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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

24
Q

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

A

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

25
What is meant by anosmic?
No sense of smell
26
What can cause hypopituitarism?
Apoplexy, Tumour, Infiltration, Surgery, Radiation
27
What is the hormone profile in hypopituitarism?
↓LH ↓FSH ↓Testosterone
28
What is congenital Primary Hypogonadism?
Klinefelters (47XXY)
29
What is the hormone profile in Klinefelters?
↑LH ↑FSH ↓Testosterone
30
What cause cause acquired primary hypogonadism?
Cryptochordism, Trauma, Chemo, Radiation
31
What is the cause of Kallmanns Syndrome?
Failure of migration of GnRH neurones with the olfactory fibres - can lead to anosmia Causes failure of puberty Infertility
32
What is the treatment for hyperprolactinaemia?
Dopamine Agonist - Cabergoline Surgery
33
What are the symptoms of prolactinaemia?
Oligo or Amenorrhoea, Low Libido, Infertility
34
What are the symptoms of Klinefelter?
Tall Mildly Impaired IQ Reduced Chest Hair Wide Hips Low Bone Density Small Penis / Testes Breast Development Female Like Pubic Hair Patterns
35
What are the blood tests which should be conducted for Male Infertility?
LH, FSH, PRL Morning Fasting Testosterone - Highest in the morning, and fasting as glucose can impact T Karyotyping Semen Analysis
36
What imaging should be conducted for. male infertility investigation?
Scrotal US / Doppler - if Testicular Volume is irregular Pituitary MRI - if LH, FSH eetc is low
37
What are the key examinations which should be performed for investigating male infertility?
BMI, sexual characteristics, testicular volume, anosmia
38
What are the lifestyle treatments for male infertility?
Optimise BMI Smoking Cessation Alcohol Reduction
39
How is male infertility treated?
Gondaotrophin treatment
40
Why is giving males only testosterone not helpful in increasing fertility?
Will treat low libido, and other associated symptoms, however testosterone inhibits sperm production so therefore will not help fertility
41
Describe the hormone profile seen in Premature Ovarian Insufficiency?
↑LH ↑FSH ↓Oestradiol
42
What test results are needed to diagnose Premature Ovarian Insufficiency?
High FSH (>25iU/L) - x2 at least 4 weeks apart
43
What are the causes of premature ovarian Insufficiency?
Autoimmune Genetics eg Turners Cancer Therapy
44
What is the hormone profile in hypothalamic amenorrhoea?
↓GnRH - Not Measureable ↓LH ↓FSH ↓E2
45
What is the hormone profile seen in PCOS?
↓E2 ↑LH:FSH Ratio
46
Describe the causes of congenital Primary Hypogonadism in females?
turners Syndrome Premature Ovarian Insufficiency
47
What are the three Rotterdam PCOS Diagnostic?
1. Oligo / Anovulation 2. Clinical +/- Biochemical Hyperandrogenism 3. Polycystic Ovaries (Polycystic Ovaries morphology are not the same as the syndrome)
48
What are the clinical symptoms of hyperandrogenism?
Acne Hirsutism Alopecia
49
What are the biochemical symptoms of hyperandrogenism?
raised Androgens - testosterone
50
What are the treatment options for Irregular Menses?
oral Contraceptive Pill
51
What are the treatment options for Insulin Resistance?
Metformin, Diet and Lifestyle
52
What are the treatment options for Hirsutism?
Creams, Waxing and Laser Anti-Androgens like spironolone = Mineralcorticoid receptor antagonist
53
What are the implications of PCOS?
Irregular Menses Infertility Increased Insulin Resistance Hirsutism Increased Endometrial cancer Risk
54
Describe the hormone profile in turners Syndrome?
↑LH ↑FSH ↓Testosterone = Hypergonadotrophic hypogonadism
55
What are the signs of Turner's Syndrome?
Short Stature Low Hairline Shield Chest Wide Spaced Nipples Small Finger Nails Brown Nevi Webbed Neck Poor Breast Development Amenorrhoea
56
What blood tests should be done when investigating female infertility?
LH FSH PRL Oestradiol, Androgens Mid-Luteal Progesterone Karyotyping
57
What imaging

ENDOCRINOLOGY (20 decks)

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