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3rd Year - Reproductive Diseases > 4. Infertility > Flashcards

4. Infertility Flashcards

1
Q

How many couples report infertility problems?

A

1 in 7

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2
Q

When are investigations taken to see if a couple are not compatible?

A

After 1 year of trying - unless there’s a problem:

  1. Period Irregularity
  2. Past Medical History
  3. Testicular Problems
  4. Abnormal Tests - HIV / HEP B
  5. Anxiety
  6. Age - < 35 years old
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3
Q

What are the general potential pathological problems, regarding Infertility?

A
  1. Are Eggs available?
  2. Are Sperm available?
  3. Can they meet?
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4
Q

What information is needed from a Female Reproductive History?

A
  1. Duration of Infertility
  2. Previous Contraception
  3. Fertility in Previous Relationships
  4. Previous Pregnancies and Complications
  5. Menstrual History
  6. Medical / Surgical History
  7. Sexual History
  8. Previous Investigations
  9. Psychological Assessment
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5
Q

What information is needed from a Female Reproductive Examination?

A
  1. Weight
  2. Height
  3. BMI (kg/m2)
  4. Fat and Hair Distribution (Hirsutism)
  5. Galactorrhoea
  6. Abdominal Examination
  7. Pelvic Examination
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6
Q

What is Hirsutism (and Acanthosis Nigricans) a sign of?

A

Androgen Excess:

  1. Testosterone
  2. Androstenedione
  3. Dehydroepiandrosterone (DHA)
  4. Dehydroepiandrosterone Sulphate (DHAS)
  5. 17-OH Progesterone
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7
Q

What is examined for in a Pelvic Examination?

A
  1. Masses
  2. Pelvic Distortion
  3. Fixed Retroversion
  4. Tenderness
  5. Fibroids - Pressure Symptoms / Period Problems / Infertility
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8
Q

What information is needed from a Male Reproductive History?

A
  1. Previous Infertility
  2. Medical / Surgical History
  3. Occupational History
  4. Sexual History
  5. Previous Investigations / Treatment
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9
Q

What information is needed from a Male Reproductive Examination?

A
  1. Weight
  2. Height
  3. BMI (Kg/m2)
  4. Fat and Hair Distribution (Hypoandrogenism)
  5. Abdominal / Inguinal Examination
  6. Genital Examination - Testes / Epididymis / Vas Deferens / Varicocoele / Penis
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10
Q

What can cause Epididymitis?

A

STD’s:

  1. Chlamydia Trachomatis
  2. Gonorrhoea
  3. NSTD
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11
Q

What is examined for int the Vas Deferens?

A
  1. Cystic Fibrosis Mutations

2. Congenital Bilateral Absence of the Vas Deferens

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12
Q

What is examined in the Genital Region?

A
  1. Testicle Size
  2. Testicular Maldescent:
  3. a) Orchidopexy
  4. b) Hypospadias
  5. c) Testicular Tumours
  6. Varicocele - abnormal dilation and Torsion of Veins
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13
Q

What are the Baseline Female Investigations?

A
  1. Rubella Immunity
  2. Chlamydia
  3. Thyroid Stimulating Hormone
  4. Mid-Luteal Progesterone (if irregular periods)
  5. Day 1-5 FSH, LH, PRL, TSH, Testosterone (if irregular periods)
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14
Q

What are the Baseline Male Investigations?

A

Male Semen Analysis - Computerised Semen Analysis

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15
Q

What investigations are undertaken at a Fertility Clinic?

A
  1. Pelvic Ultrasound
  2. Physical Examination
  3. Further Investigation
  4. Semen Analysis repeat
  5. Tubal Patency Test
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16
Q

What are 3 methods which can cause Eggs to not be available?

A
  1. Androgen Excess -
    Clinical (Hirsutism) vs Biochemical (Testosterone)
  2. Infrequent Periods (Anovulation)
  3. Polycystic Ovaries (Ultrasound)
17
Q

What is the standard treatment for all Ovulatory Disorders?

A
  1. Treat the Underlying Cause
  2. Weight Loss / Gain for a BMI >18 and <35
  3. Ovulation Induction - Clomiefene / Gonadotrophins
18
Q

How does Clomifene (Ovulation Iduction Medication) work?

A

It is a selective Oestrogen Receptor Modulator:

  1. It binds to Oestrogen Receptors in the Ovaries
  2. This causes the Hypothalamus to percieve a Hypoestrogenic State
  3. The Pituitary will then Release Gonadotrophins
19
Q

What is the Dose Choice of Clomifene?

A

50mg - 150mg of day 2-6

Note - Progestogen Priming will need to be done in Amenorrhoea

20
Q

How is Clomifene monitored?

A

Follicle scanning in the 1st Cycle

Note - 15% will require a dose adjustment

21
Q

What are the side effects of Clomifene?

A
  1. Vasomotor

2. Visual

22
Q

What is Gonadotrophin Medication (FSH Injection) used?

A
  1. No ovulation with Clomifene
  2. Ovulation but no pregnancy
    Note - This is added to Clomifene
    Note - there is up to 3-6 cycles of this
23
Q

How can Endometriosis / Fibroids be treated?

A
  1. Surgically

2. Medically

24
Q

If a patient has been sterilised and wants to get pregnant, what are the options?

A
  1. Reversal of Sterilisation - not available on the NHS

2. Consider In Vitro Fertilisation

25
Q

What are the Treatment options if the problem is Sperm not being available?

A
  1. In Vitro Fertilisation (IVF) / Intracytoplasmic Sperm Injection (ICSI)
  2. Intra-uterine Insemination
  3. Surgery - Vasectomy reversal / Sperm retrieval
  4. Donor Insemination
26
Q

What are the 2 categories, and associated types, of Azoospermia?

A
  1. Testicular:
  2. a) Hypo-Gonadotrophic
  3. b) Normo-Gonadotrophic
  4. c) Hyper-Gonadotrophic
  5. Post-Testicular:
  6. a) Iatrogenic
  7. b) Congenital
  8. c) Infective
27
Q

What are the investigations for Azoospermia?

A
  1. History
  2. Examination
  3. Cystic Fibrosis Screen
  4. Hormone Levels:
  5. a) Follicular Stimulating Hormone
  6. b) Luteinizing Hormone
  7. c) Testosterone
  8. d) Karyotype
  9. e) Prolactin
28
Q

What is the process of In Vetro Fertilisation (IVF)?

A
  1. Eggs Harvested from the Ovary
  2. Eggs Fertilised with Sperm in the Lab
  3. Embryo’s undergo a number of cell divisions
  4. Embryos are transferred to the Womb
29
Q

What are the indications for In Vetro Fertilisation (IVF)?

A

Failure of:

  1. Tubual - Surgery
  2. Male - Donor / Intrauterine Insemination
  3. Ovulation - Clomifene / Gonadotrophins
  4. Unexplained - Superovulation / Intrauterine Insemination
30
Q

What is Intracytoplasmic Sperm Injection?

A

Injection of Mature Eggs with a Single Sperm

3rd Year - Reproductive Diseases (41 decks)

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