B8-001 Infertility Flashcards
women over […] qualify for immediate fertility evaluation
40
[…] is most predictive of fertility
maternal age
the egg is typically fertilized in the […] of the fallopian tube
ampulla
when is the embryo implanted in IVF?
day 6-7
(when it would physiologically be in the uterus preparing for implantation)
indications for ovarian reserve testing [5]
greater than 35 yo
tobacco use
prior ovarian surgery
prior gonadotoxin exposure
primary relative with POI
test most indicated for uterine/fallopian tube abnormalities
hysterosalpingogram (HSG)
pathogens causing tubal infertility
chlamydia
gonorrhea
TB (worldwide)
critical window for male abstinence allowing for proper evaluation of sperm
2-5 days between ejaculates
if primary semen analysis is abnormal, what is the recommendation?
lifestyle changes
if repeat semen analysis is abnormal, what is the recommendation?
labs looking at testosterone, prolactin, estrogen, LH, FSH
urology consult for anatomical issues
low sperm concentration/count
oligospermia
low sperm motility
asthenospermia
low/abnormal sperm morphology
teratospermia
a basic pH of the semen can indicate
GU infection
a acidic pH of the semen can indicate
obstructive azoospermia or blocked seminal vesicles
normal volume for semen analysis
> 1.5 mL
normal pH for semen analysis
7.2-8.0
normal concentration for semen analysis
greater than 15 million
(consider length of abstinence)
normal motility for semen analysis
greater than 39%
(lower indicates membrane issue)
normal total motile sperm for semen analysis
greater than 40 x 10^6
normal vitality for semen analysis
greater than 75%
normal morphology for semen analysis
greater or equal to 4%
normal WBC for semen analysis
less than 1 million
(higher indicates chronic inflammation)
treatment of male infertility with a sperm count greater than or equal to 10 million
intrauterine insemination
treatment of male infertility with a sperm count less than 10 million
IVF or ICSI
treatment of male infertility due to low motility
NECA via IUI
NECA stimulates sperm motility
treatment of male infertility due to anti-sperm antibodies
chymotrypsin/galactose via IUI
treatment of male infertility due to poor liquefaction
chymotrypsin/chymotrypsin inhibitor via IUI
most common reversible cause of male infertility
varicocele
(swelling of veins that drain the testes)
pathogens causing epididymitis/orchitis
[2]
gonorrhea
HIV
causes of retrograde ejaculation
diabetes
spinal injuries
medications
GU surgery
the presence of fructose indicates a […] origin of azoospermia
testicular
absence of fructose and sperm in semen analysis indicates
absence of seminal vesicles, vas defrens, or obstruction
chromosomal causes of male infertility [4]
klinefelters
cystic fibrosis
kallmann’s syndrome
kartagener’s syndrome
aromatase inhibitor
letrozole
SERM
clomiphene citrate
approved for estrogen + breast cancer
letrozole
estrogen agonist on ovaries
antagonist on uterus
clomiphene citrate
adverse effects of clomiphene citrate [3]
hot flashes
mood swings
increased risk of multiples
treatment for male factor or unexplained fertility
IUI
direct testing of embryos for single, inherited genetic disease
preimplantation genetic testing for monogenic disease (PGT-M)
direct testing of IVF embryos for numeric chromosome abnormalities
used in women of AMA and recurrent pregnancy loss
preimplantation genetic testing for aneuploidy (PGT-A)
asthenospermia means…
low motility, less than 39%
oligospermia means…
low concentration
less than 15,000/ml
prolonged abstinence will negatively affect […] of sperm in semen analysis
motility
[…] is secreted from the seminal vesicles, and will reveal if lack of sperm is at the level of the seminal vesicles
fructose
first line therapy for fertility therapy in women with PCOS
aromatase inhibitor (letrozole)
[…] are effective in ovulation induction in PCOS but are not first line as the risk of multiple gestation pregnancy is significantly higher
gonadotropins
viable option for PCOS related infertility that has not responded to pharmacotherapy
ovarian drilling
most common presentation for women with hydrosalpinx
infertility
best management for infertility in a patient with Turner’s syndrome
donor oocytes after cardiac clearance
(turner’s patients have increased risk of aortic rupture that doubles with pregnancy due to increased blood volume)
first line therapy in women with WHO 1 amenorrhea
behavioral modification
resumption of menses may take up to […] in women with WHO 1 amenorrhea following behavioral modification
18 months
