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BRS YEAR 2 > Endo - Infertility > Flashcards

Endo - Infertility Flashcards

1
Q

Define infertility

A

Failure to achieve clinical pregnancy after 12+ months of regular unprotected sex

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2
Q

Define regular sex

A

Every 2-3 days

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3
Q

What are the 2 types of infertility

A

Primary and secondary

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4
Q

What is primary infertility

A

Never had a live birth

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5
Q

What is secondary infertility

A

Had a live birth more than 12 months previously

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6
Q

Epidemiology of infertility

A

Affects 1/7 but after a year, half of these will have conceived.
55% seek help - positive association with socio-economic status

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7
Q

Who is most at fault for infertility

A

Equal:

30 male, 30 female, 30 male and female, 10 unknown

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8
Q

What is the impact of infertility

A

Stress on cuple, lower birth rate in population leads to lower income tax therefore negative societal impact

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9
Q

What are the male causes of infertility

A

Pre, intra and post testicular

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10
Q

What are the pre-testicular causes

A

Congenital and acquired endocrinopathies e.g. Kinlefleters, HPG, PRL, T, Y chromosome depletion

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11
Q

what are the testicular causes

A 
Congenital 
Cryptorchidism 
Infection e.g. STD
Immunological e.g. Antisperm ABs
Vascular (varicoele)
Trauma 
Toxins (radiotherapy, chemotherapy, Drugs, smoking)
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12
Q

What are the post testicular causes of infertility in males

A

Congenital e.g. CF –> no vas deferens
Erectile dysfunction
Obstructive azoospermia
Iatrogenic e.g. vasectomy

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13
Q

What is cryptorchidism

A

Failure of the testis to descend through the inguinal canal into the scrotum

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14
Q

What are the female causes of infertility from most common to least common

A 
Ovarian 
Tubal 
Uterine
Unexplained 
Cervical 
Pelvic
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15
Q

What are the pelvic causes of infertility

A

Endometriosis

Adhesions

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16
Q

What are the ovarian causes of infertility

A

Anovulation

Corpus lute insufficiency

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17
Q

What are the fallopian causes of infertility (tubulopathy)

A

Infection
Endometriosis
Trauma

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18
Q

What are the uterine causes of infertility

A

Chronic endometriosis (TB)
Adhesions (synechiae)
Fibroid
Congenital malformation

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19
Q

What are the cervical causes of infertility

A

Chronic cervicitis

Immunological (anti sperm Abs)

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20
Q

What is endometriosis

A

Presence of functional endometrial tissue outside the uterus - responds to oestrogen

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21
Q

What are the symptoms of endometriosis

A

Deep dyspareunia
Menstrual pain
Menstrual irregularity Infertility

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22
Q

What are the treatment for endometriosis

A

Laparoscopic ablation
Hysterectomy
Bilateral salphingo-oophorectomy
Hormones e.g. OCP, progesterone

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23
Q

What are fibroids

A

Benign tumours of the endometrium

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24
Q

What are the symptoms of fibroid

A 
Can be asymptomatic 
Deep dyspareunia 
Menstrual pain
Menstrual irregularity 
Infertility
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25
Q

What is the treatment for fibroids

A

Hormones: OCP, progesterone, GnRH antagonist

Hysterectomy

26
Q

Describe the rhythm of GnRH, LH, FSH vs sex steroids

A

GnRH therefore LH and FSH have a pulsatile rhythm whereas the sex steroids have a diurnal rhythm

27
Q

How does negative feedback work in men HPG axis

A

T is covered to oestrogen for negative feedback

28
Q

What are the hypothalamic causes of male infertility

A

Kallman sydrome
Acquired hypogonadotrophic hypogonadism
Hyperprolactinemia

29
Q

What are the pituitary causes of male infertility

A

Hypopituitarism

30
Q

What are the pre-testicular post pituitary causes of male infertility

A

Klinefelters

Acquired primary hypogonadism (cryptorchidism, trauma, DXT, chemo)

31
Q

What happens in Kallmann syndrome

A

Congenital hypogonadotrophic hypogonadism where during the first 10 weeks of embryonic development, there is failure of GnRH neurones to migrate from the olfactory placode with the olfactory fibres to the hypothalamus

32
Q

What are the features of Kallmann

A 
Anosmia (can be normosmic)
Cryptorchidism 
Failure of puberty
Lack of testicle development 
Micropenis 
Primary amenorrhoea
Infertility
33
Q

What happens in hyperprolactinemia

A

Prolactin binds to kisspeptin neurones inhibiting the release of kisspeptin and thus GnRH

34
Q

What is oligomenorrhoea

A

Irregular or infrequent periods longer than 35 day cycles or 4-9 per year

35
Q

What is amenorrhoea

A

No periods for 3-6 months or up to 3 a year

36
Q

What are the signs of Klinefelter’s

A 
Tall stature
Low IQ
Narrow shoulders 
Wide hips
Low bone density 
Small penis 
Breast development 
Lack of pubic or facial hair - female pubic hair pattern
37
Q

What is a normal sperm concentration

A

15 million sperm/ ml

38
Q

What is a normal sperm motility

A

40%

39
Q

What is azoospermia

A

No sperm

40
Q

What is oligospermia

A

Reduced sperm

41
Q

What are the main investigations we do when males present with infertility

A

Semen analysis
Blood tests
Microbiolgoy
Imaging

42
Q

What is the general treatment for male infertility

A

Optimise BMI
Smoking cessation
Alcohol reduction

43
Q

What is the specific treatment for male infertility

A

Dopamine agonist
Gonadotropin treatment
Testosterone
Surgery

44
Q

Before investigating female infertility, what should we make sure of first

A

Make sure not pregnant or breast feeding

45
Q

What is primary amenorrhoea

A

Hasn’t had first period at 16

46
Q

What is secondary amenorrhoea

A

Periods start but then stop for at least 3-6 months

47
Q

What is POI

A

Primary ovarian insufficiency: early menopause

48
Q

What are the POI symptoms

A

Same as per menopause

49
Q

What are POI conception rates

A

20% - the odd egg may be released

50
Q

What is POI diagnosis

A

High FSH > 25 iU/L - 2 readings at least 4 weeks apart

51
Q

What are the causes of POI

A

Autoimmune
Genetic
Cancer therapy e.g. DXT/ Chemo

52
Q

What is a gonadal ovarian cause of female infertility

A

PCOS

53
Q

PCOS epidemiology

A

Affects 5-15% of women at reductive age - most common endocrine disorder in women and most common cause of infertility

54
Q

What do we use to diagnose PCOS

A

Rotterdam PCOS diagnostic criteria

55
Q

What is the worst metabolic risk combination for PCOS

A

Oligo/anovulation and Hyperandrogenism

56
Q

What do we use to treat PCOS

A 
Metformin 
OCP
Clomiphene, letrozole, IVF
Diet and lifestyle 
Creams, waxing, laser
Anti-adnrogens e.g. spironolactone
Progesterone courses
57
Q

What is Turner’s syndrome

A

45 X0 - congenital hypergonadotrophic hypogonadism

58
Q

What are the signs of Turner’s

A 
Short
Low hairline
Webbed neck 
Shielded chest
Coarctation of the aorta
Wide nipples
Brown nevi 
Amemnorrhoea
Elbow deformity 
Poor breast development 
Underdeveloped repro. tract
59
Q

What are the blood tests we perform for female infertility

A 
LH, FSH, PRL
Oestradiol, androgens. 
Follicular phase 17-OHP, mid luteal progesterone
SHBG
Albumin/ Fe 
Pituitary/ TSH/fT4
Karyotype
60
Q

What other investigations do we do for female infertility

A

Pregnancy test
Microbiology
Imaging

BRS YEAR 2 (37 decks)

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