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Reproductive - Reproductive Gynaecology > Female Infertility > Flashcards

Female Infertility Flashcards

1
Q

What are the 3 main causes of female infertility?

A

Anovulation, tubal disease, uterine/peritoneal disease

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2
Q

Investigations for female infertility are used to assess what?

A

Ensure regular ovulation and patent tubes

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3
Q

What investigation is used to tell if a woman is ovulation?

A

Mid-luteal phase (day 21) progesterone level should be > 16pmol/l

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4
Q

What hormones are measured in an endocrine profile for a female?

A

Day 2-5 LH/FSH, oestrogen, testosterone, sex hormone binding globulin, prolactin and TFTs

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5
Q

What is an endocrine profile used for in the investigation of female infertility?

A

To establish a cause of irregular or infrequent menstrual cycles

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6
Q

High testosterone and a high LH: FSH ration is seen in which condition?

A

PCOS

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7
Q

High FSH and low anti-Mullerian hormone indicate what?

A

Low ovarian reserve

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8
Q

A urine sample is used to test for what in the investigation of female infertility and why?

A

Chlamydia, a common cause of tubal disease

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9
Q

What is the first line imaging investigation for female infertility?

A

US of ovaries, uterus and tubes

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10
Q

What must be confirmed before embarking on ovulation induction?

A

Tubal patency

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11
Q

How may tubal patency be confirmed in low risk women?

A

Hysterosalpingography

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12
Q

How may tubal patency be confirmed in high risk women?

A

Laparoscopy and dye

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13
Q

When is a hysteroscopy indicated in the investigation of female infertility?

A

If there are uterine abnormalities suspected/found on US

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14
Q

What is the WHO group 1 type of anovulatory disorders?

A

Hypogonadotrophic hypo-oestrogenic

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15
Q

How do type 1 anovulatory disorders usually present?

A

Amenorrhoea

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16
Q

What will be the relevant hormone levels in type 1 anovulatory disorders?

A

Low FSH/LH/oestrogen, high prolactin

17
Q

What are some causes of type 1 anovulatory disorders?

A

Pituitary tumours, hypothalamic dysfunction

18
Q

What is the treatment for type 1 anovulatory disorders?

A

Treat the underlying cause

19
Q

What is the WHO group 2 type of anovulatory disorders?

A

Normogonadotrophic normo-oestrogenic

20
Q

How do type 2 anovulatory disorders usually present?

A

Oligo/amenorrhoea and maybe also increased body weight, acne and hirsutism

21
Q

What will be the relevant hormone levels in type 2 anovulatory disorders?

A

Normal LH, FSH levels but high LH: FSH ration, high testosterone and low sex hormone binding globulin

22
Q

What condition is the most common cause of type 2 anovulatory disorders?

A

PCOS

23
Q

What are some treatment options for type 2 anovulatory disorders?

A

Weight loss, ovulation induction, ovarian drilling

24
Q

What is the WHO group 3 type of anovulatory disorders?

A

Hypergonadotrophic hypo-oestrogenic

25
Q

What will be the relevant hormone levels in type 3 anovulatory disorders?

A

High LH/FSH, low oestrogen

26
Q

What are some causes of type 3 anovulatory disorders?

A

Hypothyroidism, premature ovarian failure, Turner’s

27
Q

What are some treatment options for type 3 anovulatory disorders?

A

HRT, donor oocytes

28
Q

When can ovulation induction be used as a treatment for subfertility?

A

If semen analysis is normal, tubes are patent and the female partner has a BMI < 30

29
Q

Before starting ovulation induction, if the woman is amenorrhoeic, what is given to induce a withdrawal bleed?

A

Progestogen for 7-10 days

30
Q

What is the most commonly used agent for ovulation induction? What type of drug is this?

A

Clomifene citrate, an anti-oestrogen

31
Q

How does clomifene citrate work?

A

It stops the production of oestrogen and hence stops oestrogen giving negative feedback to the pituitary gland so more FSH is produced

32
Q

What are some medications that may be used in combination with clomifene citrate?

A

Metformin, letrozole, hMG, FSH

33
Q

What type of drug is letrozole?

A

Aromatase inhibitor

34
Q

How is ovarian induction monitored?

A

US scanning

35
Q

When is tubal surgery offered to women?

A

If they have mild disease and are aged < 37

36
Q

How are women with moderate-severe tubal disease treated?

A

Referred to ACT

Reproductive - Reproductive Gynaecology (12 decks)

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