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Urogenital System > 14.Management and Treatment of the Infertile Couple > Flashcards

14.Management and Treatment of the Infertile Couple Flashcards

1
Q

What is the definition of Primary Infertility

A

The inability to conceive, despite regular unprotected sexual intercourse for 1 year

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2
Q

What is the definition of Secondary Infertility

A

The inability to conceive having had at least one pregnancy despite regular unprotected sexual intercourse for 1 year

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3
Q

What percentage of couples in any population, is infertile?

A

8-10%

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4
Q

What is the most common cause of infertility in women in sub-Saharan Africa?

A

Bilateral tubal occlusion

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5
Q

What is the most common cause of infertility in women in developed countries

A

No demonstrable cause

-Then ovulatory disorders

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6
Q

What percentage of infertile couples is caused by infertility in the female only in Sub-Saharan Africa

A

31%

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7
Q

What percentage of infertile couples is caused by infertility in the male only in Sub-Saharan Africa

A

22%

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8
Q

What percentage of infertile couples is caused by infertility in both partners in Sub-Saharan Africa

A

21%

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9
Q

What percentage of infertile couples is caused by infertility in the female only in developed countries

A

37%

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10
Q

What percentage of infertile couples is caused by infertility in the male only in developed countries

A

8%

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11
Q

What percentage of infertile couples is caused by infertility in both partners in developed countries

A

35%

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12
Q

What are the four steps in the clinical management of the infertile couple

A

History
Examination
Investigations
Treatment

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13
Q

What are five details taken when taking the history of the partners in an infertile couple

A

There is no substitute for a thorough history from both individuals
If they attend together, examine separately and ask about STI and undeclared pregnancies
Look for development of secondary sexual characteristics
Look for features of endocrine disorders
Examine the reproductive organs

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14
Q

When taking the he history of the ovarian cycle, list five aspects

A

Regular cycle?
Cervical mucous cascade
Moliminal(premenstrual) symptoms
Spasmodic dysmenorrhea

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15
Q

What is the examined when doing the Examination of the female half of the infertile couple

A 
BMI
Hair distribution 
Thyroid
Breasts
Vaginal/Pelvic Exam
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16
Q

In the examination for Hirsutism, which 11 sites are examined

A 
Upper lip
Chin
Chest
Upper back
Lower back
Upper abdomen 
Lower abdomen
Forearm 
Arms
Legs
Thighs
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17
Q

What is the grade scale for Hirsutism

A

A scale from 1 to 4, 1 being a few hairs and four being heavy hair growth

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18
Q

What is the purpose of the Hirsutism scoring system

A

It allows initial assessment and facilities comparison whilst on treatment

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19
Q

List six social issues that can be contributing factors to infertility

A 
Smoking
Alcohol
STI
Obesity
Occupation Exposure to heat 
Cell phones
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20
Q

To make a diagnosis at a PRIMARY care level, which 3 assessments/ tests are done

A

Test of ovulation
Tubal patency
Semen analysis

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21
Q

Which tests are performed at the SECONDARY and TERTIARY level when making a specific diagnose for infertility

A 
Trans vaginal ultrasound 
Laparoscopy 
Hysteroscopy
Endocrine anovulation work up
Chromosomes
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22
Q

List 4 tests of Ovulation

A

Mid - Luteal (Day21) Progesterone level
Urinary LH
Serial T/V Ultrasound follicle scan
Basal body temperature

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23
Q

To diagnose Tubal Patency which tests are done

A

Hysterosalpingogram HSG

Laparoscopy and dye insufflation

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24
Q

List four male factors for infertility

A

Azoospermia
Oligozoospermia
Asthenozoospermia
Teratozoospermia

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25
Define teratospermia/teratozoospermia
Defined as abnormal sperm morphology (shape)
26
Defined as abnormal sperm morphology (shape)
Teratozoospermia
27
Define asthenozoospemia
Reduced sperm motility
28
Reduced sperm motility
Asthenozoospermia
29
Define Oligozoospermia
Low sperm count
30
Low sperm count
Oligozoospermia
31
How is the Semenanalysis collected at the HWFMU
By appointment Abstain for 2 days after compulsory ejaculation Masturbation collection in a private secluded room 24 hour test
32
``` Diagnose the cause of infertility in this male: Volume 3.5mls Liquefaction: Complete Viscosity: Normal Sperm Count: 7M/ml Motility: 72% Progression 1.5 ```
Oligospermic Sperm Count is low (<20M/ml)
33
What are three surgical processes for sperm removal
PESA: Percutaneous Epididymal Sperm Aspiration TESA: Testicular Sperm Aspiration TESE: Testicular Sperm Extraction
34
List five steps in Counseling and Emotional Support for the infertile couple
``` Education on human fertility in general Their diagnosis in particular Treatment options Success rate Adoption ```
35
What advice would you give to the infertile male who drinks and smokes
Stop smoking <3-4 units of alcohol/week
36
What is the treatment for erectile dysfunction
Viagra | Psychotherapy
37
What is the treatment for women who do not produce ova but which to become pregnant
Clomiphene
38
What are two types of Artificial Insemination
Artificial Insemination by Husband (AIH) | Artificial Insemination by Donor (DI)
39
What are three treatment methods for fertility with an infertile male
Artificial Insemination Intrauterine Insemination Assisted Conception
40
What are the treatment methods for the infertile female with amenorrhea
Treatment directed at the cause | E.G. Bromocriptine for hyperlactinaemia
41
What are the treatment methods for the infertile female with tubal occlusion
Surgery vs In Vitro Fertilization IVF
42
What are the treatment methods for the infertile female with Endometriosis
Medical and surgical treatment
43
What five treatments can be used for the Induction of ovulation
``` Clomiphene Citrate Letrozole hMG,human menopausal gonadotrophin Pure FSH GnRH agonists ```
44
What are the steps to induction of ovulation for Oligo-amenorrhea
Clomiphene citrate 50-100mg od po x 5days , from day 5-9 of the cycle Serial ultrasound - track follicle growth Trigger ovulation with injection of hCG
45
What is the treatment for the female with ovarian failure
Oocyte donation
46
What is the treatment for the infertile female with hyperprolactinaemia
Dopamine agonist | Neurosurgical ablation
47
What is the treatment for the infertile female with Polycystic Ovarian Syndrome, PCOS
Metformin, clomiphene,ovarian endocoagulation
48
Describe the process of Intrauterine Insemination
Ovulation induction with ultrasound monitoring | Washed sperm instilled in the uterine cavity on the day of ovulation
49
Describe In Vitro Fertilization (IVF)
Fertilization in a glass dish
50
Define In vivo fertilizartion
Occurs in the fallopian tube
51
List 8 indications for In-Vitro Fertilization (IVF)
``` Tubal Factors Endometriosis Cervical factors Immunological causes Offspring of women treated with DES Male infertility Multifactorial infertility Unexplained infertility ```
52
List two examples of Tubal factors that are indications for in Vitro Fertilization
Irreversible tubal damage | Failed tubal surgery
53
List two examples of Endometriosis that are indications for in Vitro Fertilization
If no pregnancy after medical or surgical treatment Oocyte recovery rate is lower with persistent stage III or IV organs After resection ovarian function may be altered
54
List two examples of Cervical Factors that are indications for in Vitro Fertilization
Sperm fail to penetrate mucous
55
List two examples of immunological causes that are indications for in Vitro Fertilization
Anti-sperm antibodies
56
List two examples of male infertility that are indications for in Vitro Fertilization
Azoospermia amenable to treatment with intracytoplasmic sperm injection
57
What are five indications for Oocyte donation
``` Premature menopause Chemotherapy induced ovarian failure Autoimmune Ovarian Failure Physically inaccessible ovaries Autosomal dominant or sex linked disorders ```
58
What is the criteria for In Vitro Fertilization
Patients less than 40 (Over 40 have poor results with increased abortion rates) Normal FSH Ovulation spontaneous or readily induced Good health (mental and physical)
59
In vitro fertilization IVF steps
Parenteral induction of ovulation Oocyte retrieval In vitro fertilization Embryo transfer
60
How many embryos are implanted in the uterus in in vitro fertilization
3
61
What is the take home baby rate of in vitro fertilization
12-15%
62
List three other techniques for Artificial Pregnancy
Gamete Intra Fallopian Transfer Zygote Intra Fallopian Transfer PROnuclear Stage Oocyte Transfer

Urogenital System (17 decks)

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