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Endocrine lectures > Assessment of infertility > Flashcards

Assessment of infertility Flashcards

1
Q

what is the definition of infertility?

A

failure to achieve a clinical pregnancy after 12 months of more of regular unprotected sexual intercourse (in absence of known reason) in a couple who have never had a child (WHO definition)

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2
Q

how long do you have to wait for IVF treatment in tayside?

A

2 years

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3
Q

which factors increase the chances of conception?

A

Woman aged under 30 years
Previous pregnancy
Less than three years trying to conceive
Intercourse occurring around ovulation
Woman’s body mass index (BMI) 18.5 – 30m/kg2
Both partners non-smokers
Caffeine intake less than two cups of coffee daily
No use of recreational drugs

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4
Q

what are common causes of secondary infertility?

A

tubal disease
fibroids
endometriosis/adenomyosis
weight related
age related

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5
Q

what are the physiological causes of infertility?

A

before puberty, pregnancy, lactation, menopause

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6
Q

what are gynaecological causes of infertility?

A

hypothalamic: anorexia/bulimia, excessive exercise
pituitary: hyperprolactinaemia, tumours, Sheehan syndrome
ovarian: PCOS, premature ovarian failure

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7
Q

what are the blood results in anorexia nervosa

A

low FHS, LH and oestradiol

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8
Q

what are the features of PCOS?

A

obesity, hirsutism or acne, menstrual cycle abnormalities and infertility

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9
Q

what is the criteria for a diagnosis of PCOS?

A

chronic anovulation
polycystic ovaries
hyperandrogenism (clinical or biochemical)

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10
Q

what can cause premature ovarian failure?

A

idiopathic, genetic (Turner’s syndrome, fragile X), chemotherapy, radiotherapy, oophorectomy

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11
Q

what are the clinical features of premature ovarian failure?

A

hot flushes, night sweats, atrophic vaginitis, amenorrhoea, infertility

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12
Q

what are the biochemical features in premature ovarian failure?

A

high FSH, high LH, low oestradiol

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13
Q

what are the inflammatory 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

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14
Q

what are the non infective causes of tubal disease?

A

endometriosis
surgical (sterilisation, ectopic pregnancies)
fibroids
polyps
congenital
salpingitis isthmica nodosa

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15
Q

what is the definition of endometriosis?

A

presence of endometrial glands outside uterine cavity

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16
Q

what is the cause of endometriosis?

A

Retrograde menstruation is most likely cause, altered immune function, abnormal cellular adhesion molecules, genetic

17
Q

what are the clinical features of endometriosis?

A

dysmenorrhoea (classically before menstruation), dysparenuia, menorrhagia, painful defaecation, chronic pelvic pain, uterus may be fixed and retroverted, scan may show characteristic ‘chocolate’ cysts on ovary, infertility, asymptomatic

18
Q

what are some examples of non obstructive male infertility?

A

47 XXY, chemotherapy, radiotherapy, undescended testes, idiopathic

19
Q

what are the clinical features of non obstructive male infertility?

A

low testicular volume
reduced secondary sexual characteristics
vas deferens present

20
Q

what are the biochemical features of non obstructive male infertility?

A

High LH, FSH and low testosterone

21
Q

what are some examples of obstructive infertility?

A

congenital absence (cystic fibrosis), infection, vasectomy

22
Q

what are the clinical features of obstructive male infertility?

A

normal testicular volume
normal secondary sexual characteristics
vas deferens may be absent

23
Q

what are the biochemical features of obstructive male infertility?

A

Normal LH, FSH and testosterone

24
Q

how is female infertility investigated?

A

BMI
General examination, assessing body hair distribution, galactorrhoea
Pelvic examination, assessing for uterine and ovarian abnormalities/tenderness/mobility

25
Q

how is male infertility investigated?

A

BMI
General examination
Genital examination, assessing size/position testes, penile abnormalities, presence vas deferens, presence varicoceles

Endocrine lectures (32 decks)

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