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Endocrine > Assessment of infertility > Flashcards

Assessment of infertility Flashcards

1
Q

When will infertility rise?

A 
Older women
Chlamydia infections
Obesity
Male factor infertility
Awareness of treatments
Change in expectations
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2
Q

What are the chances of spontaneous pregnancy?

A

6 months - 75%
12 months - 90%
2 years - 95%

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3
Q

What is the definition of infertility?

A

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

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4
Q

What is primary infertility?

A

Never been able to concieve a pregnancy

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5
Q

What is secondary infertility?

A

Couple previously conceived although pregnancy not sucessful - miscarriage or ectopic

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6
Q

What factors will increase the chance of conception?

A 
Women under 30 
Previous pregnancy
Less than 3 years trying to concieve 
Intercourse occuring around ovulation 
BMI between 18.5 and 30 
Both non smokers
Caffeine intake less than 2 cups daily 
No use of recreational drugs
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7
Q

What are physioloical causes of anovulatory infertility?

A

Pre-pubertal
Pregnancy
Lactation
Menopause

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8
Q

What are hypothalamic causes of anovulatory infertility?

A

Anorexia/bulimia

Excessive exercise

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9
Q

What are pituitary causes of anovulatory infetility?

A

Hyperprolactinaemia
Tumours
Sheehan syndrome

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10
Q

What are ovarian causes of anovultatory infertility?

A

PCOS

Premature ovarian failure

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11
Q

What are other causes outside gynalogocial causes for anovulatory infertility?

A 
Chronic renal failure
Testosterone secreting tumours
CAH 
Thyroid 
Drugs: depo-povera, explanon, OCP
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12
Q

What are the clinical features of anorexia nervosa?

A 
Low BMI
Loss of hair
Increased languo
Low pulse
Low BP 
Anaemia
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13
Q

What are the endocrine features of anorexia nervosa?

A

Low FSH
Low LH
Los oestrogen

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14
Q

What is the aetiology of PCOS?

A

Inherited condition

Weight gain exacerbates condition

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15
Q

What are the clinical features of PCOS?

A 
Obesity
Hirsutism
Acne
Cycle abnormalities
Infertility
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16
Q

What are the endocrine features of PCOS?

A

High free androgens
High LH
Impaired glucose tolerance

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17
Q

How is PCOS diagnosed?

A

2 out of 3:
Chronic anovulation
Polycystic ovaries
Hyperandrogenism (clinical or biochem)

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18
Q

What is the aetiology of premature ovarian failure?

A 
Idiopathic
Genetic (turners, fragile X) 
Chemo
Radiotherapy
Oophorectomy
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19
Q

What are the clinical features of premature ovarian failure?

A

Hot flushes
Night sweats
Atrophic vaginitis

20
Q

What are the endocrine features of premature ovarian failure?

A

High FSH
High LH
Low oestrogen

21
Q

What are the infective causes of tubal disease?

A

PID (chlamydia, gonnrhoea, anaerobes, syphylis, TB)
Transperitoneal spread: appendicitis, intra-abdominal abscess
Following procedure: IUCD insertion, hysteroscopy, HSG

22
Q

What are the non infective causes of tubal disease?

A 
Endometriosis
Surgical (sterilisation, ectopic pregnancies)
Fibroids
Polyps
Congenital
Salpingitis isthmica nodosa
23
Q

What are the clinical features of hydrosalpinx?

A 
Abdo pain
Vaginal discharge
Cervical excitations menorrhagia
Dysmenorrhoea
Infertility
Ectopic pregnancy
24
Q

What is endometriosis?

A

Presence of endometrial glands outside uterine cavity

25
Q

What is the aetiology of endometriosis?

A

Retrograde menstruation
Altered immune function
Abnormal cellular adhesions molecules
Genetic

26
Q

What are the clinical features of endometriosis?

A 
Dysmenorrhoea
Dyspareunia
Menorrhagia
Painful defecation
Chronic pelvic pain
Retroverted and fixed uterus
Chocolate cysts
Infertility
27
Q

What endocrine problems can cause male infertility?

A

Hypogonadotrophic hypogonadism
Hypothyroidism
Hyperprolactinaemia
Diabetes

28
Q

What genetic ocnditions can cause male infertility?

A

Klienfelters syndrome
Primary cilliary dyskinesia
CF

29
Q

What drugs can decrease sperm count?

A

Alcohol, tobacco, mariuana

Testosterone supplements

30
Q

What drugs can cause hromonal imbalances in males?

A 
Marjuinaa
Testosterone supplements
Anabolic steroids 
Opiates
Spironolactone
31
Q

What drugs can decrease sex drive?

A 
Excessive alcohol
SSRI antidepressants (prozac)
32
Q

What drugs can decrease the ability of sperm to fertiize the egg?

A

CCB

Drugs for gout - colchine, allopurinol

33
Q

What are the clincal features of non obstructive male infertility?

A

4 XXY, radiotherapy, undescended testes, idiopathic
Low testicular volume
Reduces secondary sexual characteristics
Vas deferens present

34
Q

What are the endocrine features of non obstructive male infertility?

A

High LH
High FSH
Low testosteron

35
Q

What are the causes of obstructive male infertility?

A

Congenital absence - CF
Infection
Vasecomty

36
Q

What are the clinical features of obstructive male infertility?

A

Normal LH
Normal FSH
Normal testosterone

37
Q

What should be examined in an infertile woman?

A

BMI
Body hair distribution
Galactorrhoea
Pelvic exam assessing for uterine and ovarina abnormalities

38
Q

What should be examined in an infertile male?

A

BMI
General exam
Genital examination - assessment of size/position testes, penile abnormalities, presence of vas deferens, presence of varicoceles

39
Q

When should progesterone be assessed?

A

Midluteal progesterone level (day 21 of aa 28 day cycle)

A progesterone over 30 suggests ovulation

40
Q

How is tubal patency assessed?

A

Hysterosalpingiogram or laproscopy

41
Q

When should a pelvic ultrasound be performed?

A

Abnormality on pelvic exam e.g. enlarged uterus or adnexal mass
Possible polyp

42
Q

What investigations should be done in an anovulatory woman?

A 
Urine HCG
Prolacin 
TSH
Testosterone and SHBG
LH, FSH, oestradiol
43
Q

What investigations should be performed in a women with hirutism?

A

Testoesteron and SHBG

44
Q

What investigations should be perfomed in a woman with amenorrhoea?

A

Endocrine profile

Chromosome analysis

45
Q

When should semen be analysed?

A

Twice over 6 weeks apart

Need to have abstained for 3 days prior

46
Q

What are the normal semen parameters?

A 
More than 1.5 ml
pH 7.2-7.8
More than 15x10 to the power of 6 per ml
More than 50% motile
More than 4% of normal morphology
Less than 1x10 to the power of 6 WBC per ml
47
Q

What investigations should be done in an abnormal semen analysis?

A 
LH and FSH
Testosterone 
Prolactin
Thyroid function 
Chromosome analysis
CF
Testicular biopsy

Endocrine (35 decks)

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