Fertility Flashcards

Question

Modifiable risk factors for POF

Answer 1

Smoking Chronic disease treatment

Answer 2

90% no underlying cause found; spontanous/ idiopathic Autoimmune (5%) - 12OH-Ab or ACA (adrenocortical antibiodies), addisons --> refer endo - TPO Ab; TSH measured yearly Genetic: Turners, Fragile X, Galactossaemia Fam Hx Infections: mumps, TB, malaria Surgery Cancer rx

Answer 3

Genetic/ chromosomal: - karyotyping --> ? Turners --> +ve: refer endo, cardio and genetics - Test for Y chromosome material --> discuss gonadectomy - Fra-X --> refer genetics - Autosomal Ab testing if evidence suggesting specific mutation eg BPES Antibodies: - ACA/ 12OH Ab --> refer endo TPO-Ab --> TSH testing yearly

Answer 4

Anxiety Changes in mood Chhanges in skin conditions Difficultysleeping Discomfort during intercourse Feelings of loss of self Hair loss of thinning headaches or migraines Hot flushes Increase in facial hair Joint stiffness L/o self confidence Night sweats Palpitations Problems w memory/. brain fog Tinnitus L/olibido Recurrent UTIs Vaginal dryness

Answer 5

Amenorrhoea and symptomatic GDG recommends: Oligo/amenorrhoea for 4/12 and FSH >25 on 2 or more occasions 4 weeks apart

Answer 6

Lifestyle - weight-bearing exercise, weight, diet, smoking E replacement - reduces fractures Bisphosphonates COCP DEXA - if osteo, repeat in 5 years after E

Answer 7

Reduced life expectancy if untreated - CVS risks Small chance of conception Still use contraception if want to avoid pregnancy Therapy

Answer 8

No increase in breast Ca P for uterine protection - ethinylestradiol + oral cyclic progesterone Annual monitoring Androgens - evaluated 3-6 monthly, limited to 24 months BRCA gene - HRT conrtaindicated in BRCA survivors, carriers w BSO can have HRT Migraines and HTN should not be a contraindication

Answer 9

Ovarian hyperstimulation syndrome Complication of ART - exposure to HCG, LH following controlled ovarian stimulation by FSH - Production of proinflammatory markers - VEGF - Increase vascular permeability - loss of fluid into 3rd space --> ascites, pleural and pericardial effusions - severe --> hypovolaemia, reduced serum osmolality and reduced sodium

Answer 10

Abdo distension and pain following trigger injection to promote final follicular maturation Early OHSS: within 7 days of injection; excessive ovarian response Late OHSS: >10 days post HCG injection Symptoms: severe pain, pyrexia, peritonism Bloods: elevated HCT, reduced osmolality, reduced sodium

Answer 11

Pelvic infection Abscess Appendicitis Ovarian torsion Cyst rupture Bowel perf

Answer 12

Abdo bloating Abdo pain N&V Breathlessness Reduced urine output Leg and vulval swelling Assoc comorbs such as thrombosis

Answer 13

Time of onset of symptoms relative to trigger Med used for trigger - hcg vs GnRH agonist Number of follicles on final monitoring scan Number of eggs collected Were embryos replaced and how many PCOS diagnosis

Answer 14

Abdo bloating Mild abdo pain Ovarian size < 8cm

Answer 15

Moderate abdo pain Nausea +/- vomiting Ultrasound evidence of ascites Ovarian size 8-12 cm

Answer 16

Clinical ascites +/- hydrothorax Oliguria <30ml/hr Haematocrit >0.45 Hyponatraemia <135 Hypo-osmolality <282 Hyperkalaemia >5 Hypoproteinaemia <35 Ovarian size >12

Answer 17

Tense ascites/ large hydrothorax Haematocrit >0.55 WCC > 25 Oliguria/ anuria Thromboembolism ARDS

Answer 18

Counselling Fluid in/out monitoring No NSAIDS If severe - LMWH Paracentesis Monitoring: - review in 2-3 days - baseline labs repeated if worsening - haematocrit NB guide to the degree of intravascular depletion

Answer 19

Severe pain Unable to maintain fluid intake Worsening OHSS Unable to attend follow up Increasing HCT Critical OHSS

Answer 20

MDT if persistent haemoconcentration and dehydration Critical --> ICU Sx relief: - analgesia (no NSAIDs) - fluid replacement - avoid diuretics - ascites --> paracentesis - Thrombosis --> LMWH, TEDS Surgical management if torsion/ ectopic If in pregnancy - incr risk of PET and PTL