Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Gynaecology > Fertility > Flashcards

Fertility Flashcards

1
Q

1st

A

1st

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

When are a couple ‘subfertile’

A

If conception has not occurred after a year of regular unprotected intercourse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What % of couples are ‘subfertile’?

A

15%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What % of fertility problems are due to anovulation?

A

30%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What % of fertility problems are due to male problems?

A

25%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What % of fertility problems are due to fallopian tube damage?

A

25%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What % of fertility problems are due to coital problems?

A

5%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are 30% of fertility problems?

A

30% are unexplained

Total adds up to more than 100% because more than one is often present

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What 3 investigations can be done for ovulation

A

1) Progesterone serum levels rise in mid-luteal phase suggests ovulation has occurred eg. day 21 of 28 day cycle or day 28 of a 35 day cycle
2) US monitor follicular growth (often not performed as time consuming)
3) Urine predictor kits to indicate if LH surge has taken place

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What % of fertility problems are due to cervical problems?

A

Less than 5%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is needed to diagnose PCOS? x3

A

Two or more out of

1) PCO on USS
2) Irregular periods (>35 days apart)
3) Hirsutism - clinical (acne/excess body hair) or biochemical (raised serum testosterone)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What can occur in some women around the time of ovulation?

A

Increase vaginal discharge
Spotting
Pelvic pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Examination signs of ovulation

A

Temperature normally drops 0.2 degrees preovulation and then rises 0.5 degrees in luteal phase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the only concrete proof of ovulation

A

Conception

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What % of women have PCO

A

20%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Other drug treatment for PCOS symptoms

A

Metformin to reduce insulin levels and therefore androgens and hirsutism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What influences susceptibility to PCOS?

A

Genetics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the first step in pathology of PCOS?

A

Disordered LH production and peripheral insulin resistance - compensatory raised insulin levels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the effect of raised insulin and LH in PCOS?

A

Raised insulin and LH causes ovaries to increase androgen production
Insulin also increases adrenal androgen production and reduce hepatic production of steroid hormone binding globulin - therefore increased free androgen levels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What do increased androgen levels in PCOS lead to?

A

Disrupt folliculogenesis leading to excess small ovarian follicles and irregular or absent ovulation
Also cause hirsutism (acne and body hair)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

How does weight influence pathology of PCOS?

A

Increased body weight leads to increased insulin and consequently androgen levels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are health complications of PCOS?

A

50% develop type II diabetes in later life

30% develop gestational diabetes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Treatment of symptoms in PCOS if fertility not required x2

A

COC- will regulate menstruation and treat hirsutism

Cyproterone acetate or spironolactone - treat hirsutism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Ovarian causes of anovulation (other than PCOS)? x3

A

Premature ovarian failure
Gonadal dysgenesis
Luteinized unruptured follicle syndrome - egg never released - unlikely to occur every month

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Topical drug used in PCOS?

A

Eflornithine - topical antiandrogen used for facial hirsutism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

How does hypothalamus cause anovulation?

A

Reduced GnRH release leads to amennorhoea because of reduced stimulation of pituitary therefore reduced FSH and LH and in turn reduced oestradiol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

In whom is hypothalamic hypogonadism common?

A

Women with AN

Women on diets, athletes and those under stress

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Medical cause of hypothalamic hygonadism

A

Kallmann’s syndrome - GnRH secreting neurones fail to develop

29
Q

How does pituitary cause anovulation?

A

Hyperprolactinaemia reduces GnRH release - eg. benign tumour or hyperplasia of pituitary cells

30
Q

What do women with hyperprolactinaemia commonly have

A

Oligomenorrhoea or amenorrhoea with galactorrhoea and SOL signs if pituitary tumour

31
Q

How does pituitary damage cause anovulation?

A

Reduced FSH and LH release - GnRH is normal - eg. Sheehans syndrome

32
Q

First line to treat anovulation in PCOS?

A

Clomifene - limited to 6months use - antioestrogen working on hypothalamus and pituitary receptors therefore increases release of LH and FSH

33
Q

Problem with Clomifene which means ovulation rate (70%) is higher than live birth rate (40%)

A

Oestrogenic therefore it thins the endometrium

34
Q

Risk with clomifene

A

Risk of multiple pregnancy

35
Q

Second line drug for ovulation in PCOS

A

Metformin - often used in clomifene-resistant patients to increase their response (also treats hirsutism)

36
Q

Surgical treatment for PCOS

A

Laparoscopic ovarian diathermy

37
Q

What can be used to induce ovulation in PCOS if clomifene has failed and if weight is normal

A

Purified or recombinant FSH or LH - daily SC Injections in a dose step-up regimen until ovaries begin to respond
Or GnRH pump SC

38
Q

What is a complication of gonadotrophin stimulation treatment

A

Ovarian hyperstimulation syndrome (OHSS) - very large and painful follicles (more common during IVF than standard ovulation induction)

39
Q

Risk factors for OHSS x4

A

Gonadotrophin stimulation
Younger than 35
Previous OHSS
Polycystic morphology on US

40
Q

Where does LH act on in testis

A

Leydig cells to produce testosterone

41
Q

What do FSH and testosterone act on in testis?

A

Sertoli cells - involved in synthesis and transport of sperm

42
Q

What is needed for semen analysis?

A

Sample should be produced by masturbation with last ejaculation occurring 2-7 days previously
Sample analysed within 1-2h of production

43
Q

What should be done if semen analysis is abnormal?

A

Repeat after 12 weeks

44
Q

General advice for male subfertility

A

Drug exposures

Loose clothing and testicular cooling

45
Q

What is azoospermia

A

No sperm in semen sample

46
Q

What is oligospermia

A

Less than 15million/ml

47
Q

What is severe oligospermia

A

Less than 5million/ml

48
Q

Causes of abnormal semen anaylsis

A

Unknown
Drugs: smoking/alcohol/drugs (Sulfasalazine or steroids) /chemicals exposure
Impaired cooling
Antisperm antibodies - common after vasectomy reversal
Infections
Varicocele
Genetic abnormalities (XXY)

49
Q

Indications for assisted conception x6

A 
All/any other methods have failed 
Unexplained subfertility 
Male factor subfertility (ICSI) 
Tubal blockage (standard IVF) 
Endometriosis 
Genetic disorders
50
Q

What does high FSH and LH and low testosterone imply with male subfertility

A

Primary testicular failure - may be associated with cryptorchidism

51
Q

Options if male subfertility is not treatable

A

Intrauterine insemination if mild-moderate dysfunction

IVF if more severe - ICSI or donor sperm

52
Q

Law with contacting sperm/egg donors

A

Children can contact donor from age of 18 - therefore there is a national shortage of donors

53
Q

Causes of tubal damage leading to subfertility

A

PID
Endometriosis
Previous pelvic surgery can lead to adhesion formation

54
Q

Cervical problems causes subfertility

A

Antibody production by the women - antibodies agglutinate and kill the sperm
Infection in the vagina or cervix that prevent mucus production
Cone biopsy for carcinoma

55
Q

Detection of female structural problems

A

Laparoscopy and dye test - to visualise and assess tubes

Hysterosalpingogram - contrast inserted through cervix

56
Q

What is IUI

A

Intrauterine insemination - washed sperm injected directly into uterus - can be performed in normal cycle but more success if gonadotrophin ovulation induction first

57
Q

Who is IUI suitable for?

A

Couples with unexplained subfertility, cervical, sexual and some male factors

58
Q

Fors and againsts of IUI

A

Much cheaper

Less successful

59
Q

What is needed for IUI

A

Patent tubes for oocyte to reach sperm

Cycles need to be regular and ovulatory

60
Q

What is IVF

A

Fertilised outside uterus and then transferred back

61
Q

What does recipient need in ooctye donation?

A

Oestrogen and progestrone to prepare endometrium for transfer of fresh embryos

62
Q

Who is IVF suitable for?

A

Don’t need patent tubes

Need normal ovarian reserve so that sufficient oocytes can be collected

63
Q

How is ovarian reserve assessed for IVF?

A

Used to be FSH but now AMH is much better - produced by ovary therefore direct measure of reserve

64
Q

Complications with egg collection in IVF

A

Intraperitoneal haemorrhage and pelvic infection

65
Q

Fertilisation, culture and transfer stage of IVF details

A

Eggs incubated with washed sperm and transferred to growth medium
Cultured until cleavage (day 2-3) or blastocyst (day 5-6) stage and then transcervical uterine transfer
Spares can be frozen - traditionally 2 cleavage embryos are transferred or single blastocyst
Then progesterone or hCG given until 4-8 weeks gestation

66
Q

What is ICSI?

A

Intracytoplasmic sperm injection - sperm injected into oocyte cytoplasm
Useful for male factor infertility

67
Q

What is PGD

A

Preimplantation genetic diagnosis - day 3 embryos contain about 8 cells - one or two removed and tested for genetic abnormalities with PCR

68
Q

Who is PGD good for?

A

Couples who are carriers of single gene defects eg. cystic fibrosis
Chromosome translocations therefore high risk of aneuploidy
Sexing for male affected disease eg.haemophilia
Older women >37 can have all embryos screened for abnormal ones

69
Q

What is asthenospermia

A

Absent or low motility

Gynaecology (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions