204, 205 infertility

Question 1

What is the definition of infertility?

Answer 1

one year of unprotected intercourse without conception

Question 2

What are anatomic causes of female infertility?

Answer 2

uterine factors (congenital abnormalities, aquired disorders like fibroids)

tubal/transport factors (ex. PID)

Question 3

What are ovulatory-related causes of female infertility?

Answer 3

PCOS

hypothalamic amenorrhea (disrupted GnRH secretion)

hyperprolactinemia

thyroid disease

primary ovarian insufficiency

Question 4

What is the definition of primary ovarian insufficiency?

Answer 4

menopause before age 40

Question 5

What assessment methods can be used for assessing infertility?

Answer 5

hysterosalpingogram, sonohysterogram, hysteroscopy, transvaginal ultrasound

Question 6

How is ovulation measured biochemically?

Answer 6

measure serum progesterone at day 21 and 28 of the cycle

Question 7

How is ovarian reserve assessed?

Answer 7

day 3 FSH

AMH levels (correlates to number of small antral follicles)

antral follicle count on transvaginal ultrasound

Question 8

What are pharmacological inducers of ovulation?

Answer 8

clomiphene citrate (SERM), letrozole, injectable gonadotropins

Question 9

What is the difference between hypogonadotropic hypogonadism and hypergonadotropic hypogonadism?

Answer 9

hypogonadotropic = isolated GnRH deficiency

hypergonadotropic = primary testicular failure

Question 10

Describe the mechanism(s) by which varicoceles decrease male reproductive potential?

Answer 10

disruption of the scrotal counter-current heat exchange mechanism

Question 11

What are the clinical hallmarks of men with congenital bilateral absence of the vas deferens?

Answer 11

bilateral absence of the ves deference usually means distal 2/3 of epididymis and seminal vesicles are often absent too

Question 12

What clinical features and semen tests results differentiate men with retrograde ejaculation from men with ejaculatory duct obstruction?

Answer 12

retrograde: low volume, normal semen pH
obstruction: low volume, acidic pH

Question 13

Compare and contrast treatment options for men with obstructive azoospermia and men with nonobstructive azoospermia?

Answer 13

obstructive: surgical correction (if feasible), vasovasostomy, epididymovasostomy, TUR-unroofing of obstructed ducts
nonobstructive: requres microTESE + IVF/ICSI

Question 14

What is the failure rate associated with each of the following types of male contraception: timing method, condom, and vasectomy

Answer 14

timing: 25%
condom: 18%
vasectomy: <1%

Question 15

What are the most common risks associated with vasectomy?

Answer 15

hematoma, infection, chronic pain, sperm granuloma, recanalization

Question 16

What possible condition could be implicated in men with unilateral or bilateral absence of the vas deferens or azoospermia with normal testicular biopsy?

Answer 16

cystic fibrosis (CFTR testing required)

Question 17

What is histerosalpingogram (HSG) best for assessing? Saline infused sonohysterogram?

Answer 17

HSG: tubal patency

SIS: submucosal fibroids

HSG is gold standard but is more expensive

Question 18

How is ovarian reserve assessed?

Answer 18

day 3 FSH (higher means brain is working harder to stimulate ovaries)

AMH (made by small antral/preantral follicles, correlates directly to size of reserve)

antral follicle count (measured at day 3)

Question 19

What drugs are used to induce ovulation?

Answer 19

clomiphene citrate (SERM, blocks estrogen and increases FSH)

letrozole (aromatase inhibitor, leads to FSH production)

Injectable gonadotropins

Question 20

How do varicoceles impact fertility?

Answer 20

decreased fertility due to higher temperature

Question 21

What are the indications for microdissection testicular sperm extraction?

Answer 21

non-obstructive azoospermia

Question 22

What genetic syndrome is associated with congenital absence of vas deferens?

Answer 22

CFTR mutation carrier