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!!!!! BRS YR2 !!!!! > Endo - Infertility > Flashcards

Endo - Infertility Flashcards

1
Q

What is infertility?

A

disease of the reproductive system defined by the failure to achieve after >12 months of regular unprotected sexual intercourse (every 2-3 days)

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2
Q

What is primary infertility?

A

when you haven’t had a live birth previously (miscarriage doesn’t count)

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3
Q

What is secondary infertility?

A

when you have had a live birth > 12 months previously

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4
Q

What are the most common cause of infertility in a couple?

A

→ female factor (30%)
→ male factor (30%)
→ combination of male and female factor (30%)
→ unknown factors (10%)

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5
Q

How does infertility psychologically affect couples?

A

psychological distress

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6
Q

How does infertility affect society?

A

→ less births
→ less tax income
→ investigation costs
→ treatment costs

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7
Q

What are the 3 different types of infertility cause in men?

A

→ pre-testicular
→ testicular
→ post-testicular

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8
Q

What are pre-testicular causes of infertility in men?

A

congenital + acquired endocrinopathies

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9
Q

What are testicular causes of infertility in men?

A 
→ conegnital
→ cryptorchidism
→ STDs, infections
→ immunological
→ vascular
→ trauma/surgery
→ toxins (chemo, dxt, drugs, smoking)
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10
Q

What are post-testicular causes of infertility in men?

A

→ congenital
→ obstructive azoospermia
→ erectile dysfunction
→ iatrogenic

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11
Q

What is cryptorchidism?

A

undescended testes

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12
Q

What are the 6 main causes of infertility in females?

A
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13
Q

What are the ovarian causes of infertility in females?

A

→ anovulation (endo)

→ corpus luteum insufficiency

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14
Q

What are the pelvic causes of infertility in females?

A

→ endometriosis

→ adhesions

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15
Q

What are the tubal causes of infertility in females?

A

→ tubopathy due to infection, endometriosis, trauma

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16
Q

What are the uterine causes of infertility in females?

A 
unfavourable endometrium due to:
→ chronic endometriosis (TB)
→ fibroids
→ adhesions
→ congenital malformation
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17
Q

What are the cervical causes of infertility in females?

A

ineffective sperm penetration due to:
→ chronic cervicitis
→ immunological (antisperm AB)

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18
Q

What is endometriosis?

A

presence of functioning endometrial tissue outside the uterus

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19
Q

What are the symptoms of endometriosis?

A

→ more menstrual pain
→ menstrual irregularities
→ deep dyspareunia (pain during sex)
→ infertility

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20
Q

How is endometriosis treated?

A

→ hormonal
→ laparascopic ablation
→ hysterectomy
→ bilateral salpingo-oophorectomy

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21
Q

What are fibroids?

A

benign tumours of the myometrium

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22
Q

What are the symptoms of fibroids?

A 
→ usually asymptomatic
→ increased menstrual pain
→ menstrual irregularities
→ deep dyspareunia
→ infertility
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23
Q

How are fibroids treated?

A

→ hormonal (continuous OCP, prog, continuous GNRH agonists)

→ hysterectomy

24
Q

What male infertility causes are a result of low GNRH?

A

→ congenital hypogonadotrophic hypogonadism
→ acquired HH
→ hyperprolactinaemia

25
Q

What male infertility causes are a result of low LH / FSH?

A

→ hypopituitarism (tumour, infiltration, apoplexy, surgery, radiation)

26
Q

What male infertility causes are a result of low testosterone?

A

→ congenital primary hypogonadism

→ acquired primary hypogonadism

27
Q

What is Kallmann syndrome?

A

failure of migration of GNRH neurones with olfactory fibres

→ can cause anosmia

28
Q

What are the reproductive features of Kallmann syndrome?

A 
→ cryptorchidism
→ failure of puberty
→ lack of testicle development
→ micropenis
→ primary amenorrhoea
→ infertility
29
Q

How do hormone levels present in Kallmann’s syndrome?

A

low GNRH, LH, FSH, TESTOSTERONE

30
Q

What is hyperprolactinaemia?

A

too much prolactin

31
Q

How does hyperprolactinaemia cause infertility?

A

→ prolactin binds to prolactin receptors on kisspeptin neurons in hypothalamus
→ inhibits kisspeptin release
→ decreases the downstream of hormones

32
Q

How is hyperprolactinaemia treated?

A

→ dopamine agonist (e.g. cabergoline)

→ surgery

33
Q

What is Klinefelter Syndrome?

A

→ sex chromosome disorder

→ XXY

34
Q

How does Klinefelter Syndrome present physically?

A
35
Q

How does Klinefelter Syndrome present hormally?

A

→ high GNRH
→ high LH + FSH
→ low testosterone

36
Q

What are three stages of diagnosis for infertility?

A

→ history
→ examination
→ main investigations

37
Q

What do you look for when taking a history for male infertility?

A

including duration, previous children, pubertal milestones, associated symptoms (eg. T deficiency, PRL symptoms, CHH features), medical & surgical history, family history, social history, medications/drugs

38
Q

What do you look for during examination for male infertility?

A

including BMI, sexual characteristics, testicular volume, epididymal hardness, presence of vas deferens, other endocrine signs, syndromic features, anosmia

39
Q

What are the main investigations done when looking for causes of male infertility?

A

→ 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)

40
Q

What are the general lifestyle treatments for male infertility?

A

→ optimise BMI
→ smoking cessation
→ alcohol reduction

41
Q

What are the specific treatments for male infertility?

A

→ dopamine agonist for hyperPRL
→ gonadotrophin treatment for fertility
→ testosterone
→ surgery

42
Q

What female infertility causes are a result of low GNRH?

A

→ congenital
→ acquired
→ hyperprolactinaemia

43
Q

What female infertility causes are a result of low LH / FSH?

A

→ hypopituitarism (tumour, infiltration, apoplexy, surgery, radiation)

44
Q

What female infertility causes are a result of high LH / FSH?

A

PCOS

45
Q

What female infertility causes are a result of low E2?

A

→ congenital primary hypogonadism

→ acquired primary hypogonadism

46
Q

What is premature ovarian failure?

A

early menopause

47
Q

What are the causes of premature ovarian failure?

A

→ autoimmune
→ genetic
→ cancer therapy

48
Q

What is PCOS?

A

polycystic ovarian syndrome

49
Q

How is PCOS diagnosed?

A

rotterdam diagnostic criteria (2 out of 3):
→ oligo or anovulation
→ clinical or biochemical hyperandrogenism
→ polycystic ovaries

50
Q

How is PCOS treated?

A

→ metaformin
→ OCP
→ diet + lifestyle
→ progesterone courses

51
Q

What is Turners Syndrome?

A

→ sex chromosome disorder

→ X

52
Q

How does Turner’s Syndrome present physically?

A
53
Q

What do you look for in a history for female infertility?

A 
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
54
Q

What do you look for in an examination for female infertility?

A
55
Q

What are the main investigations for female infertility?

A

!!!!! BRS YR2 !!!!! (72 decks)

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