fertility Flashcards
which gene can cause 46XY problems eg f external genitalia but no ovaries
NR5A1
where is NR5A1 active (2)
urogenital ridge and gonadal primordium
definition of infertility
unabble to conceive, even with medical interventions
primary vs 2ary infertility
1 no conception
2 conception but no baby (either previous live birth or miscx etc)
subfertility
12 mo
what stimulates gnrh release re start of puberty
leptin
why anorexia no periods
no fat, no leptin, no gnrh
what would cause pituitary infertility?
What tx
hyperprolactinaemia -> inhibition of LH FSH,
bromocriptine or cabergoline (dopamine agonists)
what are type 1,2,3,4 infertility
1 hypothalamic
2 pituitary
3 ovarian failure
4 PCOS
what hormonal profile PCOS
Raised LH with normal FSH, raised free testosterone
raised anti-mullerian hormone
PCOS diagnosis requires 2/3 Rotterdam criteria. what are they
oligomenhorroea
raised androgens - hirsutism or acne
polycystic ovaries on USS
what preserves thecal cells in PCOS
insulin
which cells in PCOS release too much androgen and why are they there
obesity - insulin resistance - hyperinsulinaemia - preservation of thecal cells - too much testosterone released
is GnRH raised in PCOS
no. just raised sensitivity to it (supposedly)
which cells release AMH and what is the relevance of that in PCOS
granulosa cells - multiple follicles stimulated at once
what other endocrine disorder is also common in women with PCOS
thyroid
what type of tumour are fibroids
leiomyoma
what side effects associated with Diethylstilbesterol
when taken by mother, uterine and vaginal structural defects
also vaginal carcinoma in the mother
LH levels in women dependent on…
insulin sensitivity
abnormal secretion of what found in 81% women with recurrent miscarriage
LH
50-60% women with recurrent miscarriage have what problem give 2 examples
too much coagulation defect
Defects in factor XIII and factor XII
Anticardiolipin antibodies (aCL) or lupus anticoagulant antibodies in antiphospholipid syndrome (APS or sticky blood syndrome): ↑ the risk of developing blood clots
IgG, IgA can both be anti-sperm antibodies.
what do they inhibit
IgG blocks sperm- ovum fudion
IgA stops motility of sperm and penetration of cervical mucus
what tests constitute PCOS screen
Day 21 progesterone (16 to 28 nmol/l), LH, FSH, serum testosterone, glucose
HbA1C (if glucose abnormal on PCOS screen)
which molecule is inversely related to Anti Mullerian Hormone
Vitamin D
folate recommended for high BMI or family history of spina bifida
5mg
what drug used for ovulation induction in PCOS
clomiphene citrate
moa clomiphene citrate
Inhibits E2 negative feedback and activate GnRH secretion, correct the imbalance levels of FSH and LH
what 2nd line tx for ovulation induction in fertility tx
Human Menopausal Gonadotropin or hMG (75 IU FSH & 75 IU LH – Menotropins (Menopur))
what drug is Used for final preparation of the eggs before retrieval in IVF
HCG injection
what drug can overcome luteal phase defects (stimulates better develpmnt of corpus luteum)?
HCG
why would you give HMG as fertility tx
CC failure
what is ovarian drilling
drilling 10 holes into ovaries laparoscopically to redress FSH LH balance wtf
