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RDS Test 1 > B8.001 Infertility: Evaluating the Infertile Couple > Flashcards

B8.001 Infertility: Evaluating the Infertile Couple Flashcards

1
Q

infertility

A

<35 : no preg with timed intercourse for at least 1 year
>35: no preg with times intercourse for at least 6 mo
women > 40 qualify for immediate eval

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2
Q

relationship between maternal age and fertility/ aneuploidy/ live birth/ miscarriage

A

infertility increased with age, nearly exponential shape after 40
aneuploidy and miscarriage increases with age
chance of live birth decreases with age

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3
Q

prevalence of infertility

A

15% of couples

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4
Q

why might you do an earlier infertility workup

A 
irregular periods
severe endometriosis
known problems with tubes or uterus
known or suspected male subfertility
maternal age > 39
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5
Q

general steps in pregnancy

A
  1. egg release (ovulation)
  2. sperm must reach egg (fertilization)
  3. fertilized egg travels through fallopian tube
  4. implantation of fertilized egg onto inside of uterus
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6
Q

causes of infertility

A

male only 8%
female only 33%
male and female 35%
unexplained 24%

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7
Q

general process of diagnosing infertility

A 
both partners evaluated at the same time if possible
H&amp;P
preconception counseling
genetic screening
diagnostic testing
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8
Q

components of infertility diagnostic evaluation

A

ovulatory function
ovarian reserve
uterine or fallopian tube abnormalities
semen analysis

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9
Q

components of ovulatory function testing

A 
menstrual history
basal body temp
ovulation prediction kits
US monitoring
mid luteal progesterone
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10
Q

causes of WHO 1 infertility

A

stress
exercise
diet

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11
Q

causes of WHO 2 infertility

A

polycystic ovaries
hyperandrogenism
irregular menses

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12
Q

causes of WHO 3 infertility

A

fragile X
autoimmune
Turner’s
galactosemia

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13
Q

treatment of WHO 1 infertility

A

behavioral modification

gonadotropins

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14
Q

treatment of WHO 2 infertility

A

behavioral modifications

letrozole

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15
Q

treatment of WHO 3 infertility

A

hormone replacement therapy

donor oocytes

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16
Q

when would you consider ovarian reserve testing

A 
>35
tobacco use
prior ovarian surgery
prior gonadotoxin exposure
1st degree relative w menopause < 40
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17
Q

how to test ovarian reserve

A

antimullerian hormone
CD3 FSH and estradiol
antral follicle count

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18
Q

how to evaluate uterine or fallopian tube abnormalities

A

MRI
hysterosalpingogram (HSG)
saline sonogram (SIS)
hysteroscopy / laparoscopy

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19
Q

effects of chlamydia on tubal infertility

A

causes a build up of scarring that can block the fallopian tube and prevent fertilization

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20
Q

tubal HSG findings in genital TB

A 
specific:
beaded tube
golf club tube
pipestem tube
cobblestone tube
leopard skin tube
nonspecific:
hydrosalpinx
mucosal thickening
peritubal adhesion
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21
Q

uterine HSG findings in genital TB

A 
specific:
T shaped uterus
pseudounicornate uterus
trifoliate uterus
nonspecific:
endometriosis
syneciae
distortion of uterine contour
venous, lymphatic intravasation
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22
Q

how to assess male factors of infertility

A

semen analysis

  • if abnormal: abstain 2-5 days and repeat
  • if normal: assess frequency and timing of intercourse
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23
Q

workup for male factors of infertility

A 
previous fertility/infertility
sexual dysfunction
GU anomaly
previous GU surgeries
toxic exposures
occupation / lifestyle
med/ psych illnesses
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24
Q

what to assess if semen analysis is abnormal

A

-optimize medical health
-optimize psychological health
-avoid toxins
-healthy lifestyle
IF STILL ABNORMAL
-T, PRL, E2, LH, FSH
-urology consult

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25
Q

oligospermia

A

low sperm concentration/ count

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26
Q

asthenospermia

A

low sperm motility

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27
Q

teratospermia

A

abnormal sperm morphology

28
Q

steps of semen analysis

A
  1. confirm length of abstinence (2-5 days)
  2. produce semen sample
  3. liquification (<1 hr on benchtop, 15-30 min at 37C)
  4. basic semen analysis performed, viscosity noted
29
Q

what can cause liquification problems

A

environment/ occupation

30
Q

semen analysis parameters

A 
volume > 1.5 mL
pH 7.2-8.0
concentration > 15x10^6
motility >39%
total motile > 40x10^6
vitality >75%
morphology >4% normal
WBC < 1x10^6
31
Q

sperm morphology

A 
head 
-acrosomal vesicle
-nucleus
tail
-midpiece w mitochondria
-flagellum
32
Q

artificial insemination

A

intrauterine insemination
no male factor to mild male factor
used with natural cycles in combination with ovulation induction or superovulation

33
Q

treatment of low sperm count

A

IUI (total motile > 10mil)
IVF (total motile < 10 mil)
ICSI (total motile < 10 mil)

34
Q

treatment of low motility/ poor forward progression

A

NECA (adenosine analog)

IUI

35
Q

treatment of anti-sperm antibodies

A

chymotrypsin/ galactose

IUI

36
Q

chymotrypsin

A

media which aids in degradation of Ab/sperm complexes

breaks down proteins in ejaculate

37
Q

galactose

A

media which prevents sperm from binding to Ig

38
Q

treatment of poor liquefaction

A

chymotrypsin/ chymotrypsin inhibitor

IUI

39
Q

varicocele

A

swelling of veins that drain the testicle

most common reversible cause of male infertility

40
Q

infection and male infertility

A

some infections can interfere with sperm production or sperm health or can cause scarring that blocks the passage of sperm
some result in permanent testicular damage, but usually sperm can still be retrieved

41
Q

examples of infections that can contribute to male infertility

A

epididymitis
orchitis
STIs: gonorrhea, HIV

42
Q

retrograde ejaculation

A

semen enters the bladder during orgasm

caused by: diabetes, spinal injury, medications, surgery

43
Q

medical causes of male infertility

A 
anti sperm Abs
undescended testicles
hormone imbalances
tumors
blockage/transport tubule defect
44
Q

semen without sperm or fructose

A

may indicate absence of the seminal vesicles, absence of the vas deferens in the areas of the seminal vesicles, or an obstruction at the level of the seminal vesicles

45
Q

chromosomal/ genetic causes of male infertility

A

klinefelters (XXY)
CF (blockage/absence of sperm canal)
kallmann’s (hypogonadotropic hypogonadism)
kartagener’s (dysfunctional ciliated/flagellated cells)

46
Q

medications that can lead to male infertility

A 
testosterone replacement therapy
long term anabolic steroid use
cancer meds
certain antifungals
ulcer drugs
47
Q

environmental causes of male infertility

A 
industrial chemicals
heavy metal exposures
radiation or x-rays
overheating the testicles
occupation (sitting, outdoor, tight clothing)
48
Q

treatments for female infertility

A
  1. ovulation induction or superovulation
    - letrozole
    - clomiphene citrate (SERM)
    - gonadotropins
  2. surgery
    - correct uterine or tube abnormalities
  3. intrauterine insemination
    - male factor or unexplained
  4. IVF
49
Q

IUI

A

intrauterine insemination

50
Q

TDI

A

therapeutic donor insemination

51
Q

what is IUI

A

fertility treatments that uses catheter to place washed sperm directly into uterus

52
Q

IVF

A

in vitro fertilization

53
Q

what is IVF

A 
eggs surgically removed from ovary
sperm mixed with egg outside body
fertilized egg (embryo) places into uterus
54
Q

prevalence of IVF

A

<5% of all fertility treatments

55
Q

treatment for unexplained infertility

A

clomid + IUI

56
Q

treatment for PCOS infertility

A

letrozole

57
Q

treatment for bilateral tubal occlusion infertility

A

IVF

58
Q

preimplantation genetic diagnosis

A

direct testing of IVF embryos

typically for single, inherited genetic disease

59
Q

preimplantation genetic screening

A

direct testing of IVF embryos for large scale chromosome abnormalities (trisomy, deletions, duplication)
recommended for advanced maternal age and recurrent pregnancy loss

60
Q

impact of stress on chance of getting pregnant

A

controversial

stress reduction may improve fertility

61
Q

preconception health

A 
stop tobacco use
no illicit drugs
limit alcohol/caffeine
maintain a healthy weight
take vitamins (folic acid for women, antioxidants for men)
get vaccinated
Zika precautions
62
Q

tobacco and fertility

A

smoking delays conception for more than a year
lowers egg count
increased risk of defects and miscarriage
lowers chance for success
in 3 months after cessation, sperm quality improves

63
Q

marijuana and fertility

A

reduces sperm number and quality
reduces testosterone production
reduces number of eggs retrieved with IVF
increased risk of premature delivery

64
Q

alcohol and fertility

A

3 glasses of wine per day impairs fertility in men
2 glasses of wine per day impairs fertility in females
decreases embryo quality
increases risk of FAS in children

65
Q

caffeine and fertility

A

lower live birth rates with IVF
may inhibit egg maturation
not a clear association

66
Q

recessive carrier screen

A

recommendations vary by ethnicity
blood test offered to all women pursuing pregnancy
1/30 caucasians are carriers for CF
recent technology can prevent rare genetic conditions in offspring

RDS Test 1 (22 decks)

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