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Block I: Reproduction & Sexuality > Clinical: Infertility and ART > Flashcards

Clinical: Infertility and ART Flashcards

1
Q

Define infertility

A

Inability to conceive after 12 months of regular unprotected sexual intercourse

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2
Q

Define primary infertility

A

If NO previous pregnancy

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3
Q

Define secondary infertility

A

If previous pregnancy(ies)

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4
Q

When to investigate and/or treat infertility

A
  • After 12 months usually
  • After 6 months, if obvious problems (i.e. oligomenorrhea, testicular surgery, advanced age)
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5
Q

5 causes of infertility

A
  • Male factor
  • Anovulatory
  • Tubal factor
  • Other
  • Unexplained
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6
Q

5 possible components of a history for male factor infertility

A
  • Previous children
  • Surgery
  • Disease
  • Medication
  • Coital problems
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7
Q

4 points to examine for male factor infertiltiy

A
  • Secondary sexual characteristics
  • Testicular volume
  • Vas deferens
  • Epididymis
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8
Q

4 points to consider in seminal analysis for male factor infertility

A
  • WHO criteria
  • Volume
  • Leucocytospermia
  • Antibodies
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9
Q

3 points of the WHO criteria for male factor infertility seminal analysis

A
  • 20 x 106/mL
  • 40% motile
  • 40% normal morphology
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10
Q

3 types of male factor infertility

A
  • Oligo-astheno-teratozo-spermia (80 - 90%)
  • Coital or ejaculatory failure (5 - 10%)
  • Azoospermia (5%)
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11
Q

5 tests for male factor infertility

A
  • Serum FSH, LH, PRL ,Testosterone
  • Karyotype
  • Scrotal US
  • Vasography
  • Testicular biopsy
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12
Q

3 things to look for in a scrotal US for male factor infertility

A
  • Masses
  • Varicocele
  • Absent vas
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13
Q

Treatment for obstructive male factor infertility

A

Reconstructive surgery or surgical sperm retrieval

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14
Q

Treatment for testicular failure male factor infertility

A

Donor insemination

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15
Q

Treatment for large varicocele male factor infertility

A

Excision

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16
Q

Treatment for hypothalamic disease male factor infertility

A

GnRH or FSH/LH

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17
Q

Treatment for oligo-astheno-teratozo-spermia male factor infertility

A

Supportive

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18
Q

4 points of history for anovulatory infertility

A
  • Menstrual cycle
  • Weight
  • Previous pregnancies
  • Other symptoms
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19
Q

6 points of examination for anovulatory infertility

A
  • BMI
  • General health
  • Thyroid disease
  • Skin/hair changes
  • Secondary sexual characteristics
  • Pelvic abnormalities (including pregnancy)
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20
Q

10 tests for anovulatory infertility

A
  • Mid-luteal serum progesterone (day 21)
  • Basal body temeprature charts
  • Urinary LH ovulation predictor kits
  • Pelvic US
  • Serum or urinary BhCG
  • Early follicular phase serum (day 2-5) FSH, LH, PRL
  • Serum testosterone and DHEAS
  • Serum TSH
  • Karyotype
  • Laparascopy
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21
Q

2 things to looks for in a pelvic US for anovulatory infertility

A
  • Follicle tracking
  • Other ovarian or uterine abnormalities
22
Q

3 most common types of anovulatory infertility

A
  • Polycystic ovary syndrome (PCOS)
  • Ovarian failure
  • Hypothalamic/pituitary disorders
23
Q

6 characteristics of PCOS anovulatory infertility

A
  • Anovulation
  • Normoestrogenemia
  • Mild androgenemia
  • Typical US appearance
  • Raised LH/FSH ratio
  • Often associated with hirsutism and obesity
24
Q

3 potential causes of ovarian failure

A
  • Premature/age related
  • Iatrogenic
  • Turner’s
25
Q

3 hypothalamic/pituitary disorders that may cause anovulatory infertility

A
  • Hyperprolactinemia
  • Thyroid disease
  • Hypopituitary-hypogonadism
26
Q

6 treatments for PCOS

A
  • Weight loss
  • Clomiphene citrate
  • FSH and hMG
  • Metformin
  • IVM (in vitro oocyte maturation)
  • IVF (in vitre fertilization)
27
Q

Treatment for ovarian failure anovulatory infertility

A

Oocyte donation

28
Q

Treatment for hyperprolactinemia anovulatory infertlity

A

Bromocriptine

29
Q

Treatment for hypothyroidism anovulatory infertility

A

Thyroxine

30
Q

Treatment ofr hypopituitary-hypogonadism anovulatory infertility

A

GnRH or hMG

31
Q

4 components of history for tubal factor infertility

A
  • Previous pregnancies (abortions)
  • STDs
  • Previous pelvic surgery
  • Pain
32
Q

4 components of examination for tubal factor infertility

A
  • Scars
  • Pelvic masses
  • Discharge
  • Fixed non-mobile uterus
33
Q

2 tests for tubal factor infertility

A

Hysterosalpingogram (HSG)

Laparascopy

34
Q

Purpose of HSG for tubal factor infertility

A

Determine uterine cavity anomalies and tubal patency

35
Q

Phase of menstrual cycle in which HSG is performed

A

Follicular phase

36
Q

4 disadvantages of performing HSG

A
  • Painful
  • Risk of infection (tubo-ovarian abscess)
  • Risk of trauma
  • Risk of pelvic irradiation
37
Q

Purpose of laparascopy in diagnosis of tubal factor infertility

A
  • Allows direct visualization of the tubes and assesses the nature and site of any disease or blockage
38
Q

2 potential surgical morbidities of laparoscopy for tubal factor infertility

A
  • Visceral damage
  • Laparotomy
39
Q

3 types of treatments for tubal factor infertility

A
  • Surgical
  • Radiological
  • IVF
40
Q

3 surgical treatments for tubal factor infertility

A
  • Tuboplasty
  • Salpingostomy
  • Microsurgical anastamosis
41
Q

Radiological treatment for tubal factor infertility

A

Selective tubal catheterization

42
Q

WHen is surgical treatment appropriate for tubal factor infertility

A

Young, monopolar disease, non other factors

43
Q

When is radiological treamtent for tubal factor infertility important

A

Young, cornual-only disease

44
Q

4 possible causes of unexplained infertility

A
  • Cervical mucus hostility
  • Endometriosis
  • Fibroids
  • Subtle ovulatory, male factor and tubal factor infertility
45
Q

3 characteristics of unexplained fertility

A

Normal SA, HSG and ovulation

46
Q

5 treatments for unexplained infertility

A
  • Reassure (50% pregnant within 3 years)
  • Clomiphene citrate (to help ovulation?)
  • IUI (intra-uterine insemination)
  • IVF
  • IVF/ICSI
47
Q

4 tests that couples being examined for infertility require

A
  • Seminal analysis
  • D21 (mid-luteal) serum progesterone
  • Pelvic ultrasound
  • Hysterosalpingogram
48
Q

Define assisted reproduction

A

Procedures which involve gamete manipulation

49
Q

5 types of assisted reproduction

A
  • IUI
  • IVF +/- ICSI
  • IVM
  • TESA/PESA
  • Gamete donation (sperm, oocyte, embryo)
50
Q

5 situations in which IUI is indicated

A
  • Unexplained infertility
  • Coital dysfunction
  • Mild male factor infertility (over 5million/mL)
  • Failed ovulation induction
  • Endometriosis
51
Q

6 situations in which IVF is indicated

A
  • Tubal disease
  • Male factor infertility (ICSI)
  • Endometriosis
  • Unexplained infertility
  • Anovulatory infertiltiy (non-responsive)
  • Congenital disease (PGD)
52
Q

3 situations in which IVM is indicated

A
  • Polycystic ovaries (needing IVF)
  • Contra-indications to ovarian stimulation (i.e. cancers, previous OHSS)
  • Repeated poor embryo quality with IVF

Block I: Reproduction & Sexuality (23 decks)

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