Causes Of Infertility

Question 1

what is kallmanns syndrome

Answer 1

Genetic disorder that causes that causes hypogonadotropic hypogonadism and an impaired sense of smell

Question 2

who is more likely to get kallmanns syndrome

Answer 2

males
although affects both genders

Question 3

clinical presentation of kallmanns syndrome

Answer 3

hypogonadism
hyposmia/anosmia

Question 4

management of kallmanns syndrome

Answer 4

hormone replacement therapy

Question 5

what is the most common genetic cause of hypogonadism

Answer 5

klinefelter’s syndrome

Question 6

what causes klinefelters syndrome

Answer 6

genetic nondisjunction

Question 7

genotype usually seen in klinefelters

Answer 7

47 XXY

Question 8

investigation for klinefelters

Answer 8

karyotyping

Question 9

complications of klinefelters

Answer 9

• increased incidence of cryptorchidism, learning disability and psychosocial issues
• Increased risk of breast cancer and non-Hodgkin lymphoma

Question 10

what is premature ovarian failure

Answer 10

when ovaries stop working before the age of 40

Question 11

name some genetic causes of premature ovarian failure

Answer 11

turners syndrome
fragile X

Question 12

name some other causes of premature ovarian failure

Answer 12

idiopathic
chemo/radiotherapy
oophorectomy

Question 13

clinical presentation of premature ovarian failure

Answer 13

hot flushes, night sweats
atrophic vaginitis
amenorrhoea
infertility

Question 14

endocrine features of premature ovarian failure

Answer 14

high FSH, LH
low oestradiol

Question 15

management of premature ovarian failure

Answer 15

HRT
egg or embryo donation
cryopreservation if it is anticipated

Question 16

what is the most common endocrine disorder in women

Answer 16

polycystic ovary syndrome

Question 17

how do people get PCOS

Answer 17

its inherited

Question 18

what can PCOS be exacerbated by

Answer 18

weight gain

Question 19

what is associated with PCOS

Answer 19

insulin resistance

Question 20

clinical presentation of PCOS

Answer 20

obesity
hirsutism or acne
cycle abnormalities and infertility

Question 21

what is needed for a diagnosis of PCOS

Answer 21

2/3 of:
1. oligo/amenorrhoea
2. polycystic ovaries
3. clinical or biochemical signs of hyperandrogenism (acne, hirsutism)

Question 22

what are the signs of polycystic ovaries (3)

Answer 22

increased ovarian volume
12+ 2-9mm follicles
unilateral or bilateral

Question 23

endocrine features of PCOS

Answer 23

• high free androgens
• normal oestrogen levels
• high LH
• impaired glucose tolerance
  
  • normal pancreatic reserve, so hyperinsulinemia

Question 24

what is given to patients with PCOS who want to get pregnant

Answer 24

clomiphene citrate

Question 25

what is given to restore menstruation and ovulation in patients with PCOS

Answer 25

metformin

Question 26

what is anorexia nervosa

Answer 26

an eating disorder characterised by a pathological fear of gaining weight and distorted body image

Question 27

who is more likely to develop anorexia

Answer 27

females

Question 28

endocrine features of anorexia nervosa

Answer 28

low FSH, LH and oestradiol

Question 29

what is the problem in type 1 ovulatory disorder

Answer 29

hypothalamus

Question 30

what is the problem in type 2 ovulatory disorder

Answer 30

pituitary

Question 31

what is the problem in type 3 ovulatory disorder

Answer 31

ovaries

Question 32

what is type 4 ovulatory disorder

Answer 32

PCOS

Question 33

how can we assess ovulation in a patient with regular cycles

Answer 33

midluteal serum progesterone

Question 34

how can we assess ovulation in a patient with irregular cycles

Answer 34

hormone evaluation

Question 35

what is a progesterone challenge test

Answer 35

administration of progesterone to induce a period

Question 36

what would indicate a normal result in a progesterone challenge test

Answer 36

withdrawal bleeding 7-10 days after progesterone

Question 37

what other tests can you do in ovulatory disorders

Answer 37

MRI of pituitary transvaginal ultrasound bone density scan

Question 38

management of type 1 anovulation

Answer 38

stabilise weight pulsatile GNRH or gonadotrophin daily injections

Question 39

what is used to asses if treatment of type 1 anovulation is working

Answer 39

ultrasound

Question 40

what are the 2 main types of tubal disease

Answer 40

infective and non-infective

Question 41

name some causes of infective tubal disease

Answer 41

pelvic inflammatory disorder transperitoneal spread e.g. appendicitis following a procedure

Question 42

name some infections associated with pelvic inflammatory disorder

Answer 42

chlamydia, gonorrhoea

Question 43

name some non-infective causes of tubal disease

Answer 43

endometriosis fibroids, polyps congenital

Question 44

what can occur as a result of pelvic inflammatory disorder

Answer 44

hydrosalpinx

Question 45

what is hydrosalpinx

Answer 45

the fallopian tube is blocked and fills with serous or clear fluid near the ovary

Question 46

clinical presentation of pelvic inflammatory disorder

Answer 46

abdo/pelvic pain febrile vaginal discharge infertility/ectopic pregnancy

Question 47

what is endometriosis

Answer 47

the presence of endometrial glands outside the uterine cavity

Question 48

how do we investigate endometriosis

Answer 48

US scan

Question 49

US scan of a patient with endometriosis

Answer 49

uterus fixed and retroverted chocolate cysts on ovary

Question 50

clinical presentation of endometriosis

Answer 50

dysmenorrhoea usually before menstruation painful sex, defaecation chronic pelvic pain menorrhagia

Question 51

what is primary hypogonadism

Answer 51

the testes are primarily affected

Question 52

name some congenital causes of primary hypogonadism

Answer 52

klinefelter's syndrome cryptorchidism Y-chromosome microdeletions

Question 53

acquired causes of primary hypogonadism

Answer 53

testicular trauma/torsion chemo/radiotherapy varicocele mumps

Question 54

what is varicocele

Answer 54

varicose veins in the scrotum

Question 55

what is secondary hypogonadism

Answer 55

hypothalamus or pituitary is primarily affected

Question 56

hypergonadotrophic hypogonadism

Answer 56

primary

Question 57

hypogonadotrophic hypogonadism

Answer 57

secondary

Question 58

name 2 congenital causes of secondary hypogonadism

Answer 58

kallmanns prader-willi syndrome

Question 59

name some acquired causes of secondary hypogonadism

Answer 59

pituitary damage hyperprolactinaemia obesity/diabetes acute systemic illness eating disorders, excessive exercise

Question 60

clinical presentation of pre-pubertal onset of male hypogonadism

Answer 60

small sexual organs decreased body hair, high pitched voice gynaecomastia decreased bone and muscle mass

Question 61

clinical presentation of post-pubertal onset of male hypogonadism

Answer 61

normal pubertal development decreased libido decreased pubic/axillary hair decreased muscle and bone mass

Question 62

investigations of male hypogonadism

Answer 62

1. measure AM testosterone 2. repeat if low 3. measure LH/FSH

Question 63

elevated LH/FSH hypogonadism

Answer 63

hypergonadotrophic hypogonadism

Question 64

low/inappropriately normal LH/FSH hypogonadism

Answer 64

hypogonadotrophic hypogonadism

Question 65

when should testosterone be measured and why

Answer 65

8-11AM as it peaks in the morn

Question 66

management of male hypogonadism

Answer 66

testosterone replacement therapy

Question 67

when is testosterone replacement contraindicated

Answer 67

previous hormone responsive cancer possible prostate cancer haematocrit >50% severe sleep apnoea or heart failure