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S3 Case 3 - Sexual Health > Female Infertility > Flashcards

Female Infertility Flashcards

1
Q

What is infertility?

A

Failure to conceive after 2 years of regular unprotected sexual intercourse (UPSI)

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2
Q

What is primary subfertility?

A

Never managed to conceive

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3
Q

What is secondary subfertility?

A

Managed to conceive in the past but difficulty conceiving again

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4
Q

What are the risk factors?

A

Smoking
Obesity
Occupational risks
Excessive alcohol consumption
Drug use

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5
Q

What are the different causes?

A

Ovarian/ovulatory
Tubal
Pelvic uterine
Male infertility
No identifiable cause

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6
Q

What is the most common type of ovarian cause?

A

Anovulation

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7
Q

What is anovulation?

A

Failure of ovary to release over a period of least 45 days

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8
Q

What is the WHO classification of ovarian problems?

A

Group I
Group II
Group III

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9
Q

What is Group I?

A

Hypogonatrophic hypogonadism
= impaired secretions of gonadotropins

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10
Q

What is seen in Group I?

A

Low levels of FSH + LH = low oestradiol levels

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11
Q

What are the causes of Group I?

A

Prolactinomas (pituitary tumours)
Hypothyroidism
Drugs - antipsychotics, antidepressants, opioids + anti-hypertensives

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12
Q

What is Group II?

A

Hypothalamic-pituitary-ovarian dysfunction

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13
Q

What is seen in Group II?

A

Raised FSH/LH ratio

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14
Q

What is the main problem seen in Group II?

A

Polycystic ovary syndrome (PCOS)

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15
Q

What are the symptoms of PCOS?

A

Fewer or no periods
Hirsutism
Obesity
Acne
Infertility

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16
Q

What is Group III?

A

Hypergonadotrophic hypogonadism
= impaired response to gonadotrophins

17
Q

What is seen in Group III?

A

High levels of FSH + LH

18
Q

What are the causes of Group III?

A

Chromosomal abnormalities
Premature ovarian failure
Surgery/trauma
Defects in hormone synthesis

19
Q

What are the causes of tubal problems?

A

Damage/blockage to fallopian tubes
= prevent sperm reaching ovum
Pelvic inflammatory disease (PID)

20
Q

What are the causes of pelvic problems?

A

Pelvic adhesions + endometriosis
Pelvic damage from chlamydia

21
Q

What are the causes of uterine problems?

A

Abnormalities = fibroids, polyps + adhesions
= affect sperm migration + embryo implantation

22
Q

What is the treatment for Group I disorders?

A

Gonadotropin releasing hormones
Or gonadotropins with LH activity

23
Q

What do GnRH analogues do?
Group I treatment

A

Activate GnRH receptor on pituitary gland = increased secretion of FSH + LH

24
Q

What are examples of GnRH analogues?
Group I treatment

A

Buserelin
Goserelin
Nafarelin

25
Q

What can also be done in the treatment of Group I disorders?

A

Hyperprolactinemia treatment with dopamine agonists
eg. Cabergoline

26
Q

What are the drugs for Group II?

A

Clomifene citrate
Metformin
BOTH

27
Q

How is Clomifene citrate used?
Group II treatment

A

Given for 5 days started on cycle day 2-5
Should NOT be used for more than 6 cycles

28
Q

Why use Metformin?
Group II treatment

A

Women with PCOS frequently experience insulin resistance

29
Q

What are the assisted reproductive technology?

A

Intrauterine insemination (IUI)
In vivo fertilisation
Intracytoplasmic sperm injection

30
Q

What is IUI?

A

Fast moving sperm placed into woman’s womb close to time of ovulation

31
Q

When is IVF considered?

A

If unsuccessful after 6 cycles of IUI despite evidence of normal ovulation a further 6 cycles then IVF considered

32
Q

When is IUI considered?

A

Difficulty having sex due to disability or psychosexual problem
Pain during intercourse
Male impotence
One partner has HIV
Sperm donation used

33
Q

What is IVF?

A

Woman’s eggs collected + fertilised manually with sperm
If successful embryo developed for 2-6 days then transferred to womb

34
Q

Who is IVF for?

A

Woman with unexplained infertility
Blocked fallopian tubes
Male infertility
Unsuccessful treatment with IUI

35
Q

What is the criteria for IVF?

A

Woman 21-39
BMI 19-30
Both non-smokers
No living children from past or present relationships
Both live at same address
Stable relationship
Neither sterilisation procedures

36
Q

What are the risks of IVF?

A

Ovarian hyperstimulation syndrome (OHSS)
Ectopic pregnancy

37
Q

What is lifestyle advice?

A

Women with BMI less than 19 = irregular periods
Both BMI over 30 = longer to conceive
Smoking + drugs = affect egg + sperm quality
Chlamydia + STIs

S3 Case 3 - Sexual Health (11 decks)

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