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HD2 > Fertility > Flashcards

Fertility Flashcards

1
Q

Define infertility

A

Disease of the reproductive system

Failure to achieve clinical pregnancy within 12 months of unprotected sex

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2
Q

Define primary infertility

A

Woman unable to ever bear a child as unable to become pregnant or carry a pregnancy
- miscarriages, ectopic, abortions and stillborn

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3
Q

Define secondary infertility

A

Unable to bear/ability to carry a child following previous pregnancy/having ability to carry pregnancy to live birth before

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4
Q

How common is infertility?

A

1 in 6 couples in UK experience some form of it

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5
Q

What are the causes of infertility and how common are they?

A
  • male factors (30%)
  • unexplained fertility (25%)
  • ovulatory disorders (20%)
  • tubal damage (20%)
  • uterine/peritoneal disorders (10%)
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6
Q

How do the testes develop?

A

On posterior wall

  • descends through inguinal canal
  • into anterior abdomen wall
  • into scrotum
  • carries vessels, lymphatic nerves, ducts
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7
Q

What are the testes composed of?

A

Semniferous tubules

interstitial tissue surrounding tunica albuginea

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8
Q

What is the tunica vaginalis?

A

Sides and anterior aspects of testes covered by closed sac of peritoneum

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9
Q

What is the epididymis?

A

SIngle, long coiled lying alongside testes

  • efferent ductules (head)
  • true epididymis (body/tail continuous with vas deferens)
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10
Q

What is the vas deferens?

A

Long muscular duct

Transport spermatozoa from tail of epididymis to ejaculatory duct in prostate

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11
Q

What does the spermatic cord contain?

A 
Vas deferens
testicular artery
Genital branch of genitofemoral nerve
Pampiniform plexus
Lymphatic vessels
Tunica Vaginalis
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12
Q

Where does the spermatic cord run?

A

Through inguinal canal

Surrounded by fascia

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13
Q

What is the main blood supply to the male reproductive system?

A

Abdominal artery branches forming gonadal testicular artery

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14
Q

What is the venous drainage of the right testicle?

A

IVC

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15
Q

What is the venous drainage of the left testicle?

A

Left renal vein

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16
Q

What is the pampiniform plexus?

A

Network of small veins found in human spermatic cord

  • surrounds artery
  • cold as exits scrotum receiving heat from artery as travels back to abdomen
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17
Q

What are the 3 phases of the ovarian cycle and how long are they?

A 
Follicular Phase (1-10)
Ovulatory Phase (11-14)
Luteal Phase (15-18)
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18
Q

What happens during the follicular phase?

A
  • 5-12 primordial follicles stimulated each month
  • 1 grows and matures
  • GnRH secreted from hypothalamus stimulating anterior pituitary to secrete LH and FSH
  • stimulates follicles to grow
  • mature follicle secretes oestrogen
  • inhibits LH and FSH secretion by anterior pituitary (negative feedback)
  • stimulates endometrium growth
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19
Q

What happens during the ovulatory phase?

A

Negative feedback temporary

  • oestrogen stimulates HPA
  • LH and FSH burst
  • completion of meiosis I and onset of meiosis II in oocyte
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20
Q

What happens during the luteal phase?

A

Granulosa cells of mature follicle divide forming corpus luteum

  • secretes progesterone and oestrogen
  • prepares uterine endometrium for implantation
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21
Q

What are the 3 phases of the menstrual cycle and how long are they?

A
  • menstrual phase (day 1-5)
  • proliferative phase (6-14)
  • secretory phase (15-28)
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22
Q

What happens in the menstrual phase?

A

Withdrawal of steroid support (oestrogen and progesterone) = endometrium collapse

  • endometrium shed with blood from rupture arteries
  • 50-150ml blood loss
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23
Q

What happens in the proliferative phase?

A

Oestrogen from mature follicle stimulates thickening of endometrium

  • glands/spinal arteries form
  • oestrogen causes progesterone receptor growth on endometrial cells
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24
Q

What happens in the secretory phase?

A

Progesterone from corpus luteum acts on endometrium = gland enlargement

  • glands secrete mucus and glycogen in preparation for implantation of fertilised oocyte
  • no fertilisation = corpus luteum degenerates = corpus albicans and progesterone levels fall
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25
Q

What is the general conception advice?

A
  • intercourse throughout the cycle
  • no smoking, alcohol
  • reduce weight/stress/drugs
  • take folic acid (400mg)
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26
Q

What is COCP?

A

Trans acid, combined oral contraceptive pill

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27
Q

What are LARCs?

A

Ling acting reversible contraceptives

28
Q

What is Gn therapy?

A

Gonadotrophins

29
Q

What are the types of ovulatory causes of infertility?

A

1) Hypopituitary failure (anorexia) - increase weight, decrease exercise, Pulsatile GnRH
2) Hypopituitary Dsyfunction (PCOS, hyperprolactinaemia) - bromocriptine as dopamine agonist which regulates prolactin levels)
3) Ovarian failure (persistent raised FSH) - donor eggs, alternative parenting

30
Q

What is the diagnostic criteria for polycystic ovarian syndrome? (PCOS)

A
  • clinical hyperandrogenaemia
  • oligomenorrhoea
  • polycystic ovaries on ultrasound
  • menstrual disturbance, acne
  • raised LH with normal FSH, raised testosterone
31
Q

What is the first line management of polycystic ovarian syndrome?

A

Clomiphene or metformin

32
Q

What is the second line management for polycystic ovarian syndrome?

A
  • combined clomiphene and metformin, lacroscopic ovarian drilling and Gn theraphy
33
Q

What is important to exclude when diagnosing polycystic ovarian syndrome?

A

Thyroid dysfunction
Congenital Adrenal Hyperplasia
Androgen secreting tumours

34
Q

What is an example of an ovulatory cause of infertility?

A

PCOS

35
Q

What are examples of tubal and uterine causes of infertility?

A

Pelvic Inflammatory Disease
Endometriosis
Fibroids

36
Q

What is pelvic inflammatory disease?

A

Infection of female upper genital tract

37
Q

What are the symptoms of pelvic inflammatory disease?

A

Asymptomatic
Pelvic gain, dyspareunia, fever
- investigate with FBC and raised ESR

38
Q

What is dyspareunia?

A

Painful sexual intercourse

39
Q

What causes pelvic inflammatory disease?

A

Bacteria and STIs

chlamydia and gonorrhoea

40
Q

How is pelvic inflammatory disease managed?

A

Antibiotics, rest, abstinence

41
Q

What is endometriosis?

A

Presence of tissue histologically like endometrium outside uterine cavity

42
Q

What are the symptoms of endometriosis?

A

Pain
Dysmenorrhoea (painful menstruation)
Menorrhagia
Dyspareunia

43
Q

How is endometriosis managed?

A

NSAIDs
COCOP
GnRH agonists
Surgery

44
Q

What are fibroids?

A

Benign tumours of SM of myometrium (uterine leiomyoma)

- heavy, regular periods

45
Q

How are fibroids treated?

A

COCP
LARCs
Surgical

46
Q

What are the male factors of infertility?

A

Testicular (infection, cancer, surgical, congenital, trauma)
Azoospermia (absence of motile sperm)
Reversal of vasectomy
Ejaculatory problems (retrograde and premature)
Hypogonadism

47
Q

What is advised when there is unexplained fertility?

A

Do not offer clomiphene as no increased chance of pregnancy/live birth

  • continue having regular unprotected intercourse
  • IV after 2 years
48
Q

Which drugs for women lead to infertility?

A
  • long term NSAID
  • chemotherapy
  • neuroleptics
  • spironolactone
  • Depo-Provera
49
Q

What is Depo-Provera?

A

Type of birth control injection

Delays fertility by around 6-12 months until return

50
Q

What drugs for men lead to infertility?

A

Anabolic steroids

Chemotherapy

51
Q

What drugs for men and women lead to infertility?

A

marijuana

cocaine

52
Q

What are the NCIE guidelines when referring to infertility services?

A
  • initial assessment: enquire lifestyle/sexual history

- only earlier referral is woman over 36 and known clinical cause of infertility/predisposition

53
Q

What primary care investigations are done for infertility?

A 
Full sexual/contraception/fertility history
PCOS screen 
FBC (fibroids)
Vitamin D
HbA1c
Viral screen rubella, HIV, hepatitis
54
Q

What secondary care investigations are done for infertility?

A

Assess ovulatory function (blood tests, ovarian reserve testing)
Assess tubal function
Assess uterine function (laparoscopy)

55
Q

How is a PCOS screen done?

A 
day 21 progesterone
LH
FSH
Serum testosterone
glucose
56
Q

What is ovarian reserve testing?

A

how receptive ovaries are to Gn stimulation

57
Q

How is IUI done?

A

Intrauterine Insemination

  • sperm separated in lab
  • remove slower speed sperm before partner is inseminated
  • insemination day 12-16
  • ultrasound if ovarian stimulating drugs used
58
Q

Who is IUI offered to?

A
  • people unable to have intercourse
  • required specific consideration
  • same sex relationships
59
Q

When is IUI tried?

A

12 cycles before IVF

60
Q

What are the methods of assisted contraception?

A

Intrauterine Insemination
In-vitro fertilisation
Intracytoplasmic Sperm Injection

61
Q

Who is IVF offered to?

A
  • women under 40 who have not conceived after 2 years of unprotected intercourse = 3 cycles
  • women 40-42 if never had IVF/6 or more IUI cycles/no evidence of low ovarian reserve = 1 cycle
62
Q

What is ovarian hyper stimulation syndrome?

A

Consequence of drugs used to stimulate ovarian function

63
Q

What is intracytoplasmic sperm injection? (ICSI)

A

Single sperm injected directly into egg

64
Q

Who is ICSI offered to?

A

Intracytoplasmic sperm injection

  • severe deficits in semen quality
  • azoospermia
  • IVF failure
65
Q

How is ICSI compared to IVF?

A

Improves fertilisation rates more

Pregnancy rate is not better

66
Q

What are the long term safety issues related to assisted reproduction?

A

Ovarian induction and ovarian stimulation (no direct associations between treatment/invasive cancer)

IVF - small increased risk of borderline ovarian tumours

HD2 (22 decks)

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