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Year 4 Family and Children ANNA > Fertility > Flashcards

Fertility Flashcards

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1
Q

Which hormone should be tested in the luteal phase of any woman experiencing difficulty conceiving?

A

Progesterone (day 21)

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2
Q

Which hormones (in addition to progesterone) should be tested in a woman with irregular periods?

A

FSH and LH

+ prolactin and free testosterone

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3
Q

???? this card ???? When should prolactin be measured?

A

Not for subfertility; only for

an ovulatory disorder, galactorrhoea (excessive or inappropriate production of milk) or a pituitary tumour

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4
Q

What 3 things are used to estimate likely ovarian response to gonadotrophin stimulation in IVF?

Also give you ovarian reserve

A
  1. FSH - high is bad (if it needs a lot of FSH to get the eggs going there can’t be many of them)
  2. AMH (anti - Mullerian hormone) - low is bad
  3. total AFC (antral follicle count) - low is bad
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5
Q

Semen analysis

What is a normal value for semen volume?

A

1.5ml +

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6
Q

Semen analysis

What is a normal value for semen pH?

A

7.2 +

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7
Q

Semen analysis

What is a normal value for sperm concentration?

A

15 million spermatozoa / ml

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8
Q

Semen analysis

What is a normal value for total sperm number?

A

39 million / ejaculate

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9
Q

Semen analysis

What is a normal value for total motility?

A

40% motile or 32% progressive motility

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10
Q

Semen analysis

What is a normal value for sperm vitality?

A

58% + live spermatozoa

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11
Q

Semen analysis

What is a normal value for sperm morphology?

A

4% + normal forms

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12
Q

If a semen analysis is abnormal when should you repeat?

A

In 3 months (allows a full cycle)

  • unless gross abnormality in which case ASAP!
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13
Q

What 2 drugs are helpful for PCOS women trying to conceive?

A

Metformin and clomiphene

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14
Q

What 2 treatments are helpful for PCOS if woman doesn’t want to get pregnant?

A

COCP +/- Weight loss

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15
Q

Why might tubal damage occur? (3)

A
  1. infection (particularly chlamydia and gonorrhoea, PID)
  2. endometriosis
  3. previous surgery resulting in the formation of peri-tubal adhesions.
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16
Q

What is HSG?

What does it assess

A

Hysterosalpingography

Assesses shape of the uterine cavity and patency of the fallopian tubes

17
Q

Where is endometriosis most commonly found?

A

Ovaries

18
Q

What are the symptoms of endometriosis?

A
  1. Pain - gynae
    • chronic pelvic pain
    • dysmenorrhoea - pain often starts days before bleeding
    • deep dyspareunia
  2. Pain - elsewhere
    • Dyschezia (painful bowel movements)
    • Dysuria
  3. Can present as: Subfertility
  4. Non-gynaecological: urinary symptoms e.g. urgency, haematuria.
19
Q

What are the signs of endometriosis on examination?

A

on pelvic examination

  1. reduced organ mobility,
  2. tender nodularity in the posterior vaginal fornix
  3. and visible vaginal endometriotic lesions
20
Q

What is the gold standard for investigation of endometriosis?

A

Laproscopy

21
Q

What is the medical management of endometriosis?

A

Management depends on clinical features - there is poor correlation between laparoscopic findings and severity of symptoms

  1. NSAIDs and/or paracetamol are the recommended first-line treatments for symptomatic relief
  2. hormonal treatments such as
    1. COCP or Mirena
    2. progestogens e.g. medroxyprogesterone acetate
    3. GnRH agonists (not long term solution)
22
Q

What is the surgical management of endometriosis?

A

laparoscopic excision and laser treatment of endometriotic ovarian cysts may improve fertility

23
Q

What treatment should those with tubal factors have for infertility?

A

IVF

24
Q

What medication could you give in endometriosis AND shrink fibroids that prevents ovulation / creates artificicial menopause?

A

Gonadotropin-releasing hormone (Gn-RH) antagonists / agonists

Year 4 Family and Children ANNA (23 decks)

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