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Endocrine > assessment + management of infertility > Flashcards

assessment + management of infertility Flashcards

1
Q

how many couples does infertility affect?

A

-it is a common condition affecting 1:6 couples

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2
Q

how has the incidence of infertility changed in the past 10 years?

A

-it’s doubled in the past 10 years

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3
Q

what is the WHO definition for infertility?

A

-failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse in a couple who have never had a child

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4
Q

what types of infertility are there?

A

Primary and secondary

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5
Q

what is primary infertility?

A

-the couple has never conceived

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6
Q

what is secondary infertility?

A

-couple previously conceived, although pregnancy may not have been successful e.g. miscarriage or ectopic pregnancy

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7
Q

what are some factors affecting pertility?

A
  • women <30 years
  • previous pregnancy
  • <3 years trying to conceive
  • intercourse occuring around ovulation
  • womans BMI 18.5-30 m/kg
  • both partners non smokers
  • caffeine intake is less than 2 cups of coffee daily
  • no use of recreational drugs
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8
Q

what are some common causes of secondary infertility?

A
  • tubal disease
  • gibroids
  • endometriosis/ adenomyosis
  • weight related
  • age related
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9
Q

what are some physiological causes of anovulatory infertility?

A
  • pre puberty
  • pregnancy
  • lactation
  • menopause
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10
Q

what are some gynaecological conditions causing anovulatory infertility?

A

Hypothalmic: anorexia/ bulimia, excessive exercise

Pituitary: hyperprolactinaemia, tumours, Sheehan syndrome

Overy: PCOS, premature ovarian failure

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11
Q

is anorexia nervosa more common in males or females?

A

-females

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12
Q

what is the aetiology of anorexia nervosa?

A
  • social cultural

- genetic

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13
Q

how does anorexia nervosa present?

A
  • weight loss
  • increased exercise
  • withdrawal from friends
  • amenorrhoea
  • infertility
  • low BMI (<18.5)
  • loss of hair
  • increased lanugo
  • low pulse and BP
  • anaemia
  • dehydration
  • reduced bone density
  • muscle weakness and loss
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14
Q

is polycystic ovary syndome (PCOS) common?

A

-yes it is the commonest endocrine disorder in women

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15
Q

what is the aetiology of PCOS?

A
  • its inherited

- weight gain exacerbates it

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16
Q

what are some clinical features of PCOS?

A
  • obesity
  • hirsutism
  • acne
  • menstrual cycle abnormalities
  • infertility
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17
Q

what are some endocrine feature of PCOS?

A
  • high free androgens
  • high LH
  • impaired glucose tolerance
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18
Q

how is PCOS diagnosed?

A

must score 2 out of three:

  • chronic anovulation
  • polycystic ovaries
  • hyperandrogenism (clinical or biochemical)
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19
Q

what can cause premature ovarian failure?

A
  • idiopathic
  • chemotherapy
  • radiotherapy
  • genetic
  • oophorectomy
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20
Q

what are the clinical features of premature ovarian failure?

A
  • hot flushes
  • night sweats
  • atrophic vaginitis
  • amenorrhoea
  • infertility
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21
Q

what are some endocrine features of premature ovarian failure?

A
  • high FSH
  • high LH
  • low oestradiol
22
Q

what are some infective causes of Tubal disease?

A
  • Pelvic inflammatory disease (chlamydia, gonorrhoea, other: anaerobes, syphilis, TB)
  • transperitoneal spread: appendicitis, intra-abdominal abscess
  • following procedure: IUCD insertion, hysteroscopy, HSG
23
Q

what are some non infective causes of tubal disease?

A
  • endometriosis
  • surgical (sterilisation, ectopic pregnancies)
  • fibroids
  • polyps
  • congenital
  • salpingitis isthmica nodosa
24
Q

what is hydrosalpinx?

A

-when a fallopian tube becomes filled with fluid due to injury or infection

25
Q

what are clinical features of hydrosalpinx?

A
  • abdominal/ pelvic pain
  • fever
  • vaginal discharge
  • cervical excitation
  • menorrhagia
  • dysmenorrhea
  • infertility
  • ectopic pregnancy
26
Q

what is endometriosis?

A

-it is an often painful disorder in which tissue similar to the tissue that normally lines the inside of your uterus — the endometrium — grows outside your uterus.

27
Q

what are causes of endometriosis?

A
  • retrograde menstruation (most likely)
  • altered immune function
  • abnormal cellular adhesion molecules
  • genetic
28
Q

what are some clinical features of endometriosis?

A
  • dysmenorrhoea
  • dysparenuia
  • menorrhagia
  • painful defecation
  • chronic pelvic pain
  • uterus may be fixed and retroverted
  • scan may show characteristic ‘chocolate’ cysts on ovary
  • infertility
  • asymptomatic
29
Q

what are some non obstructed causes of male infertility?

A
  • chemotherapy
  • radiotherapy
  • undescended testes
  • idiopathic
30
Q

what are the endocrine features of non obstructive male infertility?

A
  • high LH and FSH

- low testosterone

31
Q

what are some causes of obstructive male infertility?

A
  • congenital absence (e.g. cystic fibrosis)
  • infection
  • vasectomy
32
Q

what are the endocrine feature for obstructive male infertility?

A

-normal LH, FSH and testosterone

33
Q

what are investigations of infertility in females?

A
  • endocervical swab for chlamydia
  • cervical smear if due
  • blood for rubella immmunity
  • midluteal progesterone level
  • test of tubal patency (hysterosalpingiogram or laparoscopy)
34
Q

when is a hysteroscopy performed?

A

-only performed in cases where suspected or known endometrial pathology

35
Q

when would a pelvic ultrasound be performed?

A

-when there is an abnormality on pelvic examination (e.g. enlarged uterus)

36
Q

what are some infertility investigations in males?

A
  • semen analysis (twice over 6 weeks apart)
  • scrotal ultrasound
  • LH, FSH, testosterone, prolactin, thyroid function (endocrine profile)
  • chromosome analysis
  • testicular biopsy
  • screen for cystic fibrosis
37
Q

what is lifestyle advice for a couplet trying to conceive?

A
  • stop smoking
  • achieve BMI between 18.5 and 30
  • reduce alcohol
  • try drink less caffeinated drinks
  • stop taking recreational drugs
  • stop methadone
38
Q

does weight have an effect on miscarriage rate and fertility problems in women?

A

yes - overweight women have an increase in fertility problems and higher miscarriage rate

39
Q

what are some examples of vitamin tablets that may be prescribed for pregnancy?

A
  • folic acid

- vitamin D

40
Q

when is folic acid given for pregnancy?

A

400mcg daily before pregnancy and throughout the first 12 weeks

41
Q

what is the management of hypothalamic anovulation?

A
  • Stabilise weight (BMI>18.5)
  • Pulsatile GnRH to induce ovulation in hypothalamic amenorrhoea
  • Gonodotrophin (FSH + LH) daily injections

(both need regular ultrasound monitoring of ovarian response)

42
Q

what are symptoms of PCOS?

A
  • irregular menstrual cycle
  • hirsutism
  • acne
  • subfertility
  • alopecia
  • obesity
43
Q

what biochemical markers are found in someone with PCOS?

A
  • elevated serum LH (>10 IU/L)
  • LH/ FSH ratio >2
  • normal estradiol
  • low progesterone
  • normal or mildly elevated progesterone
  • raised testosterone
44
Q

what may be seen on a transvaginal USS of someone with PCOS?

A

-polycystic ovarian morphology

45
Q

what is the treatment for PCOS?

A

first line= ovulation induction

this can be done using a number of treatments such as:

  • Antioestrogens (clomifene citrate and tamoxifen)
  • Aromatose inhibitors (letrozole)

second line= laparoscopic ovarian drilling

46
Q

what is the risk of gonadotrophin therapy?

A
  • multiple pregnancies

- ovarian hyperstimulation syndrome (OHSS) which is when the ovaries swell and become painful

47
Q

what is the risk of laparoscopic ovarian diathermy?

A

-risk of ovarian destruction/adhesions resulting in mainly singleton pregnancies

48
Q

what is hydrosalpinx?

A

when the fallopian tube becomes filled with fluid due to injury or infection

49
Q

what is myosure instrument used for?

A

-removing polyps

50
Q

what is a uterine septum?

A

-a condition where the uterus gets an extra wedge of tissue

Endocrine (53 decks)

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