Subfertility + Infertility Flashcards Preview

Toni's Obs and Gynae > Subfertility + Infertility > Flashcards

Flashcards in Subfertility + Infertility Deck (21):
1

What is subfertility?

1 year of regular unprotected sex without conception
1/7 couples affected
Investigate those who do not conceive within 2 years
Primary: woman has never conceived
Secondary: woman has previously conceived

2

Premature ovarian failure

Low/ normal oestradiol despite high LH + FSH

3

PCOS
Aka Stein-Leventhal

Hypersecretion insulin -> GNRH -> incr LH -> incr ovarian androgen release -> less SHBG produced by liver
Rx: weight loss, clomiphene (incr FSH prod -> induces ovulation)

4

Risks of PCOS

More susceptible to:
DM
Endometrial cancer
Dyslipidaemia

5

Hypogonadotrophic hypogonadism

Failure of anterior pituitary to secrete LH + FSH = no ovulation
Secondary hypogonadism as gonads may have normal function
Hypo-oestrogenic sx

6

Secondary Amenorrhoea

Absence of menses for 6 months in prev menstruating woman
Gonadal failure: premature ovarian failure
Pituitary dysfunction: pit tumour
Psych causes: stress, travel, weight changes can reduce GNRH
Endocrine dysfunction: hypothyroidism
Dysfunctional oestrogen metabolism: anorexia nervosa

7

Prolactinoma

One of the commonest pituitary tumours
Excess prolactin inhibits gonadotropin release
Ix: MRI
Rx: dopamine agonists= bromocriptine

8

Hypothyroidism

Screen for all woman with irreg menses
Low T4 reduces negative feedback= elevated prolactin + TSH
Inhibits gonadotrophin release

9

Anorexia nervosa

Less adipose tissue
Where androgens are usually converted to oestrogens
Lower circulating levels of active oestradiol

10

Turners syndrome

45 X0 1/2500
Ovaries don't respond to gonadotrophin hormones
Almost universal infertility
Primary amenorrhoea + high FSH = karyotype to rule out Turners

11

Mullerian Agenesis
Aka Mayer-Rokitansky-Kuster-Hauser syndrome

46 XX 1/4500
Embryonic mullein ducts fail to develop
Congenital absence of uterus, cervix, upper 2/3 vagina
Normal ext genitalia, secondary sexual characteristics (ovaries intact)
Psych support and surgery for neovagina to allow intercourse

12

Lap and dye

Gold standard for tubal patency
Laparotomy = direct view, under general
Methylene blue injected into uterus via cervix
Patent =blue dye leaks from fimbrial ends of tubes
Hysteroscopy oft performed at same time

13

Hysterosalpingogram

Radio-opaque fluid into uterine cavity via cervix
X-Rays taken
Normal :radio opaque fluid leak from ends of tube
Normal: 97% correct
Abnormal: 34% correct -> lap and dye req to confirm
Avoids risk of surgery and anaesthetic, outpatient procedure

14

Salpingoscopy

Salpingoscope inserted into ampullary portion of Fallopian tube at laparoscopy to investigate fine intramural adhesions

15

Asthenospermia

Poorly motile sperm

16

Azoospermia

Complete absence of sperm - testicular failure

17

Oligospermia

Reduced sperm count of normal appearance

18

Teratospermia

Morphologically defective

19

Leucospermia

Infection

20

Sperm analysis

Two analyses needed 3 months apart
(3 months for spermatogenesis)
Production
Function
Delivery
Tested

21

Normal values in semen analysis

Vol: >2ml
pH: 7-8
Conc: >20 x 10^6/ml
Motility: >50% forward, >25% rapid linear progress
Morphology: >15% normal
Alive: >50%
Negative for antisperm antibodies
WCC: