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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
what is the mechanism of action of letrozole ?
aromatase inhibitor that blocks the conversion of testosterone to oestrogen leading to increased pituitary FSH
26
what are the different types pituitary gonadotropins ?
1. human menopausal gonadotrophins 2. purified urinary FSH 3. Synthetic FSH
27
what are the indications to using pituitary gonadotropins?
1. CC resistance 2. a patient with hypogonadotrophic anovulation 3 . in IVF procedures
28
what are the side effects of using pituitary gonadotropins ?
1. ovarian hyperstimulation | 2. increased risk of multiple pregnancies
29
what are the indications for the use of human chorionic gonadotropins ?
it is used to assist ovulation especially in CC or HMG induced cycles
30
what effect do different doses of GnRH have on FSH levels ?
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
what are the combined therapies used for infertility ?
1. Clomiphene citrate + human menopausal gonadotrophin +hCG ( to reduce the cost and decrease the chances of OHSS) 2. GnRh/HMG/hCG
32
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
1. hyperprolactinemia - bromocriptine 2. Metformin - insulin resistance 3. hypothyroidism - Eltroxin 4. Addison's disease - corticosteroids 5. adrenogenital syndrome - corticosteroids 6. PCOS - corticosteroids
33
what are the cases where laparoscopic ovarian drilling can be used ?
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
what are the possible causes of unexplained infertility ?
1. immunological and psychological factors 2. defective sperm fertilization capacity 3 .decreased ovarian reserve 4 .occult cervical infection
35
when is myomectomy via laparotomy or laparoscopy indicated ?
in large leiomyomas that are causing infertility
36
what is saline infusion sonography used to diagnose ?
submucous myoma | endometrial polyps
37
what are the causes of post-coital bleeding ?
``` cervical dysplasia ectropion polyps genital tract infections vaginal atrophy ```
38
what are the consequences of a chlamydia infection ?
causes PID | salpingitis

WH (68 decks)

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