
> = 15 million sperm/ml
