Assessment of fertility Flashcards
what does GnRH stimulate the release of from the anterior pituitary
LH and FSH
in males what cells does FSH stimulate
sertoli
what cells does LH stimulate in males
Leydig
what is the 1st day of the menstrual cycle
first day of bleeding
how long a cycle is oligomenotthoea
> 35 days
what is amennorhoea
lack of ovulation
what triggers ovulation
LH surge
when are the peaks of estradiol and progesterone during the menstruation cycle
estradiol peak before ovulation
progesterone peak following ovulation (after released egg, produced by corpus luteum)
where is estrogen secreted
ovaries (follicles), adrenal cortex, placenta in pregnancy
how does estrogen affect the endometrium
causes it to thicken
what types of cervical mucous does estrogen produce
fertile
what is the feedback role of estrogen in the follicular phase
+ve feedback stimulating gonadotrophin secretion
what is the feedback role of estrogen in the luteal phase
high estrogen concentration inhibits (-ve feedback) secretion of FSH and prolactin
what is secreted by corpus luteum to maintain pregnancy
progesterone
how does progesterone affect LH
inhibits its secretion
what cervical mucous does progesterone cause
infertile (thick)
what are the role of progesterone
maintains pregnancy, maintains thickness of endometrium, thermogenic effect (increases basal body temp), relaxes smooth muscles
how do you asses ovulation
midluteal (day 21) serum progesterone (if more than 30 nmol than ovulation)
are you likely to be ovulating if you have an irregular cycle
no- probably anovulatory
what are ovulatory disorders associated with
oligomenorrhea and amenorrhea
what are the components of a diagnostic sperm analysis
sperm count
sperm motility
sperm morphology
what is azoospermia
no sperm
is infertility more likely to be caused by male factors or ovulatory dysfunction
male factors (50%) female (25%)
what are 3 the types of ovulatory disorders
hypothalamic pituitary failure (not producing GnRH, not stimulating LH and FSH)
hypothalamic pituitary dysfunction (normal hormones/ excess LH, PCOS)
ovarian failure
what is hypogonadotrophic hypogonadism
hypothalamic pituitary failure
what are reproductive hormones like in hypothalamic pituitary failure
low levels of FSH/LH
oestrogen deficiency
normal prolactin
what reproductive feature is seen in ovulatory disorders caused by hypothalamic pituitary failure
amenorrhoea
what can cause hypothalamic pituitary failure
stress excessive exercise anorexia/ low BMI brain/ pituitary tumours head trauma/ RTX kallmans syndrome drugs (steroids, opiates)
how do you manage type 1 anovulation (hypothalamic pituitary failure)
stabilise weight (BMI>18.5) hormone therapy (pulsatile Gnrh, gonadotrophin (FSH + LH injections)
what is the rotterdam diagnostic criteria for PCOS
oilgo/amenorrhoea
polycystic ovaries
clinical and or biochemical signs of hyperandrogenism (acne, hirsutism) (testosterone, sex hormone binding globulin)
what is the fertility ‘pre treatment’ for PCOS
weight loss smoking alcohol cessation folic acid rubella immunity check prescribed drugs semen analysis for partners (patent fallopian tube)
what can be given to cause ovulation induction in PCOS
clomifene citrate / tamoxifen (estrogenic/ anti estrogenic effects)
gonadotrophin injections (directly stimulates ovaries)
laparoscopic ovarian diathermy
why is there insulin resistance in 50-80% of PCOS patients
diminished biological response to a given level of insulin
how does insulin affect hormones in PCOS
acts as co-gonadotrophin to LH
-elevated LH or altered LH/FSH
insulin lowers sex hormone binding globulin= increased free testosterone leads to hyperandrogenism
what is the role of metformin in PCOS
can be used for ovulation induction -improves insulin resistance -reduces androgen production -increases SHBG -restores menstruation and ovulation (along with lifestyle modifications)
what medication does metformin increase the sensitivity to
clomifene
what are the risks of ovulation induction
ovarian hyperstimulation
multiple pregnancy
?risk of ovarian cancer
what are the associated risks of multiple pregnancies
hyperemesis anaemia 4 x hypertension 3 x pre-eclampsia 3 x gestational diabetes mode of delivery (post partum haemorrhage) postnatal depression/ stress early/ late miscarriage low birth weight prematurity disability stillbirth/ neonatal death twin twin transfusion therapy
what is the biggest risk in multiple pregnancies
prematurity and low birth weight
what type of twins does assisted conception create
dizygotic twins
what twins have the lambinda sign
dichorionic
what twins have the T signs
monochorionic
what is twin twin transfusion syndrome
imbalance of vascular communication between twins
what are the problems associated with prematurity
intensive support, resp support, resp distress syndrome
cerebral palsy
impaired sight
congenital heart disease
what are hormones like in ovarian failure
high levels of gonadotrophins, low oestrogen levels
what are the clinical signs of ovarian failure
amenorrhea
menopausal
what is premature ovarian failure
menopause before the age of 40
what are the causes of premature ovarian failure
genetic- turner syndrome, XX gonadal agenesis, fragile X
autoimmune ovarian failure
bilateral oophrectomy
pelvic radio/ chemotherapy
unclear
what is the treatment for premature ovarian failure
HRT (mainlin missing oestrogen)
egg or embryo donation
cryopreservation
counselling/support
what is non-obstructive azoospermia
testicular failure
what are the causes of testicular failure
genetic: klinefelters, Y chromosome micordeletion orchidectomy/ undescended testes testicular trauma/ torsion/ mumps testicular cancer pelvic radiotherapy, chemotherapy autoimmune disease
what is the medical treatment for hyperprolactinaemia
dopamine agonist (should be stopped when pregnancy occurs)
what is a progesterone challenge test
menstrual bleed in response to a five day course of progesterone- indicates oestrogen levels are normal
