Female Infertility

Question 1

2 groups of female infertility?

Answer 1

anovulatory

tubal factor

Question 2

what is anovulatory infertility?

Answer 2

where no ovulation takes place
can be normal physiological (before puberty, after menopause, while breastfeeding)
can be pathological (gynae condition, systemic disorder, problem in hypothalamus/pituitary)

Question 3

hypothalamic causes of anovulatory infertility?

Answer 3

anorexia, bulimia and excessive exercise

due to reduction in FSH, LH and oestradiol

Question 4

pituitary causes of anovulatory infertility?

Answer 4

hyperprolactinaemia
high levels of prolactin prevent ovulation in the same way which it does during pregnancy and breastfeeding
symptoms include galactorrhoea, aligomenorrhoea/amenorrhoea

Question 5

other pituitary causes of anovulatory infertility??

Answer 5

sheehans syndrome (post partum hypopituitarism)
pituitary adenomas

Question 6

ovarian causes of anovulatory infertility??

Answer 6

PCOS

premature ovarian failure

Question 7

PCOS diagnosis?

Answer 7

2 or more of following features present

• anovulation
• polycystic ovaries
• hyperandrogenism (clinical or biochemical)

Question 8

symptoms of PCOS?

Answer 8

oligomenorrhoea or amenorrhoea
hirsutism (due to high androgens)
weight gain
acne
hair loss
infertility

Question 9

how does PCOS cause anovulatory infertility?

Answer 9

dont release an ovum due to overproduction of oestrogen by ovaries
in long term, increased testosterone levels can impair ovum quality and mean that any ovum released is poor quality

Question 10

endocrine features of PCOS?

Answer 10

high LH
high free androgens
impaired glucose tolerance

Question 11

what is premature ovarian failure?

Answer 11

ovaries stop producing oestrogen and healthy ova before age of 40

Question 12

symptoms of premature ovarian failure?

Answer 12

basically menopause symptoms (hot flushes, night sweats, atrophic vaginitis, amenorrhoea/oligomenorrhoea)

Question 13

what can cause premature ovarian failure?

Answer 13

unknown
can be genetic (turners, fragile X)
exposure to chemo/radiotherapy
can be autoimmune

Question 14

endocrine features of premature ovarian failure?

Answer 14

high FSH and LH

low oestrogen

Question 15

what is tubal factor infertility?

Answer 15

blockage in one or both fallopian tubes

can be infective or non-infective

Question 16

infective causes of tubal factor infertility?

Answer 16

PID
trans-peritoneal spread of other infection such as appendicitis
iatrogenic infection eg from IUD insertion

Question 17

what is PID?

Answer 17

pelvic inflammatory disease
infection in upper female genital tract
can result in endometritis, salpingitis, oophoritis, parametrises, peritonitis and tubo-ovarian abscesses

Question 18

what usually causes PID?

Answer 18

bacterial infection spreading from vagina or cervix into fallopian tubes

Question 19

symptoms of PID?

Answer 19

abdo/pelvic pain
dyspareunia 
dysmenorrhoea 
inter-menstrual bleeding
unusual vaginal discharge 
severe cases can have severe abdo pain, fever, nausea and vomiting

Question 20

how is PID managed?

Answer 20

metronidazole + oflaxacin

Question 21

what complications can occur with PID?

Answer 21

scarring and narrowing of fallopian tubes (can cause infertility and increases risk of ectopics)

Question 22

how can blocked/scarred fallopian tubes due to PID be managed?

Answer 22

laparoscopic removal of scarring and adhesions after acute inflammation has resolved

Question 23

non-infective causes of tubal factor infertility?

Answer 23

endometriosis
salpingitis isthmica nodosa
uterine polyps
uterine fibroids

Question 24

what is endometriosis?

Answer 24

endometrial tissue growing outside of uterus
can involve the ovaries, fallopian tubes and tissue lining pelvis
can sometimes spread beyond pelvis

Question 25

what happens with the endometrial tissue in endometriosis?

Answer 25

the tissue builds up over menstrual cycles (as it does inside the uterus) then breaks down and "bleeds" this can cause cysts known as "endometriomas" in the ovaries

Question 26

other possible complications in emdometriosis?

Answer 26

organs affected can be irritated and over time form scar tissue and adhesions between other pelvic organs can cause blockage or scarring of fallopian tubes which can result in fertility issues

Question 27

how does endometriosis present?

Answer 27

``` severe abdo pain thats worse during menstruation dyspareunia menorrhagia intermenstrual bleeding subfertility ```

Question 28

how can endometriosis be managed?

Answer 28

hormonal therapy can be good (COCP etc) but cant be used if trying to conceive conservative surgery can be used if trying to conceive and symptoms are very severe which would remove the tissue, cysts and adhesions without damaging repro organs

Question 29

what can be used to diagnose endometriosis and assist with removal of endometrial tissue?

Answer 29

laparoscopy

Question 30

what is salpingitis isthmica nodosa?

Answer 30

nodular scarring of fallopian tube as a result of inflammation has been referred to as diverticulosis of fallopian tube bc irregular benign extensions of tubal epithelium develop results in narrowing of fallopian tube and increases risk of infertility and ectopics

Question 31

what are uterine polyps?

Answer 31

where endometrial lining inside uterus overgrows and as a result a polyp forms

Question 32

how can uterine polyps present?

Answer 32

abnormal uterine bleeding | infertility/subfertility

Question 33

how can polyps be managed?

Answer 33

can be removed surgically via hysteroscopy if causing symptoms or diagnosed during infertility investigation

Question 34

what are uterine fibroids?

Answer 34

benign tumours of myometrium within uterus 3 main types - subserosal - intramural - submucosal v common and dont always result in infertility

Question 35

how can fibroids cause infertility?

Answer 35

can block opening of fallopian tubes can change shape of uterus, blood flow to uterine cavity and shape of uterine lining resulting in difficult implantation of foetus

Question 36

how can fibroids be managed if needed?

Answer 36

laparoscopic myomectomy