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Endocrine Week 5 2017/18 > 4: Assessment of infertility > Flashcards

4: Assessment of infertility Flashcards

1
Q

What infection can cause infertility?

A

Chlamydia

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2
Q

The ___ you are, the less fertile you are.

A

older

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3
Q

A BMI over __ significantly increases your risk of infertility and complications of pregnancy.

A

30 kg/m2

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4
Q

What is the WHO definition of infertility?

A

Failure to achieve pregnancy after 12 months of unprotected intercourse in a couple who have never had a child (without a known reason)

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5
Q

What is primary infertility?

A

Infertility in a couple who have never conceived

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6
Q

What is secondary infertility?

A

Infertility in a couple who have previously conceived

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7
Q

Under which age are you more likely to conceive?

A

30

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8
Q

At which point in the menstrual cycle is conception most likely?

A

Ovulation

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9
Q

Which lifestyle factors affect the chances of conception?

A

Weight

Smoking

Caffeine intake

Recreational drugs

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10
Q

What are the three general causes of infertility?

A

Male factors

Female factors (i.e problems with tubes, reduced egg reserves, endometrosis)

Mixture of the two

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11
Q

What is the name for failure to release an egg?

A

Anovulation

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12
Q

When is anovulation normal?

A

Before puberty

During pregnancy

After menopause

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13
Q

Which eating disorders can cause anovulation?

Why?

A

Anorexia nervosa

Bulimia nervosa

associated low BMI

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14
Q

What are some clinical features of anorexia nervosa?

A

BMI < 18.5

Hair loss

Bradycardia, hypotension

Anaemia

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15
Q

Which endocrine gland functions abnormally in anorexia nervosa?

A

Hypothalamus

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16
Q

Which hormonal changes are seen in anorexia nervosa?

A

Low GnRH…

FSH, LH…

… and oestradiol release

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17
Q

Which pituitary tumour can cause anovulation?

A

Prolactinoma

producing hyperprolactinaemia

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18
Q

Which syndrome causes infarction of the anterior pituitary gland post-partum?

A

Sheehan syndrome

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19
Q

What is the commonest endocrine disorder in woman and causes anovulation?

A

Polycystic ovary syndrome (PCOS)

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20
Q

What are the clinical features of polycystic ovary syndrome?

A

Oligo- or amenorrhoea

Hyperandrogenism symptoms - acne, hirsutism, obesity

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21
Q

What hormone changes are seen in polycystic ovary syndrome?

A

High free testosterone

High LH

(Remember that PCOS causes insulin resistance > hyperinsulinaemia. That causes the inhibition of sex hormone-binding globulin, which usually mops up testosterone, and increases the levels of LH for some reason.)

22
Q

What three factors are diagnostic of PCOS?

A

2 of Rotterdam criteria:

  1. Oligo- or amenorrhoea
  2. Ultrasound evidence of polycystic ovaries
  3. Symptoms of hyperandrogenism - acne, hirsutism, obesity
23
Q

What genetic syndrome causes premature ovarian failure and therefore infertility?

A

Turner’s syndrome

24
Q

What is the karyotype of Turner’s syndrome?

A

45 XO

25
Q

What are the clinical features of premature ovarian failure?

A

Amenorrhoea

Menopausal symptoms - hot flushes, night sweats, atrophic vaginitis (most commonly manifesting as dryness)

26
Q

In premature ovarian failure, negative feedback of the HPO axis kicks in - what hormonal changes are seen?

A

High GnRH

High FSH and LH

in an attempt to compensate for ovarian failure

but low oestradiol

because the ovaries can’t produce any

27
Q

Which other endocrine diseases cause menstrual symptoms and can lead to infertility?

A

Hyper and hypothyroidism

28
Q

Tumours producing ___ can cause virilisation and infertility.

A

testosterone

29
Q

Which drugs are designed to cause infertility?

A

Contraceptives

30
Q

In females, problems with the ___ tubes themselves can cause infertility.

A

Fallopian tubes

31
Q

What are some infective tubal diseases?

A

Pelvic inflammatory disease (chlamydia/gonorrhoea/syphilis/TB…)

Abdominal diseases e.g appendicitis

Iatrogenic

32
Q

What is endometriosis?

A

Presence of endometrial tissue OUTSIDE uterus

33
Q

What are the clinical features of endometriosis?

A

Painful, bloody menstruation (dysmenorrhoea)

Painful intercourse (dysparenuria)

Infertility

34
Q

Which surgeries can cause tubal disease?

A

Sterilisation

Removal of ectopic pregnancies

35
Q

Which type of disease, following infection by chlamydia, gonorrhoea etc, can cause ectopic pregnancy and infertility?

A

Pelvic inflammatory disease

36
Q

What are some pre-testicular causes of male infertility?

A

Hypogonadism

Hypothyroidism

Hyperprolactinaemia

Diabetes (remember it’s a big cause of ED)

Erectile dysfunction

37
Q

What is a genetic cause of male infertility?

What is the karyotype?

A

Klinefelter’s syndrome

47 XXY

38
Q

What are some post-testicular causes of male infertility?

A

Obstruction of epididymis, vas deferens

Vasectomy

39
Q

Which drugs can cause male infertility?

A

Steroids e.g testosterone, anabolic steroids

Spironolactone at high doses

40
Q

What happens to the size of the testes in non-obstructive male infertility?

A

Reduced size

41
Q

How palpable is the vas deferens in

a) obstructive
b) non-obstructive male infertility?

A

a) Non-palpable
b) Palpable

42
Q

What happens to the level of FSH, LH and testosterone in

a) obstructive
b) non-obstructive male infertility?

A

Obstructive - all normal (not a hormonal problem)

Non-obstructive - high FSH & LH, low testosterone

43
Q

A progesterone level of more than ___ nmol/L a week before period indicates that ovulation has occurred.

A

> 30 nmol/L

44
Q

Which investigations are used to determine if the fallopian tubes are patent or not?

A

Hysterosalpingiogram

Laparoscopy

45
Q

What investigation is done for suspected endometriosis in the uterus?

A

Hysteroscopy

remember hyster- means uterus

46
Q

Which imaging can be used to investigate infertility?

A

Pelvic USS

47
Q

Which hormones are measured in a patient who has anovulation?

A

Urine HCG

Prolactin

TSH

Testosterone

LH, FSH and oestradiol

48
Q

What is a sort-of varicose vein which occurs in the testes and can cause male infertility?

A

Varicocele

49
Q

What is analysed to determine the cause of male infertility?

A

Semen

Hormones (LH, FSH, testosterone, prolactin, TSH)

50
Q

Again, which imaging can be used to examine the testes?

A

Testicular / scrotal USS

51
Q

Name three classes of contraception which cause anovulation.

A

OCP

Contraceptive implant

Contraceptive injection

Endocrine Week 5 2017/18 (7 decks)

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