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finals > Fertility > Flashcards

Fertility Flashcards

1
Q

give 5 causes of infertility

A
  • Failure of sperm problem (most common)
  • Ovulation problem
  • Tubal problems
  • Uterine problems
  • Unexplained
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2
Q

give 6 pieces of lifestyle advice for coupls getting pregnant

A
  • 400mcg folic acid daily (woman)
  • healthy BMI
  • avoid smoking and excessive alcohol
  • reduce stress
  • aim for intercourse every 2-3
  • AVOID timed intercourse
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3
Q

what female hormone testing is done for fertility investigations

A
  • serum LH (high may = PCOS) on day 2-5
  • serum FSH (high may suggest poor ovarian reserve) on day 2-5
  • progesterone on day 21 : rise = ovulation has occurred
    -anti-mullerian hormone : marker of ovarian reserve. high = good ovarian reserve
  • TFT
  • Prolactin if Sx of galactorrhea or amenorrhea
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4
Q

what further Ix can be performed in secondary care to assess fertility

A

-USS pelvis for PCOS or uterine structural abnormalities
-Hysterosalpingogram to look at patency of fallopian tubes
-Laparoscopy and dye test for patency of fallopian tube, adhesions and endometriosis

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5
Q

what is a hysterosalpingogram

A

assess shape of uterus and patency of fallopian tubes
x-ray images are taken with a contrast medium
if dye doesn’t fill one of the tubes = obstruction

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6
Q

give 6 treatments options for anovulation

A

weight loss for PCOS
clomifene to stimulate ovulation
ovarian drilling in PCOS
metformin in insulin insensitivity & obesity

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7
Q

what is clomifene

A

-A selective oestrogen receptor modulator (anti-oestrogen)
Stops neg feedback of oestrogen on hypothalamus
Greater GnRH release and subsequently greater FSH and LH

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8
Q

how can sperm issues be managed

A
  • surgical sperm retrieval if there is a blockage
  • surgical correction of obstruction
  • intra-uterine insemination
  • intracytoplasmic sperim injection
  • donor insemination
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9
Q

give 3 pre testicular causes of male infertility

A
  • hypothalamus or pituitary pathology
  • suppression due to stress, chronic conditions or hyperprolactinaemia
  • kallman syndrome

can all cause hypogonadotrophic hypogonadism (low FSH, low LH = low testosterone)

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10
Q

Give 2 testicular causes of male infertility

A
  1. Testicular damage : Mumps, Undescended testes, Trauma, Radiotherapy, Chemotherapy, Cancer
  2. Genetic or congenital disorders : klinefelter, Y chromsome deletions, sertoli-cell only syndrome, anorchia (absent testes)
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11
Q

what are the post-testicular causes of male infertility

A
  • ejaculatory duct obstruction
  • rertrograde ejaculation
  • scarring from epididymitis
  • absence of vas deferens
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12
Q

give 5 Ix for male infertility

A

hormonal analysis : FSH, LH and testosterone
genetic testing
further imagining
vasography
testicular biopsy

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13
Q

what are the 6 steps of IVF

A

suppressing natural menstrual cycle
ovarian stimulation
oocyte collection
insemination
embryo culture
embryo transfer

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14
Q

how can the natural menstrual cycle be suppressed

A

-GnRH agonists (e.g. goserelin) : given in luteal phase. Itially stumulates pituitary to secrete large amounts of FSH and LH. There is then negative feedback suppressing natural GnRH, suppressing menstrual cycle.
-GnRH antagonist protocol (e.g. cetrorelix) : from 5-6 days of ovarian stimulation suppresses the body releasing LH and causing ovulation to occur

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15
Q

What Ix are performed in primary care for infertility ?

A
  • BMI - > low could indicate anovulation, high could indicate PCOS
  • Chlamydia screening
  • Semen analysis
  • Female hormonal testing
  • Rubella immunity in the mother
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16
Q

what instructions are given to men prior to a semen sample and what is assessed in the sample ?

A
  • Abstain from ejaculation for at least 3 days and at most 7 days
  • Avoid hot baths, sauna and tight underwear during the lead up to providing a sample
  • Attempt to catch the full sample
  • Deliver the sample to the lab within 1 hour of ejaculation
  • Keep the sample warm (e.g. in underwear) before delivery
  • Assess quantity and quality of semen and sperm
17
Q

Normal sperm result s

A
  • Semen volume (more than 1.5ml)
  • Semen pH (greater than 7.2)
  • Concentration of sperm (more than 15 million per ml)
  • Total number of sperm (more than 39 million per sample)
  • Motility of sperm (more than 40% of sperm are mobile)
  • Vitality of sperm (more than 58% of sperm are active)
  • Percentage of normal sperm (more than 4%)
18
Q

Explain the difference between IVF and IUI

A
  • In vitro fertilisation = fertilising egg with a sperm in the lab efore injecting embryo into uterus
  • Intrauterine insemination = injecting sperm into uterus
19
Q

how is ovarian stimulation done in IVF?

A
  • Subcut injections of FSH from day 2 of cycle over 10-14 days
  • When enough follicles have developed = injection of human chorionic gonadotropin hCG 36 hrs before egg collection
20
Q

4 complications of IVF

A

Failure
Multiple pregnancy
Ectopic pregnancy
Ovarian hyperstimulation syndrome

21
Q

How does OHSS present ?

A
  • Early : within 7 days of hCG injection
  • Late : from 10 days onwards
  • Features : Abdominal pain and bloating, N&V, Diarrhoea
    Hypotension, Hypovolaemia, Ascites, Pleural effusions, Renal failure, Peritonitis from rupturing follicles releasing blood, Prothrombotic state (risk of DVT and PE)
22
Q

how is the severity of OHSS defined ?

A
  • Mild: Abdominal pain and bloating
  • Moderate: Nausea and vomiting with ascites seen on ultrasound
  • Severe: Ascites, low urine output (oliguria), low serum albumin, high potassium and raised haematocrit (>45%)
  • Critical: Tense ascites, no urine output (anuria), thromboembolism and acute respiratory distress syndrome (ARDS)
23
Q

When would progesterone be taken to check for progesterone in a woman struggling with fertility ?

A

7 days before next expected period

24
Q

Ovulation causes of infertility

A
  • PCOS
  • Hyperprolactinaemia
  • Underweight
  • Excessive exercise
  • Premature ovarian insufficieny
25
Q

Non patent fallopian tubes as cause of infertility

A

Endometriosis
Adhesions
Infection

26
Q

If infertility is caused by hyperprolactinaemia, what other symptoms may be reported

A

Galactorrhoea
Menorrhagia
Bitemporal hemianopia
Diplopia

27
Q

Management of hyperprolactinemia as a cause of infertility

A

Dopamine agonist (e.g. bromocriptine)

28
Q
A

finals (92 decks)

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