w5 - assessment of infertility

Question 1

definition of infertility

Answer 1

failure to achieve a clinical preg after 12months in absence of known reason, in a coupleless couple

Question 2

primary infertility

Answer 2

couple never conceived

Question 3

secondary infert

Answer 3

previously conceived (altho preg may hve been shite)

Question 4

what causes a poor prognosis in infertility

Answer 4

if male infertile
endometriosis
tubal factor infertility

Question 5

anovulatory infertility is infertility due to lack of ovulation, give some conditions causing

Answer 5

hypothalami: anorexia/bulimia, excessive exercise
pit: hyperprolactinaemia, tumour, sheehan syndrome
ovarian: PCOS, premature ovarian failure

OThers: chronic renal failure, testost. secreting tumours, congenital adrenal hyperplasia

drugs - depo-provera, explanon, OCP

Question 6

clinical + endo features of anorexia

Answer 6

clin

• <18.5 |BMI
• loss of hair
• incr lanugo
• low pulse + BP
• anaemia

endo
-red FSH, LH and oestradiol

Question 7

what is polycystic ovary syndrome

Answer 7

too much androgen
leads to obesity, hirsutism/acne, cycle abnormalities, infertility
endo - high andro, high lH, impaired glucose tolerance

Question 8

diagnosis of PCOS iss a score 2/3 of

Answer 8

chronic anovulation
polycystic ovaries
hyperandrogenism

Question 9

PCOS is an inherited condition, what exacerbates it

Answer 9

weighr gain

Question 10

commonest endo disorder i nwomen

Answer 10

PCOS

Question 11

premature ovarian faiilure is the loss of ovarian function before 40. what is the causes

Answer 11

idiopathic 
genetic (turneers, fragile X) 
chemo 
radiotherapy
oophorectomy

Question 12

clinical/endo features of POF

Answer 12

hot flushes
night sweats
atrophic vaginitis

high FSH
high LH
low oestradiol

Question 13

tubal disease is a umbrella term for infection of female genital tract (endotetrisis, salpingitis, oophoritis, parametritis, tubo-ovarian abcess and peritonitis)

what are the infective causes

Answer 13

pelvic inflam disease (chlamydia, gonorrheoea, anaeorobes, syphilis, TB

transperitoneal spread
-appendicitis/intra-ab abscess

post procedure:
IUCD, insertion hysteroscopy, HSG

Question 14

non-infective causes of tubal disease

Answer 14

endometriosis 
surgical (sterilisation/ectopic preg) 
fibroids
polyps 
congenital 
salpingitis isthmica nodusa

Question 15

Clinical Features: abdominal/pelvic pain febrile
vaginal discharge dyspareunia
cervical excitation menorrhagia
dysmenorrhoea
infertility
ectopic pregnancy

these are the clinical features of __ due to pelvic inflam diseae

define

Answer 15

hydrosalpinx

distally blocked fallopian tube filled with serous or clear fluid. The blocked tube may become substantially distended giving the tube a characteristic sausage-like or retort-like shape.

Question 16

endometriosis define

Answer 16

presence of endometrial glands outside uterine cavity

Question 17

aetiology of endometriosis

Answer 17

retrogade menstruation
altered iimmune function
abnor cellular adhesion molecules
genetic also

Question 18

clinical features of endometiriosis

Answer 18

dysmenorrhoea (perior pain) (classically before menstruation), dysparenuia (sore sex)
, menorrhagia (heavy period)
painful defaecation,
chronic pelvic pain, uterus may be fixed and retroverted,

Question 19

for endometriosis, scan may show characteristic __ ___ on ovary, infertility, asymptomatic

Answer 19

chocolate cysts

Question 20

non-obstructive male infertility causes and features

Answer 20

causes

• chemo
• radio
• undescended testes
• idiopathic

clin feats

• low test. volume (orchidometer used to measure)
• reduced 2ndary sexual characteristics
• vas deferens present

endo feats

• high LH
• high FSH
• low Testosterone

Question 21

oestradiol is a hormone, function

Answer 21

main producer of oestrogen

Question 22

3 causes of obstructive male infertility

Answer 22

congental abscen (Cystic Fibrosis)
infection
vasectomy

Question 23

features of obstructive male inferl

Answer 23

norm testie volume (orchidometer)
normal 2ndary sexual characteristics
vas defs may be absent

endo
normal LH, FSH and testosterone

Question 24

key areas to cover in history for investigating infertility

Answer 24

infertility history 
gynaecology 
andrology 
sex history 
social
PMH 
surgical history 
prev ocular history

Question 25

examination of female for infertility includes

Answer 25

``` BMI gen exam body hair galactorrhoea pelvic exam, assess uterine and ovarian abnormalities ```

Question 26

examination of male for infertility

Answer 26

BMI gen exam genital - size/position of testes, penile abnorms, presence vas deferences presence varicoceles (enlargement of teste veins

Question 27

tests for female inf.

Answer 27

endocervical swab for chlamydia cervical smear if due blood for rubella immunity midluteal progesterone level (day 21 of 28 day cycle or 7 days prior to expected period in prolonged cycles), progesterone > 30nmol/l suggestive ovulation Test of tubal patency: hysterosalpingiogram or laparoscopy Others if indicated: e.g. hysteroscopy, ultrasound scan, endocrine profile and chromosomes

Question 28

a hysterosalpingiogram is used for

Answer 28

tubal patency

Question 29

when is hysteroscopy performed

Answer 29

suspected endometrial pathology (uterine septm, adhesions, polyp)

Question 30

patient with anovulatory cycle (or infrequent periods), what should be tested

Answer 30

``` urine HCG prolactin TSH sex- testosterone, sex hormone binding globulin pit - LH,FSH and oestradiol ```

Question 31

if hirsute present, 2 things that shd be measured

Answer 31

Testosterone | Sex hormone binding globulin (SHBG)

Question 32

aabnormal semen analysis, shd test 5

Answer 32

``` LH FSH testosterone prolactin thyroid ```

Question 33

patient with sev. abnormal semen analysis/azoospermic, other assessments required

Answer 33

``` endo profile chromo analysis Y chromsome microdeletions screen - cystic fibrosis testicular biopsy ```

Question 34

abnormality on genital examination shd lead to

Answer 34

scrotal US