Endo - Infertility Flashcards
What is infertility?
disease of the reproductive system defined by the failure to achieve after >12 months of regular unprotected sexual intercourse (every 2-3 days)
What is primary infertility?
when you haven’t had a live birth previously (miscarriage doesn’t count)
What is secondary infertility?
when you have had a live birth > 12 months previously
What are the most common cause of infertility in a couple?
→ female factor (30%)
→ male factor (30%)
→ combination of male and female factor (30%)
→ unknown factors (10%)
How does infertility psychologically affect couples?
psychological distress
How does infertility affect society?
→ less births
→ less tax income
→ investigation costs
→ treatment costs
What are the 3 different types of infertility cause in men?
→ pre-testicular
→ testicular
→ post-testicular
What are pre-testicular causes of infertility in men?
congenital + acquired endocrinopathies
What are testicular causes of infertility in men?
→ conegnital → cryptorchidism → STDs, infections → immunological → vascular → trauma/surgery → toxins (chemo, dxt, drugs, smoking)
What are post-testicular causes of infertility in men?
→ congenital
→ obstructive azoospermia
→ erectile dysfunction
→ iatrogenic
What is cryptorchidism?
undescended testes
What are the 6 main causes of infertility in females?
What are the ovarian causes of infertility in females?
→ anovulation (endo)
→ corpus luteum insufficiency
What are the pelvic causes of infertility in females?
→ endometriosis
→ adhesions
What are the tubal causes of infertility in females?
→ tubopathy due to infection, endometriosis, trauma
What are the uterine causes of infertility in females?
unfavourable endometrium due to: → chronic endometriosis (TB) → fibroids → adhesions → congenital malformation
What are the cervical causes of infertility in females?
ineffective sperm penetration due to:
→ chronic cervicitis
→ immunological (antisperm AB)
What is endometriosis?
presence of functioning endometrial tissue outside the uterus
What are the symptoms of endometriosis?
→ more menstrual pain
→ menstrual irregularities
→ deep dyspareunia (pain during sex)
→ infertility
How is endometriosis treated?
→ hormonal
→ laparascopic ablation
→ hysterectomy
→ bilateral salpingo-oophorectomy
What are fibroids?
benign tumours of the myometrium
What are the symptoms of fibroids?
→ usually asymptomatic → increased menstrual pain → menstrual irregularities → deep dyspareunia → infertility
How are fibroids treated?
→ hormonal (continuous OCP, prog, continuous GNRH agonists)
→ hysterectomy
What male infertility causes are a result of low GNRH?
→ congenital hypogonadotrophic hypogonadism
→ acquired HH
→ hyperprolactinaemia
What male infertility causes are a result of low LH / FSH?
→ hypopituitarism (tumour, infiltration, apoplexy, surgery, radiation)
What male infertility causes are a result of low testosterone?
→ congenital primary hypogonadism
→ acquired primary hypogonadism
What is Kallmann syndrome?
failure of migration of GNRH neurones with olfactory fibres
→ can cause anosmia
What are the reproductive features of Kallmann syndrome?
→ cryptorchidism → failure of puberty → lack of testicle development → micropenis → primary amenorrhoea → infertility
How do hormone levels present in Kallmann’s syndrome?
low GNRH, LH, FSH, TESTOSTERONE
What is hyperprolactinaemia?
too much prolactin
How does hyperprolactinaemia cause infertility?
→ prolactin binds to prolactin receptors on kisspeptin neurons in hypothalamus
→ inhibits kisspeptin release
→ decreases the downstream of hormones
How is hyperprolactinaemia treated?
→ dopamine agonist (e.g. cabergoline)
→ surgery
What is Klinefelter Syndrome?
→ sex chromosome disorder
→ XXY
How does Klinefelter Syndrome present physically?
How does Klinefelter Syndrome present hormally?
→ high GNRH
→ high LH + FSH
→ low testosterone
What are three stages of diagnosis for infertility?
→ history
→ examination
→ main investigations
What do you look for when taking a history for male infertility?
including duration, previous children, pubertal milestones, associated symptoms (eg. T deficiency, PRL symptoms, CHH features), medical & surgical history, family history, social history, medications/drugs
What do you look for during examination for male infertility?
including BMI, sexual characteristics, testicular volume, epididymal hardness, presence of vas deferens, other endocrine signs, syndromic features, anosmia
What are the main investigations done when looking for causes of male infertility?
→ semen analysis
→ blood tests (looking for LH, FSH, PRL, morning fasting T, SHBG (sex hormone binding globulin), albumin, iron studies, pituitary/thyroid profile, karotyping)
→ microbiology (urine test, chlamydia swab)
→ imaging (scrotal US, MRI pituitary)
What are the general lifestyle treatments for male infertility?
→ optimise BMI
→ smoking cessation
→ alcohol reduction
What are the specific treatments for male infertility?
→ dopamine agonist for hyperPRL
→ gonadotrophin treatment for fertility
→ testosterone
→ surgery
What female infertility causes are a result of low GNRH?
→ congenital
→ acquired
→ hyperprolactinaemia
What female infertility causes are a result of low LH / FSH?
→ hypopituitarism (tumour, infiltration, apoplexy, surgery, radiation)
What female infertility causes are a result of high LH / FSH?
PCOS
What female infertility causes are a result of low E2?
→ congenital primary hypogonadism
→ acquired primary hypogonadism
What is premature ovarian failure?
early menopause
What are the causes of premature ovarian failure?
→ autoimmune
→ genetic
→ cancer therapy
What is PCOS?
polycystic ovarian syndrome
How is PCOS diagnosed?
rotterdam diagnostic criteria (2 out of 3):
→ oligo or anovulation
→ clinical or biochemical hyperandrogenism
→ polycystic ovaries
How is PCOS treated?
→ metaformin
→ OCP
→ diet + lifestyle
→ progesterone courses
What is Turners Syndrome?
→ sex chromosome disorder
→ X
How does Turner’s Syndrome present physically?
What do you look for in a history for female infertility?
including duration previous children pubertal milestones breastfeeding? Menstrual History: oligomenorrhoea or 1/20 amenorrhoea, associated symptoms (eg. E deficiency, PRL symptoms, CHH features) medical & surgical history family history social history medications/drugs
What do you look for in an examination for female infertility?
What are the main investigations for female infertility?
