Endo - Infertility

Question 1

What is infertility?

Answer 1

Failure to achieve pregnancy after 12 months or more of unprotected sexual intercourse

Question 2

What is primary infertility?

Answer 2

When have not had a live birth previously

Question 3

What is secondary infertility?

Answer 3

When have had a live birth >12 months previously

Question 4

What are the pre-testicular causes for infertility?

Answer 4

Congenital & acquired endocrinopathies;
Klinefelters 47XXY
Y chromosome deletion

Question 5

What are the testicular causes for infertility?

Answer 5

• (Congenital)
• Cryptorchidism
• Infections
• Immunological
• Vascular
• Trauma/surgery
• Toxins

Question 6

What are the post-testicular causes for infertility?

Answer 6

• Congenital
  
  • Absence of vas deferens
• Obstructive azoospermia
• Erectile dysfunction
• Iatrogenic
  
  • Vasectomy

Question 7

What is cryptorchidism?

Answer 7

Testes do not pass through the inguinal canal and stay undescended

Question 8

What can cause infertility in females?

Answer 8

Ovarian causes (40%):
     - Anovulation(endo)
     - Corpus luteum insufficiency
Tubal causes (30%):
     - Infection
     - Endometriosis
     - Trauma
Uterine causes (10%):
     - Chronic endometritis
     - Fibroid
     - Adhesions
     - Congenital malformation
Cervical causes (5%):
     - Chronic cervititis
     - Immunological (Antisperm Ab)
Pelvic causes (5%):
     - Endometriosis
     - Adhesions
Unexplained (10%)

Question 9

What is endometriosis?

Answer 9

The presence of functioning endometrial tissue outside the uterus - responds to oestrogen!

Question 10

What are the symptoms of endometriosis?

Answer 10

• Increased menstrual pain
• Menstrual irregularities
• Deep dyspareunia - pain on sexual intercourse
• Infertility

Question 11

What treatment can be given for endometriosis?

Answer 11

• Hormonal
• Laprascopic ablation
• Hysterectomy
• Bilateral Salpingo-oophorectomy

Question 12

What are fibroids?

Answer 12

Benign tumours of the myometrium - responds to oestrogen!

Question 13

What are the symptoms of fibroids?

Answer 13

• Usually asymptomatic
• Increased menstrual pain
• Menstrual irregularities
• Deep dyspareunia - pain on sexual intercourse
• Infertility

Question 14

What treatment can be given for fibroids?

Answer 14

• Hormonal

- Hysterectomy

Question 15

What is the hypothalamic-pituitary-gonadal axis?

Answer 15

1) Kisspeptin neurons stimulate GnRH neurons
2) The GnRH neurons release GnRH and this causes the release of gonadotrophs in the anterior pituitary gland
3) LH & FSH are released into the systemic circulation
4) These gonadotrophs reach the gonads and stimulate the release of either testosterone oestrogen
5) These chemicals then have a negative feedback effect on the kisspeptin neurons

Question 16

What would happen to LH, FSH and testosterone levels in hyperprolactinaemia?

Answer 16

LH - down
FSH - down
Testosterone - down

Question 17

What would happen to LH, FSH and testosterone levels in primary testicular failure?

Answer 17

LH- up
FSH - up
Testosterone - down

Question 18

What is Kallmann syndrome?

Answer 18

Failure of migration of GnRH neurons with olfactory fibers in a developing foetus - leads to:
- Low GnRH
- Low LH & FSH
- Low testosterone
(hypotgonadotrophic hypogonadism

Question 19

What is the treatment for hyperprolactinaemia?

Answer 19

• Dopamine agonist (cabergoline)

- Surgery/DXT

Question 20

What are the causes for hperprolactinaemia?

Answer 20

• Prolactinoma (micro/macro)
• Pituitary stalk compression
• Pregnancy and breastfeeding
• Medications (dopamine agonists)

Question 21

What treatment can be given for male infertility?

Answer 21

General lifestyle:

• Optimise BMI
• Reduce alcohol intake
• Smokin cessation

Specific treatment:

• Dopamine agonist for hyper prolactinaemia
• Gonadotrophin treatment for fertility
• Testosterone
• Surgery

Question 22

What is primary amenorrhoea?

Answer 22

When you start menstruating later than the age of 16

Question 23

What is secondary amenorrhoea?

Answer 23

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

Question 24

What is oligomenorrhoea?

Answer 24

Irregular or infrequent periods, >35 day cycles
OR
4-9 cycles per year

Question 25

What would happen to the individual levels of LH, FSH and oestradiol in primary ovarian insufficiency?

Answer 25

LH: up
FSH: up
Oestradiol: down

Question 26

What would happen to the individual levels of LH, FSH and oestradiol in anorexia nervosa-induced amenorrhoea?

Answer 26

LH: down
FSH: down
Oestradiol: down

Question 27

How do you diagnose PCOS?

Answer 27

Rotterdam PCOS diagnostic criteria

Question 28

How can you treat PCOS?

Answer 28

• Oral contraceptive pill - amenorrhoea
• Metformin - insulin resistance and amenorrhoea
• Anti-androgens - hirsutism