CH. 46 Female Infertility

Question 1

what is the function of the cervix?

Answer 1

to secrete mucus for the mobility of the sperm, and keep pregnancy within the uterus

Question 2

what would be two indications to evaluate the cervicx with ultrasound?

Answer 2

• pregnancy
• Hx of miscarriage (incompetent cervix)

Question 3

what is the normal cervical length?

Answer 3

> 3cm

Question 4

when evaluating the uterus what structures are you assessing?

Answer 4

• structural anatomy of the myometrium
• endometrium

Question 5

can you typically see the fallopian tubes?

Answer 5

no

Question 6

how can they evaluate the function of the fallopian tubes?

Answer 6

hysterosalpingogram or Saline Infused sonogram (SIS)

Question 7

list the ovarian phases

Answer 7

follicular phase, ovarian phase, and luteal phase

Question 8

what should the size of a follicle in the follicular phase be?

Answer 8

less than 5mm

Question 9

what size should a dominant follicle be in the ovarian phase?

Answer 9

22mm

Question 10

what size should a corpus lutein cyst be in the luteal phase?

Answer 10

2-5mm

Question 11

what is the sonographic appearance of the dominant follicle?

Answer 11

• round
• anechoic
• approx 2.2cm

Question 12

what is the sonographic appearance of the corpus luteum?

Answer 12

small hypoechoic structure peripherally within the ovary that can also be filled with blood and be more echo-filled with a ring of fire

Question 13

describe PCOS

Answer 13

• inhibits FSH and LH
• never produces a dominant follicle and doesn’t ovulate like it should
• have at least 19 small follicles around the periphery of the ovary

Question 14

list two factors that may cause pain and infertility in the peritoneal cavity

Answer 14

• adhesions
• endometriosis

Question 15

describe how you would perform a fertility series of ultrasound.

Answer 15

• make sure follicles are <15mm
• scan after meds are given and assess growth of follicles and endo thickness. you want follicles to get to >20mm and make sure endo becomes trilaminar
• monitor every few days and measure follicles

Question 16

what are the two most common drugs used to stimulate follicles?

Answer 16

• pergonal
• clomid

Question 17

what can be a consequence of using these fertility drugs?

Answer 17

ovarian hyperstimulation syndrome

Question 18

what is ovarian hyperstimulation syndrome (OHS)?

Answer 18

where the ovaries produce multiple large cysts that don’t ovulate and ovaries become very enlarged

Question 19

how does OHS appear on ultrasound?

Answer 19

• enlarged ovaries
• multiple large, anechoic cysts

Question 20

how is insemination performed?

Answer 20

• strong sperm is collected and is placed directly in the uterus with a catheter for fertilization

Question 21

how is IVF performed?

Answer 21

• when there is fertilization of an egg outside the body
• they aspirate the oocytes, incubate them until fertilization occurs and then the embryos are placed into the uterus

Question 22

where is the embryo placed with traditional IVF?

Answer 22

the uterus

Question 23

what does GIFT stand for?

Answer 23

gamete intrafallopian transfer

Question 24

where are the sperm and egg placed in GIFT?

Answer 24

in the fallopian tube

Question 25

where does fertilization take place in GIFT?

Answer 25

in the fallopian tube

Question 26

What does ZIFT stand for?

Answer 26

zygote Intrafallopian transfer

Question 27

where are the sperm and egg joined with ZIFT?

Answer 27

in a petri dish

Question 28

where is the embryo placed after several days with ZIFT?

Answer 28

the fallopian tube

Question 29

list three complications of assisted reproduction

Answer 29

- ovarian hyperstimulation syndrome - multiple gestations - ectopic pregnancy