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ENDOCRINOLOGY > 1b Infertility > Flashcards

1b Infertility Flashcards

1
Q

What is Infertility?

A

A disease of the reproductive system defined by the failure to achieve a clinical
pregnancy after ≥12 months of regular unprotected sexual intercourse.

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2
Q

What is primary infertility?

A

not had a live birth previously

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3
Q

What is secondary infertility?

A

Had a live birth over 12 months ago

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4
Q

What is the most common cause on infertility?

A

Combined Male and Female Factors

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5
Q

Cost of infertility to the couple:

A
  • No biological child
  • Impact on couples wellbeing
  • Impact on larger family
  • Treatments and Investigations (which often fail = more distress)
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6
Q

What is the cost of infertility to society?

A
  • Less births
  • Less tax income
  • Investigation costs
  • Treatment costs
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7
Q

What are the pre-testicular causes of infertility? - MALE

A

Endocrinopathies eg Klinefelter 47XXY
Issues with HPG Axis, T, PRL

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8
Q

What is cryptochordism?

A

Undescended testis - testis start embryologically in the inguinal canal, therefore undescended means they are left there

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9
Q

What toxins can cause infertility?

A

Chemo, Toxins, Drugs, Smoking

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10
Q

What are the testicular causes of Infertility

A

Cryptochordism
Immunological
Vascular
Trauma / Surgery
Toxins

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11
Q

What are the post testicular causes of infertility?

A

Congenital
Obstructive Azoospermia
Erectile Dysfunction
Latrogenic

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12
Q

What are the uterine causes of infertility?

A

Congenital Malformation
Infection
Scarring/Inflammation/Adhesions/Fibroids

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13
Q

What are the tubular causes of infertility? - FEMALE

A

Infection, Trauma, Endometriosis

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14
Q

What are the ovarian causes of infertility?

A

Anovulation - no ovulation
Corpus Luteum Insufficiency

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15
Q

What is endometriosis?

A

Presence of functioning endometrial tissue outside the uterus

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16
Q

Why does endometriosis cause increased period pains

A

Endometriosis responds to oestrogen
Mid cycle oestrogen increases therefore exacerbates menstrual pain

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17
Q

What are the symptoms of endometriosis?

A

Increased menstrual Pain
Menstrual irregularities
Deep dyspareunia
Infertility

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18
Q

What are fibroids?

A

BENIGN TUMOURS OF THE MYOMETRIUM

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19
Q

What are the symptoms associated with fibroids?

A

Usually Asymptomatic
Increased menstrual Pain
Menstrual irregularities
Deep dyspareunia
Infertility

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20
Q

How is Oestrogen made in Males?

A

Aromatised from testosterone

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21
Q

Describe the HPG Axis?

A
  1. kiss peptin binds to kiss peptin receptors
  2. Stimulates GnRH release
  3. Binds to gonadotrophs - FSH and LH secretion, which leads to T and O secretion
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22
Q

Describe the hormone profile in hyperprolactinaemia?

A

↓GnRH (Not measurable in the systemic circulation)
↓LH
↓FSH
↓Testosterone

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23
Q

Describe the hormone profile in Kallmann Syndrome?

A

↓GnRH (Not measurable in the systemic circulation)
↓LH
↓FSH
↓Testosterone

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24
Q

What are some causes of acquired hypogonadotrophic hypogonadism? (female)

A

Low BMI, Excess Exercise, Stress = No Periods, Anorexia Nervosa

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25
Q

What is meant by anosmic?

A

No sense of smell

26
Q

What can cause hypopituitarism?

A

Apoplexy, Tumour, Infiltration, Surgery, Radiation

27
Q

What is the hormone profile in hypopituitarism?

A

↓LH
↓FSH
↓Testosterone

28
Q

What is congenital Primary Hypogonadism in males?

A

Klinefelters (47XXY)

29
Q

What is the hormone profile in Klinefelters?

A

↑LH
↑FSH
↓Testosterone

30
Q

What cause cause acquired primary hypogonadism?

A

Cryptochordism, Trauma, Chemo, Radiation

31
Q

What is the cause of Kallmanns Syndrome?

A

Failure of migration of GnRH neurones with the olfactory fibres - can lead to anosmia

Causes failure of puberty
Infertility

32
Q

What is the treatment for hyperprolactinaemia?

A

Dopamine Agonist - Cabergoline
Surgery

33
Q

What are the symptoms of prolactinaemia?

A

Oligo or Amenorrhoea, Low Libido, Infertility

34
Q

What are the symptoms of Klinefelter?

A

Tall
Mildly Impaired IQ
Reduced Chest Hair
Wide Hips
Low Bone Density
Small Penis / Testes
Breast Development
Female Like Pubic Hair Patterns

35
Q

What are the blood tests which should be conducted for Male Infertility?

A

LH, FSH, PRL
Morning Fasting Testosterone - Highest in the morning, and fasting as glucose can impact T
Karyotyping
Semen Analysis

36
Q

What imaging should be conducted for. male infertility investigation?

A

Scrotal US / Doppler - if Testicular Volume is irregular
Pituitary MRI - if LH, FSH eetc is low

37
Q

What are the key examinations which should be performed for investigating male infertility?

A

BMI, sexual characteristics, testicular volume, anosmia

38
Q

What are the lifestyle treatments for male infertility?

A

Optimise BMI
Smoking Cessation
Alcohol Reduction

39
Q

How is male infertility treated?

A

Gondaotrophin treatment

40
Q

Why is giving males only testosterone not helpful in increasing fertility?

A

Will treat low libido, and other associated symptoms, however testosterone inhibits sperm production so therefore will not help fertility

41
Q

Describe the hormone profile seen in Premature Ovarian Insufficiency?

A

↑LH
↑FSH
↓Oestradiol

42
Q

What test results are needed to diagnose Premature Ovarian Insufficiency?

A

High FSH (>25iU/L) - x2 at least 4 weeks apart

43
Q

What are the causes of premature ovarian Insufficiency?

A

Autoimmune
Genetics eg Turners
Cancer Therapy

44
Q

What is the hormone profile in hypothalamic amenorrhoea?

A

↓GnRH - Not Measureable
↓LH
↓FSH
↓E2

45
Q

What is the hormone profile seen in PCOS?

A

↓E2
↑LH:FSH Ratio

46
Q

Describe the causes of congenital Primary Hypogonadism in females?

A

turners Syndrome
Premature Ovarian Insufficiency

47
Q

What are the three Rotterdam PCOS Diagnostic?

A
  1. Oligo / Anovulation
  2. Clinical +/- Biochemical Hyperandrogenism
  3. Polycystic Ovaries (Polycystic Ovaries morphology are not the same as the syndrome)
48
Q

What are the clinical symptoms of hyperandrogenism?

A

Acne
Hirsutism
Alopecia

49
Q

What are the biochemical symptoms of hyperandrogenism?

A

raised Androgens - testosterone

50
Q

What are the treatment options for Irregular Menses?

A

oral Contraceptive Pill

51
Q

What are the treatment options for Insulin Resistance?

A

Metformin, Diet and Lifestyle

52
Q

What are the treatment options for Hirsutism?

A

Creams, Waxing and Laser
Anti-Androgens like spironolone = Mineralcorticoid receptor antagonist

53
Q

What are the implications of PCOS?

A

Irregular Menses
Infertility
Increased Insulin Resistance
Hirsutism
Increased Endometrial cancer Risk

54
Q

Describe the hormone profile in turners Syndrome?

A

↑LH
↑FSH
↓Testosterone
= Hypergonadotrophic hypogonadism

55
Q

What are the signs of Turner’s Syndrome?

A

Short Stature
Low Hairline
Shield Chest
Wide Spaced Nipples
Small Finger Nails
Brown Nevi
Webbed Neck
Poor Breast Development
Amenorrhoea
Coractation of the Aorta

56
Q

What blood tests should be done when investigating female infertility?

A

LH
FSH
PRL
Oestradiol, Androgens
Mid-Luteal Progesterone
Karyotyping

57
Q

What is a cause of uterine infertility which is oestrogen responsive?

A

fibroids

58
Q

What is klinefelters also known as?

A

Primary testicular failure

59
Q

What is an example of a condition in males which is hypergonadotrophic hypogonadism?

A

Klinefelters

60
Q

In Kallmann Syndrome, where are the neurones supposed to migrate to and from?

A

From the hypothalamus to the olfactory placode

61
Q

What is premature ovarian insufficiency also known as?

A

early menopause

62
Q

what hormone pattern would you see in anorexia nervosa-induced amenorrhoea?

A

LH Down
FSH Down and Oestradiol Down

ENDOCRINOLOGY (20 decks)

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