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year 4 OBS and Gynea > fertility > Flashcards

fertility Flashcards

1
Q

what are the different tests you may do in an infertility workup?

A
  • Serum LH and FSH on day 2 to 5 of the cycle (checks ovarian reserve) - high FSH is bad- high LH may suggest PCOS
  • Serum progesterone on day 21 of the cycle (or 7 days before the end of the cycle if not a 28-day cycle).- tests ovulation as the corpus leuteum will have released progesterone
  • Anti-Mullerian hormone- released by granulosa cells and can tell you about ovarian reserve- can be measured at any point in the cycle
  • Thyroid function tests when symptoms are suggestive- hypothyroid can lead to anovulation
  • Prolactin (hyperprolactinaemia is a cause of anovulation) when symptoms of galactorrhea or amenorrhoea
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2
Q

what is a normal/ good FSH level?

A

<9

> 20- no go

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3
Q

what are the different problems that may be causing infertility?

A 
Sperm problems (30%)
Ovulation problems (25%)
Tubal problems (15%)
Uterine problems (10%)
Unexplained (20%)
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4
Q

what is the initial screening for fertility?

A 
Body mass index (BMI) (low could indicate anovulation, high could indicate PCOS)
Chlamydia screening
Semen analysis
Female hormonal testing (see below)
Rubella immunity in the mother
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5
Q

which types of imaging can be done to investigate infertility?

A
  • Ultrasound pelvis to look for polycystic ovaries or any structural abnormalities in the uterus
  • Hysterosalpingogram to look at the patency of the fallopian tubes
  • Laparoscopy and dye test to look at the patency of the fallopian tubes, adhesions and endometrios
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6
Q

what precautions should be taken before a hysterosalpingogram and why?

A

There is a risk of infection with the procedure, and often antibiotics are given prophylactically for patients with dilated tubes or a history of pelvic infection. Screening for chlamydia and gonorrhoea should be done before the procedure.

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7
Q

what percentage of couples become pregnant after 1 year of regular intercourse without contraception?

A

85%

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8
Q

what level of progesterone at day 21 indicates that ovulation has occurred?

A

> 30nmol/l

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9
Q

what progesterone level would make you want to repeat the levels?

A

16-30nmol/l

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10
Q

what progesterone level would prompt referral to a specialist?

A

<16

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11
Q

what hormonal levels indicate premature ovarian failure?

A

raised FSH, LH levels
e.g. FSH > 40 iu/l
low oestradiol
e.g. < 100 pmol/l

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12
Q

what’re management options for annovulation?

A
  • Weight loss for overweight patients with PCOS can restore ovulation
  • Clomifene may be used to stimulate ovulation
  • Letrozole may be used instead of clomifene to stimulate ovulation (aromatase inhibitor with anti-oestrogen effects)
  • Gonadotropins may be used to stimulate ovulation in women resistant to clomifene
  • Ovarian drilling may be used in polycystic ovarian syndrome
  • Metformin may be used when there is insulin insensitivity and obesity (usually associated with PCOS)
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13
Q

how can tubal factors be managed?

A
  • tubal stents during hysterosalpingogram
  • in vitro fertilisation
  • laparoscopy to remove endometrial tissue or adhesions
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14
Q

how can sperm problems be managed?

A
  • surgical retrieval if there is a tube blockage
  • surgical correction- to fix vas deferens
  • intrauterine insemination
  • donor insemination
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15
Q

what are the hormone levels like in PCOS?

A

FSH- normal
LH- raised
Oestrogen- low or normal
Testosterone- raised

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16
Q

what test should you do to check for uterine abnormalities?

A

hysteroscopy

17
Q

what is the mechanism of metformin in PCOS?

A

increases peripheral insulin sensitivity

18
Q

what type of anovulation is hypogonadotrophic hypogonadal an ovulation?

A

hypothalamic amenorrhoea

19
Q

what type of anovulation is normogonadotropic normoestrogenic anovulation?

A

PCOS

20
Q

what type of anovulation is hypergonadotrophic hypooestrogenic anovulation?

A

premature ovarian insufficiency

attempts at ovulation induction are typically unsuccessful and therefore usually require in-vitro fertilisation (IVF) with donor oocytes to conceive

21
Q

what is the mechanism of action of letrazole

A

aromatase inhibitor, reducing the negative feedback caused by estrogens to the pituitary gland, therefore increasing the amount of follicle-stimulating hormone (FSH) production and promoting follicular development

22
Q

what is the mechanism of action for clomifine?

A

selective estrogen receptor modulator (also known as SERMs), which acts primarily at the hypothalamus, blocking the negative feedback effect of estrogens.

This subsequently leads to an increase in gonadotropin-releasing hormone (GnRH) pulse frequency and therefore FSH and LH production, stimulating ovarian follicular development

23
Q

which type of anovulation is gonadotropin therapy mostly used for?

A

class 1 ovarian dysfunction= hypogonadotropic hypogonadism

  • for women with PCOS it is only considered after weight loss, clomifine and letrazole
24
Q

what happens in ovarian hyper stimulation syndrome?

A

ovarian enlargement with multiple cystic spaces form, and an increase in the permeability of capillaries leads to a fluid shift from the intravascular to the extra-vascular space, which has the potential to result in multiple life-threatening complications including:

  • Hypovolaemic shock
  • Acute renal failure
  • Venous or arterial thromboembolism
25
Q

how is ovarian hyper stimulation syndrome managed?

A
  • Fluid and electrolyte replacement
  • Anti-coagulation therapy
  • Abdominal ascitic paracentesis
  • Pregnancy termination to prevent further hormonal imbalances
26
Q

how does metformin help with ovulation?

A

nsulin resistance -> hyperinsulinaemia -> androgen excess -> arrest in antral follicular development -> anovulation

Metformin treats insulin resistance and hyperinsulinaemia, therefore allowing follicular development and subsequent ovulation

27
Q

if semen analysis is abnormal- how soon should it be repeated?

A

3 months

28
Q

when should semen analysis be preformed?

A

after a minimum of 3 days and a maximum of 5 days abstinence. The sample needs to be delivered to the lab within 1 hour

year 4 OBS and Gynea (34 decks)

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