Female Infertility 2 Flashcards

Describe the differential diagnosis of infertility.

1
Q

What are the common disorders in the differential diagnosis for infertility?

A
  • Male factor
  • Anatomic disorders of the female reproductive tract
  • Anovulation
  • Decreased ovarian reserve
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the common male factors that lead to infertility?

A
  • Usually idiopathic (40-50%)
  • Primary gonadal disorders (30-40%)
  • Disorders of sperm transport (10-20%)
  • Hypothalamic-pituitary disorders (1-2%)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are some common anovulatory causes of infertility?

A
  • More common:
    • polycystic ovarian syndrome
    • hypothalamic amenorrhea
  • Less common:
    • hyperprolactinemia
    • thyroid disease
    • premature ovarian failure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are some anatomic abnormalities of the female reproductive tract that can lead to infertility?

A
  • Abnormalities of the uterine cavity
    • congenital
      • _​_mullerian duct abnormalities
    • acquired
      • _​_fibroids, polyps, Asherman’s syndrome
  • Abnormalities of the fallopian tubes
    • usually related to prior ascending infection or pelvic surgery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What effect does age have on infertility?

A
  • No significant effect on the uterus or endometrial development or function
  • No effect on the egg itself in terms of live birth per transfer rate
  • Decreased ovarian reserve
    • 6-7 million oogonia by 16-20 week gestation and 1-2 million at birth
    • 300,000 to 500,000 at puberty, 400-500 at reproductive age
    • By age 40, size of the follicular pool declines to ~25,000
    • At menopause, <1000 follicles remain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Polycystic ovary syndrome

A
  • Most common endocrinopathy of women
  • Perimenarchal onset
  • Hyperandrogenemia
  • Insulin resistance
  • Frequently associated with obesity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Hypothalamic amenorrhea

A
  • Usually a functional disorder:
    • Excessive exercise
    • Inadequate nutrition
    • Stress
  • Common pathway is disruption of pulsatile GnRH secretion from the hypothalamus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are some less common problems that lead to infertility?

A
  • Cervical abnormalities
  • Endometriosis
  • Sexual dysfunction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are some cervical abnormalities that can lead to infertility?

A
  • Chronic cervicitis or cervical stenosis
    • conization or other treatments for cervical disease
    • impairs sperm-mucus interaction
    • usually identified by speculum examination
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Endometriosis

A
  • Benign disease, defined by presence of endometrial glands and stroma outside of the uterus
    • ectopic tissue usually located in the pelvis but can appear anywhere in the body
  • Associated with pelvic pain and infertility
  • Possible pathogenic mechanism (no generally accepted theory)
    • retrograde menstruation and implantation
    • coelomic metaplasia
    • direct transplantation
    • vascular dissemination
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How does endometriosis cause infertility?

A
  • 20-40% of infertile women have the disease
    • distorted adenexal anatomy
      • inhibits or prevents ovum capture after ovulation
    • excess production of:
      • prostaglandins
      • metalloproteinases
      • cytokines
      • chemokines
    • results in chronic inflammation
    • impairs ovarian, tubal, or endometrial function
    • disorders of folliculogenesis, fertilization, or implantation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How is the diagnosis of unexplained infertility derived?

A
  • Diagnosis of exclusion
    • implies the following:
      • normal semen quality
      • normal ovulatory function
      • normal uterine cavity
      • bilateral tubal patency
  • Incidence from 10-30% among infertile populations
  • 2 potential explanations for unexplained infertility
    • poor oocyte quality
    • other specific abnormalities that cannot be identified with existing tests:
      • sperm function
      • fertilization
      • implantation
      • embryo development
How well did you know this?
1
Not at all
2
3
4
5
Perfectly