Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Essentials - Gynecology > 14. Female infertility > Flashcards

14. Female infertility Flashcards

1
Q

Define: Infertility (1)

A

Inabilityto conceive after 1 yr of regular intercourse without contraception

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Define: Fecundability (1)

A

Probability that a single cycle will result in pregnancy (20%–25%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Define: Fecundity (1)

A

Probability that a single cycle will result in a ive irth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

In women, there is a significant age-related ↓ fertility and ↑ in spontaneous miscarriage largely attributable to what? (2)

A
  • progressive follicular depletion
  • ↑ incidence of abnormalities of aging oocytes.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Infertility affects approximately __% of couples.

A

15%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Female-associated factors account for approximately __% of infertility problems.

A

50%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Male-associated factors contribute significantly to infertility in up to approximately __% of couples.

A

35%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Approximately __% of couples will have “unexplained infertility” (cause is uncertain).

A

10% to 15%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Describe phases and lengths of phases in Menstrual Cycle (4)

A
  • Menstrual phase: 1 to 4 d
  • Follicular phase: 5 to 13 d
  • Ovulation: 14 d
  • Luteal phase: 15 to 28 d
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Name mechanisms of female infertility (3)

A
  • Ovulatory dysfunction (20%–40%)
  • Anatomic abnormality (25%–35%)
  • Other (40% –45%)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Name DDX: Ovulatory dysfunction causes of infertility (6)

A
  • Hypothalamic (hypothalamic disorder 2° to stress, poor diet, or excessive exercise)
  • Pituitary (prolactinoma, medication-induced, hypopituitarism)
  • Polycystic ovary syndrome (PCOS)
  • Primary Ovarian Insufficiency
  • Systemic disease (thyroid dysfunction)
  • Anovulation associated with transition to menopause
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Name DDX Anatomic abnormality causes of infertility: Uterine factors (4)

A
  • Infection (chronic endometritis)
  • Fibroids
  • Congenital anomalies (agenesis, uterine septum, bicornuate uterus)
  • Asherman syndrome
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Name DDX Anatomic abnormality causes of infertility: Cervical factors (3)

A
  • Acidic cervical mucus
  • Antisperm antibodies
  • Structural defects (previous LEEP, cone biopsy, cryo/laser Rx)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Name DDX Anatomic abnormality causes of infertility: Tubal factors (3)

A
  • PID
  • Tubal occlusion (previous ectopic)
  • Tubal adhesions (previous surgery, endometriosis)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Name DDX other causes of infertility (3)

A
  • Endometriosis
  • Multifactorial
  • Unexplained
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Name Lifestyle factors Associated with infertility (5)

A
  • Obesity
  • Smoking
  • EtOHuse
  • Drug use
  • Caffeine
17
Q

Name Risk factors of infertility (6)

A
  • Hx of PID
  • Hx of tubal or pelvic surgery
  • Hx of endometriosis
  • Prev. EP
  • Inutero DES exposure
  • Hx of septic abortion
18
Q

Describe approach of infertility (4)

A
  • Evaluate for male infertility factor
  • Determine whether patient cycles are ovulatory
  • Identify factors that ↑ risk of tubal infertility
  • Examine patient for signs and Sx of endocrinopathy and gynecologic disease
19
Q

Describe Evaluation of Coital Practices (4)

A
  • Sexual dysfunction (dyspareunia, impotence,etc.)
  • Frequency of intercourse
  • Timing of intercourse
  • Use of lubricants
20
Q

Describe: Physician’s Approach to Infertility (4)

A
  • Discuss in a non judgmental manner
  • Full disclosure to patients (make certain patients have full access to relevant information)
  • Identify if certain options lie outside your moral boundaries and refer to another MD if appropriate
  • Protect the patients’ right to freedom of moral choice
21
Q

One year of infertility is not a prerequisite for who? (3)

A
  • All women > 35yr
  • Women with irregular or infrequent menses
  • Women with a Hx of PID or endometriosis
22
Q

Describe HX evaluation: Infertility (10)

A
  • Developmental Hx
  • Coital practices
  • Previous STI
  • Previous infertility
  • Obstetric Hx
  • Past surgical Hx
  • FHx infertility
  • Medications
  • Substance abuse
  • ROS (Sx of hyper PRL, FSH, etc.)
23
Q

Describe HX evaluation: Physical exam (8)

A
  • Breast (Tanner staging, discharge)
  • Sx of hyperandrogenism
  • Speculum and bimanual exam
  • Cervial discharge
  • Uterus/adnexa
  • Tenderness
  • Shape
  • Mobility
24
Q

How to R/O ovulatory dysfunction? (6)

A
  1. Basal body temperature graph
  2. Urinary LH
  3. D3 FSH, LH
  4. D 21-23 serum progesterone
  5. Serum TSH, PRL, 17-OHP
  6. Transvaginal U/S
25
Q

How to R/O structural abnormality? (5)

A
  • Saline infusion sonography
  • Hysterosalpingogram
  • Hysteroscopy
  • Laparoscopy
  • *R/O infection: swab for STI, mycoplasma, ureoplasma
26
Q

Describe: Ovarian reserve (1)

A

the size and quality of the remaining ovarian follicular pool intended to predict future fecundability or provide prognostic information regarding likelihood of successful Rx.

27
Q

How to Consider assessment of ovarian reserve in case of infertility? (4)

A
  • D 3 FSH, estradiol
  • Clomiphene citrate challenge test
  • Antral follicle count (via transvaginal U/S ) (a bnorma l <10)
  • Anti-mullerian hormone (AMH)
28
Q

How to R/O male factor in infertility? (2)

A
  • Semen analysis
  • Physical exam
29
Q

Describe the approach to infertility (Figure)

A
30
Q

Name: Indications for Specialty Referral in Couples Presenting with Female Infertility (7)

A

Factor infertility (gynecologist and/or reproductive endocrinology and infertility specialist):

  • Female with abnormal day 3 FSH and/or estradiol
  • Female with abnormal hysterosalpingogram (HSG) due to:
  • Tubal abnormalities
  • Abnormal intrauterine cavity
  • Women with laparoscopy showing severe pelvic adhesions
  • Women in whom pregnancy fails to occur after surgical Rx of endometriosis
  • Couples desiring IVF and/or other advanced reproductive technologies
31
Q

Describe Management of female factor infertility (7)

A
32
Q

Describe Counsel and education in infertility (5)

A
  • Time intercourse in relation to ovulation (2d before to 2d after)
  • Pre-conceptual use of folic acid (0.4–1.0 mg/d at least 3 mo before conception)
  • Options of: (a) pursue Rx, (b) live child free, or (c) adoption
  • Setting appropriate expectations of Rx (goals, limitations, success rates)
  • Referral to psychologists, support groups etc. as required
33
Q

Describe the management of infertility if: Infection (1)

A

Antibiotics (see STI topic)

34
Q

Describe the management of infertility if: Ovulatory dysfunction (4)

A

Essentials - Gynecology (14 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions