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Endocrinology > Assessment of fertility > Flashcards

Assessment of fertility Flashcards

1
Q

what does GnRH stimulate the release of from the anterior pituitary

A

LH and FSH

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2
Q

in males what cells does FSH stimulate

A

sertoli

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3
Q

what cells does LH stimulate in males

A

Leydig

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4
Q

what is the 1st day of the menstrual cycle

A

first day of bleeding

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5
Q

how long a cycle is oligomenotthoea

A

> 35 days

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6
Q

what is amennorhoea

A

lack of ovulation

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7
Q

what triggers ovulation

A

LH surge

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8
Q

when are the peaks of estradiol and progesterone during the menstruation cycle

A

estradiol peak before ovulation

progesterone peak following ovulation (after released egg, produced by corpus luteum)

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9
Q

where is estrogen secreted

A

ovaries (follicles), adrenal cortex, placenta in pregnancy

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10
Q

how does estrogen affect the endometrium

A

causes it to thicken

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11
Q

what types of cervical mucous does estrogen produce

A

fertile

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12
Q

what is the feedback role of estrogen in the follicular phase

A

+ve feedback stimulating gonadotrophin secretion

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13
Q

what is the feedback role of estrogen in the luteal phase

A

high estrogen concentration inhibits (-ve feedback) secretion of FSH and prolactin

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14
Q

what is secreted by corpus luteum to maintain pregnancy

A

progesterone

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15
Q

how does progesterone affect LH

A

inhibits its secretion

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16
Q

what cervical mucous does progesterone cause

A

infertile (thick)

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17
Q

what are the role of progesterone

A

maintains pregnancy, maintains thickness of endometrium, thermogenic effect (increases basal body temp), relaxes smooth muscles

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18
Q

how do you asses ovulation

A

midluteal (day 21) serum progesterone (if more than 30 nmol than ovulation)

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19
Q

are you likely to be ovulating if you have an irregular cycle

A

no- probably anovulatory

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20
Q

what are ovulatory disorders associated with

A

oligomenorrhea and amenorrhea

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21
Q

what are the components of a diagnostic sperm analysis

A

sperm count
sperm motility
sperm morphology

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22
Q

what is azoospermia

A

no sperm

23
Q

is infertility more likely to be caused by male factors or ovulatory dysfunction

A 
male factors (50%)
female (25%)
24
Q

what are 3 the types of ovulatory disorders

A

hypothalamic pituitary failure (not producing GnRH, not stimulating LH and FSH)

hypothalamic pituitary dysfunction (normal hormones/ excess LH, PCOS)

ovarian failure

25
Q

what is hypogonadotrophic hypogonadism

A

hypothalamic pituitary failure

26
Q

what are reproductive hormones like in hypothalamic pituitary failure

A

low levels of FSH/LH
oestrogen deficiency
normal prolactin

27
Q

what reproductive feature is seen in ovulatory disorders caused by hypothalamic pituitary failure

A

amenorrhoea

28
Q

what can cause hypothalamic pituitary failure

A 
stress
excessive exercise 
anorexia/ low BMI
brain/ pituitary tumours 
head trauma/ RTX
kallmans syndrome 
drugs (steroids, opiates)
29
Q

how do you manage type 1 anovulation (hypothalamic pituitary failure)

A 
stabilise weight (BMI>18.5)
hormone therapy (pulsatile Gnrh, gonadotrophin (FSH + LH injections)
30
Q

what is the rotterdam diagnostic criteria for PCOS

A

oilgo/amenorrhoea
polycystic ovaries
clinical and or biochemical signs of hyperandrogenism (acne, hirsutism) (testosterone, sex hormone binding globulin)

31
Q

what is the fertility ‘pre treatment’ for PCOS

A 
weight loss 
smoking alcohol cessation 
folic acid 
rubella immunity 
check prescribed drugs 
semen analysis for partners 
(patent fallopian tube)
32
Q

what can be given to cause ovulation induction in PCOS

A

clomifene citrate / tamoxifen (estrogenic/ anti estrogenic effects)

gonadotrophin injections (directly stimulates ovaries)

laparoscopic ovarian diathermy

33
Q

why is there insulin resistance in 50-80% of PCOS patients

A

diminished biological response to a given level of insulin

34
Q

how does insulin affect hormones in PCOS

A

acts as co-gonadotrophin to LH
-elevated LH or altered LH/FSH
insulin lowers sex hormone binding globulin= increased free testosterone leads to hyperandrogenism

35
Q

what is the role of metformin in PCOS

A 
can be used for ovulation induction 
-improves insulin resistance 
-reduces androgen production
-increases SHBG
-restores menstruation and ovulation 
(along with lifestyle modifications)
36
Q

what medication does metformin increase the sensitivity to

A

clomifene

37
Q

what are the risks of ovulation induction

A

ovarian hyperstimulation
multiple pregnancy
?risk of ovarian cancer

38
Q

what are the associated risks of multiple pregnancies

A 
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
39
Q

what is the biggest risk in multiple pregnancies

A

prematurity and low birth weight

40
Q

what type of twins does assisted conception create

A

dizygotic twins

41
Q

what twins have the lambinda sign

A

dichorionic

42
Q

what twins have the T signs

A

monochorionic

43
Q

what is twin twin transfusion syndrome

A

imbalance of vascular communication between twins

44
Q

what are the problems associated with prematurity

A

intensive support, resp support, resp distress syndrome

cerebral palsy
impaired sight
congenital heart disease

45
Q

what are hormones like in ovarian failure

A

high levels of gonadotrophins, low oestrogen levels

46
Q

what are the clinical signs of ovarian failure

A

amenorrhea

menopausal

47
Q

what is premature ovarian failure

A

menopause before the age of 40

48
Q

what are the causes of premature ovarian failure

A

genetic- turner syndrome, XX gonadal agenesis, fragile X

autoimmune ovarian failure

bilateral oophrectomy

pelvic radio/ chemotherapy

unclear

49
Q

what is the treatment for premature ovarian failure

A

HRT (mainlin missing oestrogen)

egg or embryo donation

cryopreservation

counselling/support

50
Q

what is non-obstructive azoospermia

A

testicular failure

51
Q

what are the causes of testicular failure

A 
genetic: klinefelters, Y chromosome micordeletion 
orchidectomy/ undescended testes
testicular trauma/ torsion/ mumps 
testicular cancer 
pelvic radiotherapy, chemotherapy 
autoimmune disease
52
Q

what is the medical treatment for hyperprolactinaemia

A

dopamine agonist (should be stopped when pregnancy occurs)

53
Q

what is a progesterone challenge test

A

menstrual bleed in response to a five day course of progesterone- indicates oestrogen levels are normal

Endocrinology (46 decks)

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