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
unexplained infertility - what are the 4 things we test for to see what the problem is? this is both partners (SFOO is unexplained)
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
26
Evalution of the Infertile Couple
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
27
Testing unexplained infertility - 4 tests - blood test and ultrasound?
Blood tests​: AMH, FSH/E2 Ultrasound: ​ Baseline transvaginal ultrasound Antral Follicle Count (AFC)
28
Other testing
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)​
29
Saline Infusion Sonogram (SIS) - what days of cycle to do this?
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
30
Hysterosalpingogram (HSG)
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
31
HSG, cont.  Tubal infection (Hydrosalpinx)
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
HyCoSy​ Hysterosalpingo Contrast Sonography (hycosy foam)
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
Antibiotic Prophylaxis for tubal evaluation procedures
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
Hysteroscopy
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
Semen Analysis
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
female factors for infertility (infertility is OUTDAE)
(40%) - ovulation disorders, uterine factor, tubal factor, diminishede ovarian reserve, age, endometrosis
37
male factors for infertility
(30%) usually all about the sperm - azo, oliog, aztheno, terato
38
male factor - oligosperimia (olga is small)
refers to decreased sperm concentration
39
male factor - teratospermia
abnormal morphology (shape of sperm)
40
male factor - asthenospermia (start with motility)
abnormal motility
41
male factor - oligasthenospermia
very common -low count with reduced motility
42
male factor - oligoasthenoteratozospermia
most common - sperm count, movement, shape all have abnormal parameters
43
male factor - azospermia
absence of sperm
44
male factor - evaluation
urologist, blood tests
45
sperm keeps for
about a day
46
Polycystic Ovarian Syndrome (PCOS)
Affects 5-10% of women​ Menstrual irregularity​ Clinical or biochemical evidence of hyperandrogenism (hirsutism)​ Ultrasound evidence of polycystic ovaries
47
48
Hypogonadotropic Hypogonadism ("hypo hypo") - who gets it?
Lack of hormones that normally stim. The ovaries.​ ie. GnRH, FSH, LH.​ Ex. Female Athlete Triad: Anorexia, Amenorrhea and Osteoporosis
49
ovulatory disorders - 2 main ones (ovulation disorders are HH)
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
low sperm concentration = treatment
sperm cryo and banking, surgical retrieval techniques, ICSI, sperm donor
51
azoospermia - treatment
surgical retrieval, sperm cryo and banking, surgical retrieval techniques, ICSI, sperm donor
52
cIVF
c = conventional. It's just putting the egg and sperm together and letting them mix naturally
53
ICSI
ixie - injecting sperm into egg to create an embryo
54
What are six etiologies of Primary Infertility in the female? (infertility in women is outdae)
uterine, tubal, diminished ovarian reserve, endomentrosis, and age
55
Define Azoospermia?
no sperm
56
Review the main difference between:​ Obstructive and Nonobstructive Azoospermia.
one is an obstruction and the other is unknown
57
Name the two tests SPRING recommends to evaluate ovarian reserve.
AMH (anti mullerian) and AFC (antro-follicle count)
58
What are two tests that can advise on tubal patency?
Hysterosalpingography (HSG) or hysterosalpingo-contrast sonography (HyCoSy)
59
why would an HSG be recommended?
60
Name three key parameters that are screened in a semen analysis.
concentration, motility, and morphology
61
ON TEST - What is the calculation that helps inform of potential treatment options? And what should the number be? (TMC has CMV)
volume X sperm concentration X motility = should be >20-25 Million
62
Fecundity
Fecundity is defined as the probability of a woman achieving a live birth for any given month
63
men - causes of infertility - acquired conditions
Acquired conditions​: Infections causing testicular swelling (mumps, gonorrhea, or chlamydia)​ Varicocele-> enlargement of veins in the scrotum​ Lifestyle​ Environmental​ Age-related factors​
64
men - causes of infertility - endocrine (the end for men is THD)
Endocrine​: Diabetes​ Hyperprolactinemia ​(elevated prolactin) Thyroid
65
oligospermia
fewer sperm cells
66
azoospermia (A = absent)
no sperm
67
fibroids - Submucosa (mucus in the uterus)
Submucosa (push into uterus) l,
68
fibroids - Intramural (muscle mural)
Intramural (in the muscle)
69
fibroids - sub serosal (seriously in the cavity)
Sub serosal (intra-cavity - this is the worst)
70
Most common tests for tubal patency:​ (HHot for tubes)
Hysterosalpingogram (HSG)​ Laparoscopy with chromopertubation​ (dye into tube and watch it) New tesfet:​ HyCoSy
71
fertility test - when is FSH done?
day 1-4 menstrual cycle
72
risk factors for early DOR
Risk factors for early loss of ovarian reserve include:​ Smoking​ Family​ History of premature ovarian failure​ Previous ovarian surgery​ Previous chemotherapy
73
unexplained infertility - what should AMH be?
(AMH >1)​
74
unexplained infertility - FSH and E2 - this is just the normal #s you already know
by "day 3" FSH/E2 (FSH less than <10 w/E2 less than <80)​
75
asthenospermia (a start with motility)
poor motility
76
most important in sperm test
TMC >20-25 M (Total Motile Sperm Count (TMC) is a calculation of: Ejaculation Volume x Sperm Concentration x Motility)​