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XIO > Common diagnosis > Flashcards

Common diagnosis Flashcards

1
Q

primary infertility definition - how long trying without getting pregnant?

A

In a woman with no prior conception,​

12 months of attempting conception without success​

85% of couples succeed in this time​

​

Earlier investigation may be warranted in women over 35 years of age after 6 months of trying.​

​

Earlier investigation recommended in some patients due to history: i.e. Tubal ligation, vasectomy, chemotherapy, age, genetic

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2
Q

“Normal” couples have a fecundity approaching what percentage?

A

A. 5%​

B. 20%​***

C. 50%​

D. 75%

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3
Q

Etiology of Primary Infertility

(primarily OUTDAE)

A
  1. Ovulatory Disorders​
  2. Uterine Factor​
  3. Tubal Factor​
  4. Diminished Ovarian Reserve​
  5. Age​
  6. Endometriosis
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4
Q

Causes of Male factor infertility - genetic - 5 of them

A

Genetic​:

Y-Microdeletion​ (deletions on Y chromosome)

Klinefelter syndrome (47, XXY) or other chromosomal condition ​

Congenital Bilateral Absence of the Vas (CF)​ - missing the vas deferens

Insensitivity to hormones (androgens), which include testosterone​

Cryptorchidism (? Genetic)​

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5
Q

Y-Chromosome Microdeletions

  • (C olig)
A

Microdeletions of segments of the Y-Chromosome can lead to alterations of spermatogenesis​

​

10-15% of men with oligospermia->azoospermia may be affected​

AZFc (this is a deletion from the Y chromosome) ->Oligospermia​

AZFa or AZFb (this is a deletion from the Y chromosome)->azoospermia (no sperm at all)

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6
Q

male factor - Obstructive Azoospermia:

A

There is a missing or blocked connection in the epididymis, vas deferens or elsewhere in the reproductive tract that will not allow sperm to exit the body.​

Causes:​

Congenital ​

I.e.. CBAVD-Congenital absence of the vas deferens—(CF )​

Surgical​

Previous genital tract infection

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7
Q

Obstructive Azoospermia: options?

A

Sperm may be able to be retrieved directly from the testicle by a reproductive urologist. Sperm aspiration​

Only Tx. Option IVF/ICSI

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8
Q

Nonobstructive Azoospermia:

A

No sperm is being produced due to a structural or functional defect in the testicle.​

Causes:​

Hormonal​

Genetic​

Testicular

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9
Q

Nonobstructive Azoospermia: - options?

A

Possible to try surgical procedure to retrieve sperm—low chance for success​

Medication may help..

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10
Q

Klinefelter’s Syndrome, 47 XXY - what hormone is high?

A

Most common sex chromosome disorder​​

High FSH, low testosterone levels​​

Small testes​​

Azoospermia​​

Possible option of microTESE​

Female body shape​

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11
Q

female factors

(OUTDAE)

A

ovulation disorders, uterine factor, tubal factor, diminished ovarian reserve (DOR), age, endomentrosis

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12
Q

ovulation disorders

(PHHHL has ovulation disorders)

A

PCOS, Hypogonadotropic Hypogonadism (“hypohypo”), hypothyroidism, hyperprolactemia, luteal phase deficiency

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13
Q

fibroids

A

benign (non-cancerous) tumors of the uterine muscle wall that can cause abnormal uterine bleeding. Also known as leiomyomas or myomas. ​

Classified by location.

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14
Q

polyps - where are they found?

A

Uterine polyps are growths attached to the inner wall of the uterus that extend into the uterine cavity. Generally benign

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15
Q

adenomysosis

(aden grows)

A

Endometrial tissue grows into the uterine muscle.

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16
Q

mullerian anomalies - is it congenital?

A

Congenital disorder of the female reproductive tract.

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17
Q

Uterine Anomalies:

A

Fibroids (muscle tumor)/myoma ​
Polyps​

Adenomyosis​

Mullerian anomalies

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18
Q

Diagnostic Tests - uterine factors

A

Pelvic Ultrasound (transvaginal)​

Hysterosalpingogram (HSG)​

Saline Sonogram (SIS)​

HyCoSy ​ (vaginal ultrasound)

Hysteroscopy (HSC)​ (thin tube with camera)

MRI (not done at our clinic)

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19
Q

tubal factors - most damaging cause?

A

Fallopian tubes are required for fertilization to occur within the body​

​

Risk factors for tubal obstruction/disease:​

Previous STD/PID​ - this is the worst

Previous surgery​

Previous tubal sterilization (ligation)​

​

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20
Q

Endometriosis

A

Endometriosis is a condition in which endometrial tissue, which normally lines the uterus, develops outside of the uterine cavity in abnormal locations such as the ovaries, fallopian tubes, and abdominal cavity.​

Symptoms:​

Pelvic/Abdominal pain esp. w/menstrual bleeding or sex​

Some asymptomatic ​

​

30% to 50% of infertile women have endometriosis.​

Sometimes, endometriosis can grow inside your ovary and form a cyst (endometrioma).

treatment for preg with endometrosis is IVF

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21
Q

age - why?

A

Fertility begins to decline at age 35

Fewer follicles (oocytes) remaining in ovary​

Increased chromosomal abnormalities within the oocyte​

Higher rates of aneuploid (chromosomally abnormal) embryos

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22
Q

age - tests - same 5 tests

3 hormone, 2 ultrasound

A

Blood tests:​

AMH (Anti Mullerian Hormone)​ - can be done at anytime

FSH /Estradiol(E2)

Ultrasound (transvaginal)​

AFC (Antral follicle count)- to assess follicles (egg sacs)

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23
Q
A
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24
Q

Diminished Ovarian Reserve (DOR)

A

DOR refers to accelerated ovarian aging resulting in reduced fertility​

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25
Q

unexplained infertility - what are the 4 things we test for to see what the problem is? this is both partners

(SFOO is unexplained)

A

Diagnosis of exclusion after testing shows:​

Normal Semen Analysis​
Patent fallopian tubes and normal uterine cavity​
Normal Ovarian reserve testing​
Documentation of ovulation​

30% of couples are diagnosed with “unexplained” infertility

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26
Q

Evalution of the Infertile Couple

A

Female:​

Hormonal Causes:​

Measure ovarian reserve​

Ovulation?​

Hormonal imbalance​

Structural Causes:​

Evaluation of Uterus and Ovaries​

Evaluation of the Fallopian tubes and uterine cavity​

Male​

Semen Analysis

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27
Q

Testing unexplained infertility - 4 tests - blood test and ultrasound?

A

Blood tests​:

AMH, FSH/E2

Ultrasound: ​

Baseline transvaginal ultrasound Antral Follicle Count (AFC)

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28
Q

Other testing

A

Determine ovulatory status​

Ultrasound evaluation during cycle to assess follicular growth​

“Day 21” progesterone blood test​

If irregular menstrual cycles:​

Thyroid testing (blood test)-part of standard workup, all patients.​

Prolactin (if indicated)​

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29
Q

Saline Infusion Sonogram (SIS) - what days of cycle to do this?

A

In office procedure, well tolerated​

Done between CD (cycle day) 5-12​

(after bleeding, before ovulation)​

Sterile saline injected to distend the uterus​

Can detect abnormal growths inside the uterus, such as fibroids or polyps

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30
Q

Hysterosalpingogram (HSG)

A

HSG is an x-ray procedure used to see whether the fallopian tubes are patent (open) and if the inside of the uterus (uterine cavity) is normal. ​

Also known as “the dye test”​

Done CD 5-12 (after bleeding, before ovulation)​

Iodine contrast (ensure no shellfish allergy)​

Can be performed at some SPRING facilities

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31
Q

HSG, cont. Tubal infection (Hydrosalpinx)

A

Hydrosalpinx- Hydrosalpinx is a composite of the Greek words ὕδωρ (hydōr – “water”[1]) and σάλπιγξ (sálpinx – “trumpet”[1]); its plural is hydrosalpinges.​

it’s fluid in the tube

You can’t get rid of tubal infections

Causes:​

Most common cause: Previous STI (Sexually transmitted infection)-ie. GC/Chlamydia.​

Other causes: Adhesion formation from surgery, endometriosis, cancer of the tube, ovary or other surrounding organs.​

Symptoms:​

Most asymptomatic, some have lower abdominal pain​

Treatment:​

Salpingectomy: Surgical removal of the fallopian tube (Uni (one) or Bi (both) tubes).​

If left in place, the fluid can leak into the uterus which decrease pregnancy rates by ~ half.

32
Q

HyCoSy​
Hysterosalpingo Contrast Sonography

(hycosy foam)

A

Newer procedure to assess uterine cavity & tubal patency​

Offering for self-pay patients ​

Done CD 5-12 (after bleeding, before ovulation)​

Patient to have empty bladder​

Must do HPT day of to ensure no pregnancy.​

Normal to have light spotting/liquid - foam seen post procedure

33
Q

Antibiotic Prophylaxis for tubal evaluation procedures

A

Most uterine/tubal evaluations carry a low risk of causing future infection, therefore the standard of care is NOT to prescribe antibiotics for these procedures unless indicated.​

Indications for prescribing Doxycycline 100mg BID (twice daily) x 5days:​

Patient with a history of pelvic inflammatory disease (PID)*​

Findings of hydrosalpinx on exam​

Indications for prescribing Doxycycline 100mg BID x 1 day​

Spring patients completing tubal evaluation outside of Spring Fertility. This is in case a hydro if found on exam. If hydro is found, they will need 4 days additional antibiotics prescribed.​

*Prior to scheduling HSG/HyCoSy/SIS, PN/RN must ask patient if any history of PID. If yes, antibiotic should be prescribed and patient should begin morning of procedure.

34
Q

Hysteroscopy

A

Hysteroscopy (HSC) is a minimally invasive surgical procedure ​

Camera is inserted into the vagina and through the cervix to get a detailed visualization of the uterine cavity.​

Normally done under anesthesia, in the OR. ​

This procedure can find and remove polyps, fibroids, scar tissue using small instruments inserted through the hysteroscope.

35
Q

Semen Analysis

A

Parameters (Normal):​

Concentration (Count) ≥ 15 x106/ml​

Motility (movement) ≥40%​

Morphology (Shape) ≥4%​

Volume ≥1.5mls​

Color Whitish, gray, opalescent​

Viscosity Normal​

liquefaction Complete in 30 min​

agglutination 0​

presence of round cells and leukocytes : ≤ 1 x 106/ml​

Forward progression 2-4​

most important in sperm test - TMC

36
Q

female factors for infertility

(infertility is OUTDAE)

A

(40%) - ovulation disorders, uterine factor, tubal factor, diminishede ovarian reserve, age, endometrosis

37
Q

male factors for infertility

A

(30%) usually all about the sperm - azo, oliog, aztheno, terato

38
Q

male factor - oligosperimia

(olga is small)

A

refers to decreased sperm concentration

39
Q

male factor - teratospermia

A

abnormal morphology (shape of sperm)

40
Q

male factor - asthenospermia (start with motility)

A

abnormal motility

41
Q

male factor - oligasthenospermia

A

very common -low count with reduced motility

42
Q

male factor - oligoasthenoteratozospermia

A

most common - sperm count, movement, shape all have abnormal parameters

43
Q

male factor - azospermia

A

absence of sperm

44
Q

male factor - evaluation

A

urologist, blood tests

45
Q

sperm keeps for

A

about a day

46
Q

Polycystic Ovarian Syndrome (PCOS)

A

Affects 5-10% of women​

Menstrual irregularity​

Clinical or biochemical evidence of hyperandrogenism (hirsutism)​

Ultrasound evidence of polycystic ovaries

47
Q
A
48
Q

Hypogonadotropic Hypogonadism (“hypohypo”) - who gets it?

A

Lack of hormones that normally stim. The ovaries.​

ie. GnRH, FSH, LH.​

Ex. Female Athlete Triad: Anorexia, Amenorrhea and Osteoporosis

49
Q

ovulatory disorders - 2 main ones

(ovulation disorders are HH)

A

Hypothyroidism​

Hyperprolactinemia​ - too much prolactin (can be caused by pituitary tumor), or nipple stimulation (running, etc)

“Luteal Phase deficiency” - corpus luteum is not functioning so progesterone level not as high as it should be

50
Q

low sperm concentration = treatment

A

sperm cryo and banking, surgical retrieval techniques, ICSI, sperm donor

51
Q

azoospermia - treatment

A

surgical retrieval, sperm cryo and banking, surgical retrieval techniques, ICSI, sperm donor

52
Q

cIVF

A

c = conventional. It’s just putting the egg and sperm together and letting them mix naturally

53
Q

ICSI

A

ixie - injecting sperm into egg to create an embryo

54
Q

What are six etiologies of Primary Infertility in the female? (infertility in women is outdae)

A

uterine, tubal, diminished ovarian reserve, endomentrosis, and age

55
Q

Define Azoospermia?

A

no sperm

56
Q

Review the main difference between:​

 Obstructive and  Nonobstructive Azoospermia.
A

one is an obstruction and the other is unknown

57
Q

Name the two tests SPRING recommends to evaluate ovarian reserve.

A

AMH (anti mullerian) and AFC (antro-follicle count)

58
Q

What are two tests that can advise on tubal patency?

A

Hysterosalpingography (HSG) or hysterosalpingo-contrast sonography (HyCoSy)

59
Q

why would an HSG be recommended?

A
60
Q

Name three key parameters that are screened in a semen analysis.

A

concentration, motility, and morphology

61
Q

ON TEST - What is the calculationthat helps inform of potential treatment options? And what should the number be?

(TMC has CMV)

A

volume X sperm concentration X motility = should be >20-25 Million

62
Q

Fecundity

A

Fecundity is defined as the probability of a woman achieving a live birth for any given month

63
Q

men - causes of infertility - acquired conditions

A

Acquired conditions​:

Infections causing testicular swelling (mumps, gonorrhea, or chlamydia)​

Varicocele-> enlargement of veins in the scrotum​

Lifestyle​

Environmental​

Age-related factors​

64
Q

men - causes of infertility - endocrine

(the end for men is THD)

A

Endocrine​:

Diabetes​

Hyperprolactinemia ​(elevated prolactin)

Thyroid

65
Q

oligospermia

A

fewer sperm cells

66
Q

azoospermia

(A = absent)

A

no sperm

67
Q

fibroids - Submucosa

(mucus in the uterus)

A

Submucosa (push into uterus) l,

68
Q

fibroids - Intramural

(muscle mural)

A

Intramural (in the muscle)

69
Q

fibroids - sub serosal
(seriously in the cavity)

A

Sub serosal (intra-cavity - this is the worst)

70
Q

Most common tests for tubal patency:​

(HHot for tubes)

A

Hysterosalpingogram (HSG)​

Laparoscopy with chromopertubation​ (dye into tube and watch it)

New tesfet:​

HyCoSy

71
Q

fertility test - when is FSH done?

A

day 1-4 menstrual cycle

72
Q

risk factors for early DOR

A

Risk factors for early loss of ovarian reserve include:​

Smoking​

Family​

History of premature ovarian failure​

Previous ovarian surgery​

Previous chemotherapy

73
Q

unexplained infertility - what should AMH be?

A

(AMH >1)​

74
Q

unexplained infertility - FSH and E2 - this is just the normal #s you already know

A

by “day 3” FSH/E2
(FSH less than <10 w/E2 less than <80)​

75
Q

asthenospermia

(a start with motility)

A

poor motility

76
Q

most important in sperm test

A

TMC >20-25 M (Total Motile Sperm Count (TMC) is a calculation of: Ejaculation Volume x Sperm Concentration x Motility)​

XIO (400 decks)

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