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6. Women's Health > 2- Infertility and Abortions > Flashcards

2- Infertility and Abortions Flashcards

1
Q

What is defined as the probability of achieving a pregnancy in one menstrual cycle?

A

Fecundability

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2
Q

What is defined as infertility in pts 35 yrs and younger?

A

Inability to conceive after 12 months of unprotected intercourse

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3
Q

What is defined as infertility in pts 35 yrs and older?

A

Inability to conceive after 6 months of unprotected intercourse

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4
Q

What is the difference between primary and secondary infertility?

A

Primary- infertility in pts who have never conceived (increases with age)

Secondary- infertility in pts after prior fertility

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5
Q

What is the greatest contributor to infertility as a couple?

A

Female factor infertility > male factor infertility

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6
Q

What are the 4 main categories of male factor infertility?

A

Endocrine/ systemic disorders

Primary testicular defects in spermatogenesis

Sperm transport disorders

Idiopathic male infertility

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7
Q

In regards to semen analysis, what must be done prior to providing the sample and how many samples are taken?

A

2-7 days of sexual abstinence

2 samples, 1-2 weeks apart

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8
Q

What factors are evaluated as part of semen analysis? (according to WHO criteria) (7)

A

Volume

Sperm concentration

Total sperm #

Morphology

Vitality

Progressive motility

Total motility (progressive + nonprogressive)

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9
Q

What is the most common congenital abn causing hypogonadism and can be a cause of infertility in men?

A

Klinefelter’s syndrome (47 XXY)

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10
Q

What are the main contributing factors to female infertility?

A

Ova, patent oviduct, anatomic abns of uterus

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11
Q

What are the main complications of ovulation a/w infertility in females?

A

PCOS, thyroid dysfunction, hyperprolactinemia

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12
Q

Lack of progesterone in PCOS has what effect on menstruation?

A

Results in unopposed estrogen = hyperplastic growth of endometrial lining = irregular sloughing = oligomenorrhea

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13
Q

How does thyroid dysfunction contribute to infertility?

A

Can lead to oligomenorrhea or amenorrhea

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14
Q

What factors/ circumstances lead to high prolactin?

A

Breastfeeding

Breast stimulation/ intercourse

Extreme exercise

Meds (Risperidone)

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15
Q

If serum prolactin levels are elevated, repeat test should be performed with instruction of what?

A

No exercise, intercouse, breast stimulation + fasting

(24 hours)

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16
Q

If prolactin levels are persistently elevated, what should be evaluated for?

A

Pituitary adenoma with MRI

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17
Q

What is the tx of anovulation due to PCOS?

A

Weight loss

Provera cycling

Metformin

Clomiphene

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18
Q

What is the tx of anovulation due to hyper or hypothyroidism?

A

Hyper = PTU

Hypo = Levothyroxine

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19
Q

What is the tx of anovulation due to hyperprolactinemia?

A

Bromocriptine, but d/c once (+) pregnancy test

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20
Q

What drugs are used for ovulation induction?

A

Letrozole- 1st line (but not FDA approved for this use- pt edu)

Clomiphine

(often used w/ intrauterine insemination (IUI))

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21
Q

What is the short term, but potentially life threatening SE a/w use of Clomiphine and Letrozole for ovulation induction?

A

Ovarian hyperstimulation (can lead to thromboembolic event)

22
Q

What often results from untreated STDs/ PID and can lead to infertility?

A

Occluded oviduct

23
Q

Hydrosalpinx, mucous, and anatomic anomalies can lead to what complication, thus leading to infertility?

A

Occluded oviduct

24
Q

In addition to occluded oviducts, what other tubal factors can lead to infertility?

A

Injury/ surgery to oviduct

(ex. salpingectomy, previous ectopic pregnancy)

25
Q

How can tubal factors be ruled out as the cause of infertility?

A

Hysterosalpingogram (HSG)

(dye fills uterine cavity, shows possible occlusion)

26
Q

What are the limitations to HSG?

A

Evaluates for tubal patency, not function

(also not covered by most insurances +/- painful)

27
Q

What is the treatment for tubal factors as a cause of infertility?

A

IVF = 1st line

Surgical tubal repair (increased risk of ectopic pregnancies)

28
Q

What are the 2 most important questions to ask at an infertility visit?

A

Regular menstrual cycles, frequency of intercourse

29
Q

Mittelschmerz (pain w/ ovulation) and cervical mucous described as “spinnbarkeit” or “egg white” are signs of what?

A

Regular ovulation

30
Q

Medical hx of what could indicate male infertility?

A

Hx of mumps

31
Q

What surgical hx has the potential to lead to male infertility?

A

Vasectomy, hernia repair, orchiectomy

32
Q

In addition to medical hx, meds, and social hx, what other hx should be obtained for eval of possible male infertility?

A

Surgical hx

Developmental hx (loss of body hair/ decreased shaving, pubertal developmental milestones, learning disabilities)

33
Q

What “combined M/F” questions should be asked at an infertility visit?

A

Primary vs secondary infertility (including hx of miscarriages/ abortions)

Time period trying to conceive

Previous use of contraceptive

34
Q

What are important PE findings for female infertility visit?

A

BMI (> 27 or < 17)

Pain w/ pelvic exam (esp posterior cul de sac)

35
Q

Is it necessary to wait 6-12 months for possible conception if known specific infertility cause with either partner?

A

No- refer early

36
Q

When might an elective abortion be performed?

A

Unplanned pregnancy, fetal anomalies, maternal health

37
Q

What meds are used for elective abortion and when can they be used?

A

Misoprostol, Mifepristone

Up to 70 days of gestational age

38
Q

The following are all options for what?

Suction D+C, dilation and evacuation, stimulation of labor

A

Surgical options for elective abortion

(decision based on gestational age)

39
Q

What condition is considered a spontaneous abortion (SAB)?

A

Miscarriage- pregnancy loss prior to 20 weeks gestation

Most common complication of pregnancy

40
Q

What is included in the workup for spontaneous abortion?

A

CBC, Rh type, HCG quantitative, pelvic/ transvaginal US

41
Q

What is the most common cause of spontaneous abortion?

A

Abnormal karyotype (usually occurs in 1st trimester)

42
Q

What is required for Rh negative women with spontaneous abortion?

A

Rhogam injection

43
Q

Are genetic studies performed for isolated SAB?

A

Rarely

44
Q

What type of SAB is a/w a closed cervical os and presents with bleeding and (+) urine pregnancy test?

A

Threatened

45
Q

What type of SAB is a/w an open cervical os and presents with bleeding?

A

Inevitable

46
Q

What type of SAB is a/w a closed cervix, absent fetal heartbeat and NO bleeding?

A

Missed

47
Q

How is recurrent abortion (aka “habitual aborter”) defined?

A

3+ consecutive losses prior to 20 weeks

(risk of future SABs increase with each subsequent SAB)

48
Q

What is the more common congenital uterine anomaly?

A

Bicornuate (partial)

49
Q

What are the the causes of recurrent abortion? (5)

A

Abn karyotype

Uterine malformations

Antiphospholipid antibody

Chronic uncontrolled medical conditions

Insufficient progesterone levels

50
Q

What is included in the workup for recurrent abortion with respect to general hx?

A

Maternal age, hx of chronic diseases

51
Q

What karyotype information should be obtained in workup for recurrent abortion?

A

Karyotype of both parents + aborted embryo

52
Q

Aside from general hx and karyotype information, what else is included as part of the workup for recurrent abortion? (4)

A

Luteal phase progesterone

Antiphospholipid antibody

Lupus workup

Uterine cavity eval

6. Women's Health (13 decks)

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