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Cardio > Biochemistry Pregnancy and Fertility > Flashcards

Biochemistry Pregnancy and Fertility Flashcards

1
Q

Definition of sub-fertility →

Cumulative conception rates:

A
  1. 4 Months 65%
  2. 9 Months 82%
  3. 12 Months 85%
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2
Q

Causes of Subfertility →

A
  1. Ovulatory failure 21%
  2. Tubal damage 14%
  3. Endometriosis 6%
  4. Mucus defect 3%
  5. Sperm defects 24%
  6. Other male 2%
  7. Coital failure 6%
  8. Unexplained 28%
  9. Others 11%
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3
Q

Assessment of Ovulation →Progesterone (nmol/L)

A

> 30 ovulation (not sub-fertile)
<30 reduced conception rate
Low level repeat next cycle

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4
Q

“day 21” progesterone
7 days before menses

Note → Variability in period together → change in follicular phase not luteal phase.
Timing

A

“day 21” progesterone
7 days before menses

Note → Variability in period together → change in follicular phase not luteal phase.

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5
Q

Primary Ovarian Failure →

A
  1. Impaired follicular development >
    a. Low oestradiol
    b. High LH/FSH (better marker) – PCOS or irregular ovulation – can alter LH levels.

→ No negative feedback to hypothalamus.

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6
Q

Causes of Ovarian Failure

A 
➢	Premature ovarian Failure
➢	Post menopausal
➢	Autoimmune damage
➢	Surgery
➢	Irradiation (late effects of childhood or early adult cancer)
➢	Dysgenesis (Turners Syndrome)
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7
Q

Secondary Ovarian Failure

A

➢ Impaired LH/FSH production
➢ Low LH/FSH – not completely suppressed *
➢ Impaired follicular development > low estradiol

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8
Q

Causes of secondary Ovarian Failure

A
  • LHRH deficiency (Kalmann’s syndrome)
  • Pituitary tumours (prolactinoma)
  • Secondary hypopituitarism e.g. irradiation, infiltrative and vascular disorders
  • Function – weight loss, stress, exercise, starvation
  • Systemic disease – e.g. thyroid, adrenal
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9
Q

Kallmann’s Syndrome:

A
  1. Absent sense of smell

2. Won’t go into puberty

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10
Q

Polycystic Ovarian Syndrome → Epi

A

87-90% oligomenorrhea, 26-37% amenorrhoea

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11
Q

Polycystic Ovarian Syndrome → Diagnosis

A
  1. Ultrasound → 15 cysts arranged around cortex, echogenic stromal compartment.
  2. Or Endocrine studies (less time consuming)
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12
Q

Polycystic Ovarian Syndrome → Characteristic features of PCOS

A
  1. Obesity
  2. Insulin resistance – independent from obesity contribution
  3. Increased cardiovascular risk
  4. Hirsutism
  5. Oestrogenisation – from multiple follicles
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13
Q

Polycystic Ovarian Syndrome → Serum Levels

A

LH increased
FSH normal
LH:FSH ratio abnormal
Testosterone increased (free testosterone is a better discrimination

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14
Q

Polycystic Ovarian Syndrome → Abnormal

A

Not all patients show the pattern
LH 12.6 93.1-26.0) 1-10 iu/L
• Sensitivity (positivety in disease)-60%
• Specificity (negativity in health)-94%

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15
Q

Hormonal Assessment of the infertile male:

A

Semen Analysis
Abnormal
Testicular Problem

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16
Q

Semen Analysis

A

Normal – no endocrine tests

Abnormal

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17
Q

Abnormal

A

LH/FSH, prolactin testosterone
• Testicular problem
• Hypothalamic pituitary

18
Q

Testicular Problem

A

Normal endocrinology

Abnormal endocrinology

19
Q

Hypergonadotrophic hypogonadism (testicular failure)

serum levels

A

Low Testosterone
High LH
High FSH

20
Q

Isolated germinal compartment failure serum levels

A 
Normal testosterone
Normal LH (acting on Leydig)
High FSH (abnormal sertoli cell function)
21
Q

Non-Endocrine – impaired sperm serum levels

A 
Obstructive azoospermia
Retrograde ejaculation
→ Normal Testosterone
→ Normal LH
→ Normal FSH
22
Q

Hypogonadotrophic hypogonadism → serum levels

A

Low Testosterone, LH, FSH

23
Q

Chemical

A

Increases – Alk phos, hormone binding proteins

Decreases – Albumin, creatinine, urea

24
Q

Physiological

A

Increases – plasma volume, cardiac output, weight gain, GFR early pregnancy
Deceases – Fasting BG early pregnancy, renal threshold for glucose

25
Q

Endocrine

A

Increase – Oestrogen, progesterone, prolactin, hCG

Decrease – LH and FSH

26
Q

Gestational diabetes → Epi

A

1-2% women develop gestational diabetes

27
Q

Gestational diabetes → Diagnostic problem

A

15% women develop g;ycosuria

No accepted reference ranges

28
Q

Gestational diabetes → Diagnostic tests

A

Blood glucose, random/fasting

GTT (glucose tolerance)

29
Q

Gestational diabetes → Risk Factors for gestational diabetes

A
  • BMI >30 kg/m2
  • Previous macrosomic baby weighing >4.5 kg
  • Previous gestational diabetes
  • Family history diabetes (first degree relative)
  • Family origin with a high prevalence of diabetes
30
Q

Gestational diabetes → Diagnostic tests

A

Blood tests: U and E, urate, urine protein, clotting, LFT

HELLP

31
Q

Gestational diabetes → HELLP

A

Haemolysis, Elevated Liver enzymes, low Platelets

32
Q

Gestational diabetes → HELLP diagnosis

A

Abnormality seen with raised ALT/AST

33
Q

Gestational diabetes → Urate in gestational diabetes

A

Independent raise in pregnancy not explained by the change in renal function associated with pregnancy
Increase urate = worse prognosis

34
Q

Pregnancy related liver disease “Big 5”

A
  1. Pre-eclampsia
  2. HELLP
  3. Hyperemesis Gravidarum
  4. Acute Fatty Liver of Pregnancy
  5. Obstetric Cholestasis
35
Q

Pregnancy Unrelated Liver Disease

A
  1. Pre-existing liver disease

7. Liver disease co-incident with pregnancy

36
Q

Obstetric Cholestasis → Definition

A

Usually occurs in the 3rd trimester

Significant peri-natal mortality and maternal morbidity

37
Q

Obstetric Cholestasis → Cardinal feature

A

Generalised puritis (not specific)

38
Q

Obstetric Cholestasis → Biochemical tests

A

Serum bile acids (sensitive but not specific)
ALT and AST often raised
Alkaline phosphatase and bilirubin – no significant contribution

39
Q

Second Trimester

A

Triple or quadruple test which provides the current standard of a detection rate above 75% and a false-positive rate of less than 3%

40
Q

New Guidance First trimester

A

The “combined test” (nucal translucency, hCG, pregnancy associated plasma protein A) should be offered between 11-13 weeks 6 days

41
Q

Down’s Syndrome Screening Markers – 2nd Trimester

A 
AFP
hCG
Free-beta hCG
Alpha hCG
Unconjugated estriol (uE3)
Inhibin – A
42
Q

Down’s Syndrome Screening Markers – 1st Trimester

A

Pregnancy associated plasma protein A nuchal translucency

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