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female infertility Flashcards

1
Q

what is primary infertility in females ?

A

conception has never occurred after regular unprotected sex for a year without the use of any contraception

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2
Q

what is secondary infertility ?

A

failure of conception after a previous pregnancy
6-12 months after an ectopic pregnancy
1-2 years after a full term pregnancy

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3
Q

what are the female causes of infertility ?

A 
either :
Anovulation 
Tubal diseases 
Endometriosis 
Structural/Congenital
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4
Q

when should we start investigating ?

A 
only after one year 
OR 
earlier if the patient has predisposing factors 
age >36 
Menstrual problems 
undescended testis 
viral positive 
prior to cancer treatment
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5
Q

what investigations must be done for all couples ?

A 
semen analysis 
mid-luteal progesterone 
LH and FSH 
Rubella 
Transvaginal ultrasound 
Chlamydia from both partners
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6
Q

what tests are done for the detection of ovulation ?

A 
basal body temperature 
folliculometry / ultrasonography
premenstrual endometrial biopsy ( day 25)
hormonal assay ( mid-luteal progesterone levels ) d21
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7
Q

why is serum progesterone performed in the mid luteal phase ?

A

progesterone is produced by the corpus leuteum

these progesterone levels peak at the mid luteal phase

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8
Q

what does each result of the midluteal progesterone level indicate ?

A

. less than 3 : anovulation
. 3-10 : poor ovulation
. more than 10 : good ovulation

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9
Q

what is the aetiology of tubo-peritoneal factors ?

A
  1. salpingitis, salpingo-oophoritis and pelvic peritonitis
  2. Chronic infection
  3. Pelvic endometriosis
  4. Uterine fibroids and ovarian cysts
  5. Surgical trauma
  6. Congenital anomalies
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10
Q

what are the different causes of salpingitis and pelvic peritonitis ?

A

STDs
puerperal and post abortive salpingitis
extension from appendicitis

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11
Q

which STDS must be excluded and tested for when it comes to fertility ?

A

gonorrhea

chlamydia

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12
Q

what kind of chronic infections can cause salpingitis ?

A

Chronic TB
or
chronic non specific PID

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13
Q

how can we test for tubal patency ?

A

laparoscopy and dye
HSG (hysterosalpingogram) X RAY
Hystero contrast sonography (US)

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14
Q

what is the most optimum time in relation to the menstrual cycle should a hysterosalpingogram be done ?

A

2 to 3 days after end of menstruation

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15
Q

what is the advantage of using the laparoscopic method ?

A

both diagnostic and therapeutic

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16
Q

which of the methods used to asses tubal patency should be used in a patient with co-morbidities ?

A
  1. use radiology if the patient has no co-morbidities (hysterosalpingogram or hystero contrast sonography)
  2. if the patient has co morbidities use laparoscope
17
Q

what are the mechanisms of infertility that are due to uterine causes ?

A
  1. impairment of blastocyst implantation
  2. bilateral cornual obstruction of tubal ostia
  3. interference with transport of sperms
18
Q

what is the aetiology of uterine factors ?

A

congenital uterine abnormalities
uterine leiomyoma
uterine polyps
intrauterine synechiae (adhesions)

19
Q

what are the causes of intrauterine synechiae ?

A
  1. over curettage of basal endometrial layer ( Ashermann’s syndrome)
  2. acute septic endometritis
  3. Chronic septic infections
20
Q

how cann we treat anovulation ?

A

medical induction of ovulation

surgical induction of ovulation ( ovarian drilling )

21
Q

what are the oral drugs used for the induction of ovulation ?

A
  1. clomiphene citrate
  2. tamoxifen
  3. letrozole
22
Q

what are the indications for the use of clomiphene citrate ?

A

anovulatory conditions with normal FSH production and intact hypothalamic pituitary axis

23
Q

what diseases/conditions should clomephine citrate be used in ?

A

PCOD

Post pill amenorrhea

24
Q

what are the side effects of clomiphene citrate ?

A

luteal phase defect
increased risk of twin pregnancy
ovarian hyperstimulation

25
Q

what is the mechanism of action of letrozole ?

A

aromatase inhibitor that blocks the conversion of testosterone to oestrogen leading to increased pituitary FSH

26
Q

what are the different types pituitary gonadotropins ?

A
  1. human menopausal gonadotrophins
  2. purified urinary FSH
  3. Synthetic FSH
27
Q

what are the indications to using pituitary gonadotropins?

A
  1. CC resistance
  2. a patient with hypogonadotrophic anovulation
    3 . in IVF procedures
28
Q

what are the side effects of using pituitary gonadotropins ?

A
  1. ovarian hyperstimulation

2. increased risk of multiple pregnancies

29
Q

what are the indications for the use of human chorionic gonadotropins ?

A

it is used to assist ovulation especially in CC or HMG induced cycles

30
Q

what effect do different doses of GnRH have on FSH levels ?

A
  1. in small doses they increase FSH levels
  2. in larger preparations they first increase FSH levels followed by hypothalamic receptor down regulation which results in a decrease of FSH and LH levels
31
Q

what are the combined therapies used for infertility ?

A
  1. Clomiphene citrate + human menopausal gonadotrophin +hCG ( to reduce the cost and decrease the chances of OHSS)
  2. GnRh/HMG/hCG
32
Q

what adjuvant drugs can be used for each of these conditions :

  1. hyperprolactinaemia
  2. insulin resistance
  3. hypothyrididsm
  4. Addisons disease
  5. adrenogenital syndrome
  6. PCOS
A
  1. hyperprolactinemia - bromocriptine
  2. Metformin - insulin resistance
  3. hypothyroidism - Eltroxin
  4. Addison’s disease - corticosteroids
  5. adrenogenital syndrome - corticosteroids
  6. PCOS - corticosteroids
33
Q

what are the cases where laparoscopic ovarian drilling can be used ?

A
  1. cases which require large doses of HMG which would cause severe OHSS
  2. cases that do respond to regular doses of HMG but with severe OHSS
34
Q

what are the possible causes of unexplained infertility ?

A
  1. immunological and psychological factors
  2. defective sperm fertilization capacity
    3 .decreased ovarian reserve
    4 .occult cervical infection
35
Q

when is myomectomy via laparotomy or laparoscopy indicated ?

A

in large leiomyomas that are causing infertility

36
Q

what is saline infusion sonography used to diagnose ?

A

submucous myoma

endometrial polyps

37
Q

what are the causes of post-coital bleeding ?

A 
cervical dysplasia 
ectropion 
polyps 
genital tract infections 
vaginal atrophy
38
Q

what are the consequences of a chlamydia infection ?

A

causes PID

salpingitis

WH (68 decks)

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