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Women's Health Unit 2 > 4 Infertility and Abortion > Flashcards

4 Infertility and Abortion Flashcards

1
Q

Capacity to conceive and produce offspring

A

Fertility

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2
Q

The probability of achieving a pregnancy in one menstrual cycle

A

Fecundability

THis is a more accurate descriptor b/c it recognizes varying degrees of infertility

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3
Q

Diminished capacity to conceive despite frequent coitus

A

Infertility

Subfertility may be a more appropriate description for most couples

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4
Q

Inability to conceive offspring

A

Sterility

Used after sterilization procedure, specific illness, exposure, or genetic condition

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5
Q

____% of couples will conceive in the first 6 months of unprotected sex

A

80%

85-90% during the first 12 months

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6
Q

Fecundability decreases as…

A

A woman ages due to declining quantity and quality of oocytes

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7
Q

When is evaluation of infertility indicated?

A

Inability to conceive after 12 months of unprotected intercourse for women ≤35

If >35, it’s after 6 months

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8
Q

What are the causes of infertility?

A

Male factor = 8%

Female factor = 37%

Combined = 35%

Unknown = 5%

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9
Q

4 main categories of male factor infertility

A

Endocrine and systemic disorders

Primary testicular defects in spermatogenesis

Sperm transport disorders

Idiopathic male infertility

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10
Q

Clinical semen findings for infertility

A

Low sperm concentration
Absent sperm
Motility issues
Morphology issues

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11
Q

How are semen samples obtained for analysis

A

Masturbation sample in the office 🏥🍆💦

2-7 days of sexual abstinence to ensure accurate concentration of sample

2 samples taken 1-2 weeks apart

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12
Q

What are we testing for in semen analysis?

A 
Volume
Sperm concentration
Total sperm number
Sperm morphology
Vitality
Progressive motility
Total
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13
Q

What is Klinefelter’s syndrome

A

XXY male

Low IQ, tall, poor muscle tone, reduced sex characteristics, man boobs, small testes/infertility

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14
Q

Most common congenital abnormality causing primary hypogonadism

A

Klinefelter’s syndrome

10-15% of infertile men with azoospermia and small testes

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15
Q

Main contributing factors in female-factor infertility

A

Ova
Patent Oviduct
Anatomic abnormalities of the uterus

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16
Q

Complications of ovulation that can lead to infertility

A

PCOS

Thyroid dysfunction

Hyperprolactinemia

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17
Q

Cutaneous signs of hyperandrogenism

Oligomenorrhea/amenorrhea

Obesity/insulin resistance

Polycystic ovaries on U/S

A

Polycystic Ovarian Syndrome

18
Q

Relationship between thyroid and fertility

A

Both hypo and hyperthyroidism can disrupt normal ovulation

1/8 of women will develop thyroid dysfunction in their lifetime

Can lead to oligomenorrhea/amenorrhea

19
Q

Relationship between elevated prolactin levels and infertility

A

High prolactin states include breastfeeding, breast stimulation/intercourse, extreme exercise, and meds (RISPERIDONE**)

Serum prolactin should be repeated if elevated with pt ed regarding the above

If levels persist - evaluate for pituitary adenoma with MRI

20
Q

Treating PCOS to increase fertility

A

Proper diet and exercise education

Provera cycling

Metformin

Clomiphene (50 mg PO x 5 days beginning on cycle day 5)

21
Q

Treating thyroid disorders to improve fertility

A

Use pregnancy safe options

Hyper = PTU

Hypo = Levothyroxine

22
Q

Treating hyperprolactinemia to improve fertility

A

Bromocriptine - safe in pregnancy but d/c once pregnancy achieved

23
Q

How does Clomiphene work?

A

Selective Estrogen Receptor Modulator (SERM)

Induces ovulation in 60-85% of anovulatory women

Twins 7-9%

Triplet rate is 0.3%

24
Q

Serious short term complication of Clomiphene

A

Ovarian hyperstimulation

Can lead to thromboembolic events

25
Q

Tubal factors that affect fertility

A

Occluded oviduct (untreated STI/PID, hydrosalpinx, mucous, anatomic abnormalities)

Injury/surgery to oviduct (salpingectomy, previous ectopic pregnancy)

26
Q

Tubal factors affecting fertility can be ruled out with…

A

Hysterosalpingograpm (HSG)

27
Q

Limitations to hysterosalpingogram

A

Not covered by most insurances (~$400)

Possibly painful

Evaluates for tubal patency but not function

28
Q

Treatment for tubal factors in infertility

A

Surgical tubal repair (rare - high failure rates and risk of ectopic pregnancy)

IVF

29
Q

Two most important questions to ask in cases of infertility?

A

Are you having regular menses?

How often are you having intercourse?

30
Q

What is Spinnbarkeit?

A

Egg white cervical mucous that typically occurs during ovulation?

31
Q

What is Mittelschmerz

A

Pain with ovulation

32
Q

What medications are used for elective abortions

A

Misoprostol and Mifepristone

Effective 95-98% of the time

Risks:
• Retained products requiring D&C (2%)
• Infection - can give prophylactic abx

FDA approved up to 70 days (10 weeks) GA

33
Q

What are the three surgical methods of elective abortion?

A

Suction D&C
Dilation and evacuation
Stimulation of labor

34
Q

What is a spontaneous abortion?

A

A miscarriage

Pregnancy loss occurring prior to 20 weeks GA

Most common complication of pregnancy

35
Q

What labs do you wanna run after a spontaneous abortion?

A

CBC
Rh type
HCG quantitative
Pelvic and transvaginal U/S

36
Q

Most common cause of spontaneous abortion?

A

Abnormal karyotype - something is wrong with the embryo genetically

Usually occurs in the first trimester (specifically < 8 weeks)

37
Q

What is a threatened spontaneous abortion?

A

Closed cervical os but bleeding in the presence of a (+) urine pregnancy test

38
Q

What is an inevitable spontaneous abortion?

A

Open cervical os presenting with bleeding

39
Q

What is a missed abortion?

A

Absent heartbeat without bleeding and a closed cervix

40
Q

What is a “habitual aborted”

A

Three or more consecutive losses prior to 20 weeks

Risk of future SABs increases with each subsequent SAB

41
Q

Common causes of recurrent abortions

A 
Abnormal karyotype
Uterine malformations
Antiphospholipid antibody (Lupus)
Chronic uncontrolled medical conditions
Insufficient progesterone levels

Women's Health Unit 2 (4 decks)

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