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Endocrine Week 5 2017/18 > 5: Management of infertility > Flashcards

5: Management of infertility Flashcards

1
Q

What is the definition of infertility?

A

Failure to become pregnant despite 12+ months of unprotected sexual intercourse (without a known reason)

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2
Q

What is

a) primary
b) secondary infertility?

A

a) Primary - couple has never conceived

b) Secondary - couple has conceived before (but stillborn or ectopic)

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3
Q

The incidence of infertility is (increasing / decreasing).

A

increasing

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4
Q

What percentage of couples experience infertility?

A

15%

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5
Q

A BMI over ___ increases your likelihood of infertility.

A

over 30

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6
Q

As a woman, the older you are, the (more / less) fertile you are.

A

After puberty, older = less fertile

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7
Q

Under female causes of infertility, what are the two broad categories of disease?

A

Tubal disorders

Ovulatory disorders

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8
Q

Where in the Fallopian tubes does fertilisation occur?

A

Ampulla

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9
Q

Where do fertilised eggs implant?

A

Uterine wall

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10
Q

Which STI causes infertility?

A

Chlamydia

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11
Q

When in the luteal phase are progesterone levels usually checked?

A

Mid-phase

i.e a week after ovulation / a week before menstruation

as this is when progesterone levels should peak

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12
Q

A progesterone level of more than ___ nmol/L suggests that ovulation has occurred.

A

30 nmol/L

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13
Q

Which hormones should be checked in a woman who has oligo- or amenorrhoea?

A

GnRH

FSH and LH

Oestradiol, testosterone

Prolactin

TSH (for thyroid problems)

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14
Q

Which virus causes either miscarriage or severe congenital disease in babies whose mothers are infected?

A

Rubella virus

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15
Q

What disease does the Rubella virus cause in unborn babies?

A

Congenital rubella syndrome

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16
Q

What are the characteristic signs of congenital Rubella syndrome?

A

Rash

Microcephaly (smaller head circumference than normal)

Patent ductus arteriosus

Cataracts

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17
Q

How is congenital Rubella syndrome prevented?

A

MMR vaccine

measles, mumps, rubella

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18
Q

What is a bacterium which commonly causes pelvic inflammatory disease, leading to female infertility?

A

Chlamydia trachomatis

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19
Q

Chlamydia trachomatis is a Gram (positive / negative) coccobacillus.

A

Gram negative

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20
Q

What are two reproductive consequences of Chlamydia infection?

A

Infertility

Ectopic pregnancy

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21
Q

Which antibiotics are used to treat Chlamydia infection?

A

Azithromycin

OR

Doxycycline

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22
Q

What is a possible acute consequence of pelvic inflammatory disease?

A

Peritonitis

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23
Q

What type of menstrual cycle indicates that ovulation is occurring normally?

A

Regular cycles

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24
Q

What types of menstrual cycle indicate that ovulation isn’t occurring?

A

Prolonged cycles (oligomenorrhoea, >35 days)

No period (amenorrhoea)

25
Q

Ovulation, indicated by regular cycles, is confirmed by which test?

A

Midluteal progesterone test

26
Q

Anovulation, indicated by irregular/no cycles, is confirmed by which tests?

A

Hormone tests

(GnRH, gonadotrophins, oestradiol, testosterone, PRL, TSH)

27
Q

Why is TSH tested in women with anovulation?

A

Hyper/hypothyroidism both cause ovulatory disorders

28
Q

What are the three broad causes of ovulatory disorders?

A

I: hypothalamic - stress, anorexia, exercise, Kallmann syndrome

II: pituitary - PCOS, hyperprolactinaemia

III: ovarian failure - menopause, premature

29
Q

What is the first line treatment for PCOS?

A

Clomifene citrate

30
Q

How does clomifene citrate work?

A

SERM

Selective oestrogen receptor modulator

Blocks oestrogen receptors in the ovaries, leading to perceived low oestrogen levels, leading to increased secretion of GnRH > FSH & LH by negative feedback, causing more follicles to develop

… increasing your chances of pregnancy

31
Q

Clomifene citrate causes what?

A

Ovulation induction

32
Q

Does ovulation induction increase your chance of conceiving?

A

Yes, but not by 100%

33
Q

What is a reproductive “risk” of clomifene citrate?

A

Increased chance of multiple pregnancy i.e twins, triplets

34
Q

What is an alternative to clomifene citrate which also produces ovulation induction?

A

Tamoxifen

35
Q

If ovulation induction via clomifene citrate or similar doesn’t work, what are second line options for women with PCOS?

A

Gonadotrophin injections

Laparoscopic ovarian diathermy (drilling)

36
Q

What is the first line investigation for male infertility?

A

Semen analysis

37
Q

If semen analysis is abnormal, what is the second line investigation for male infertility?

A

Hormone tests

GnRH, FSH and LH, testosterone, prolactin, TSH

38
Q

Male sperm counts are (increasing / decreasing).

A

decreasing

which is bad

39
Q

What are some obstructive causes of male infertility?

A

Vasectomy

STI (chlamydia, gonorrhoea)

Congenital absence of vas deferens in CF

40
Q

What are some non-obstructive causes of male infertility?

A

Undescended testes

Orchitis (testicular inflammation caused by chlamydia, gonorrhoea or mumps)

Testicular trauma

Klinefelter’s syndrome (47 XXY)

41
Q

Which syndrome, also known as primary ciliary dyskinesia, can cause non-obstructive male infertility?

A

Kartagener’s syndrome

42
Q

What are some hormonal causes of male infertility?

A

Hypogonadotrophic hypogonadism

Hyperprolactinaemia

Hypothyroidism

43
Q

What is a condition associated with diabetes which may result in male infertility?

A

Erectile dysfunction

44
Q

How is male infertility treated or worked around?

A

Surgery to remove vas deferens obstruction

Artificial insemination

45
Q

What investigation can be used to check tubal patency in females?

A

Hysterosalpingogram

46
Q

Which imaging test is used to check for pelvic inflammatory disease in females?

A

Laparoscopy

47
Q

Which disease, characterised by ectopic endometrial tissue, is a cause of female infertility?

A

Endometriosis

48
Q

How is tubal disease treated?

A

Surgery

49
Q

If tubal disease cannot be treated, what method of fertilisation is used to achieve a pregnancy?

A

IVF

In vitro fertilisation

50
Q

How does IVF work?

A

Unfertilised egg extracted from female

Egg fertilised in lab using partner/donor sperm

Fertilised egg artificially implanted back in female’s uterus

51
Q

How often should couples aiming to conceive have sex?

A

2-3 times a week

52
Q

What lifestyle factors should be considered when managing infertility?

A

Alcohol

Weight

Smoking

53
Q

What supplement should all pregnant women be on?

A

Folic acid

54
Q

What virus should all pregnant women be immunised against?

A

Rubella

55
Q

Pregnant women should receive which kind of smear test?

A

Cervical smear

for cervical cancer

56
Q

Which genetic condition causes premature ovarian failure?

A

Turner’s syndrome 45 XO

57
Q

How may women with premature ovarian failure achieve pregnancy?

A

Egg donation

58
Q

Which bone disease may women with premature ovarian failure develop?

A

Osteoporosis

so put them on combined oral contraceptive pill

59
Q

What are the common investigations done for couples experiencing infertility?

A

For the woman:

Pregnancy test (just in case), all hormones, progesterone test (for ovulatory disorders), Rubella and Chlamydia

For the man:

Semen analysis, tubal patency test

Endocrine Week 5 2017/18 (7 decks)

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