Fertility Flashcards
1
Q
What is the position of the uterus in relation to the bladder?
A
Antroverted (usually)
2
Q
What type of feedback is there in the menstrual cycle?
A
Oestrogen causes positive feedback in the first half and negative feedback in the second half
3
Q
How many eggs does a woman have before birth?
A
7 million eggs
4
Q
When does atresia of eggs start?
A
20 weeks gestation
5
Q
Why does a woman’s fertility decrease after age 30?
A
Age related decline in quantity and quality of ovarian reserve
Age related increase in aneuploidy due to non-disjunction
6
Q
What is the biggest predictor of fertility?
A
Maternal age
7
Q
What is the biggest predictor of successful ovulation?
A
Regular periods
8
Q
How is the ovarian reserve measured?
A
Antral follicle count (AFC)
Anti-mullerian hormone (AMH)
9
Q
What is the life cycle of an ovarian follicle?
A
Primary follicle matures, ovulates and then becomes corpus luteum, which then regresses
10
Q
What are the 3 phases of the menstrual cycle?
A
- Menstrual phase
- Proliferative phase
- Secretory phase (progesterone rises)
11
Q
What are the 3 phases of the ovarian cycle?
A
- Follicular phase
- Ovulatory phase
- Luteal phase
12
Q
Which hormones increase during the follicular phase of the ovarian cycle?
A
FSH –> oestrogen –> GnRH –> LH
13
Q
What is the corpus luteum on TV ultrasound evidence of?
A
Ovulation
14
Q
What does the corpus luteum degenerate into?
A
corpus albicans
15
Q
What causes dysmenorrhea (pain during menstrual period)?
A
Drop in progesterone
16
Q
When does implantation begin?
A
6-7 days after ovulation (day 21 of menstrual cycle)
17
Q
What are the 3 types of female infertility?
A
- Egg problems
- Transport problems
- Implantation problems
18
Q
What causes problems with eggs (anovulation)?
A
- Hypothalamic dysfunction
- Pituitary dysfunction
- Thyroid dysfunction/ovarian failure/ PCOS
(may be hypog hypog)
19
Q
What is the most common cause of ovulatory dysfunction?
A
PCOS
20
Q
Why are obese women more likely to be infertile?
A
Endogenous oestrogen (produced from fat) causes an ovulation Weight loss can restore ovulation
21
Q
How can gonadotrophin-deficient patients be treated?
A
Given hMG to induce ovulation
22
Q
What drugs can be given to treat anovulation?
A
Clomiphene citrate
Letrozole
23
Q
How is menopause defined?
A
One year of amenorrhea
24
Q
Which hormones characterise menopause?
A
High FSH
Low oestradiol
25
What is climacteric/peri menopause?
Time around the last menstrual period (irregular periods, vasomotor symptoms etc)
26
What are the symptoms of menopause?
```
Anovulatory cycles
Menstrual irregularities
Menorrhagia (heavy periods)
Physical changes, e.g. night sweats
Psychological changes (lack of oestrogen)
```
27
What is the average age of menopause in the UK?
52 years
28
What are the long term consequences of menopause?
Osteoporosis
CV disease
Vaginal dryness/atrophy
Alzheimer's
29
How is menopause treated?
Hormonal replacement therapy (HRT) - given oestrogen, progesterone and testosterone or non-hormonal measures
30
What are the risks of hormone replacement therapy?
VTE
breast cancer
endometrial cancer
CVD
31
How is premature ovarian insufficiency diagnosed?
4 months of amenorrhoea
FSH over 30 on 2 occasions
age < 40
32
What is the cause of premature ovarian insufficiency? (POI)
Inadequate oogenesis
| Follicle depletion/dysfunction
33
What are the implications for women with POI?
higher risk of CV disease/bone disease/infertility and depression
34
How is POI treated?
Hormone replacement therapy
Fertility treatment
Psychological support
35
What are two layers of the blastocyst?
1. Trophoblast (stimulates development of placenta)
| 2. Inner cell mass (gives rise to embryo)
36
When is the embryo most susceptible to teratogens and infectious agents? (most birth defects)
Embryonic period (weeks 3-8)
37
What does TORCH (embryonic defects) stand for?
```
Toxoplasma
Other viruses (parvovirus, HIV, Zika)
Rubella
Cytomegalovirus
Herpes simplex virus
```
38
What is hypohidrotic ectodermal dysplasia?
Loss of hair, sweat glands and teeth due to defect in Eda pathway
39
What is fetal alcohol syndrome?
Microcephaly (decreased Shh)
Epicanthal folds
Epigenetic changes
40
What does failure of closure of neural tube cause?
Spina bifida
Myelomeningocoele
Meningocele
41
What factors increase the risk of a spina bifida?
Genetic
Poor maternal folate intake
Medication - e.g. valproic acid for epilepsy
42
What is being developed to treat spina bifida?
Fetal surgery (must happen before 26 weeks)
43
What causes spondylocostal dysotosis?
Defects in paraxial mesoderm
44
What causes achondroplasia?
Defects in development of cartilage
45
What is Liebenburg syndrome?
Abnormal development of arms (become legs)
| Expression of Pitz1 in arms
46
What do mesodermal defects cause?
Skeletal/limb patterning defects
47
What do endodermal defects cause?
Lung aplasia
Oesophageal atresia/fistula
Omphacele
48
What do defects in neural crest development cause?
Bilateral cleft lip
| Pierre-robin sequence (underdevelopment of lower jaw)
49
What is Hirchsprung's disease?
Vagal neural crest fails to migrate into posterior gut:
| - bowel contents build up and bowel expands
50
What are the 2 functions of the testes?
1. Produce sperm
| 2. Secrete androgens
51
Which cells are found in the seminiferous tubules?
Spermatogonial stem cells
Sertoli cells
Leydig cells
52
What is the function of the Sertoli cells?
Support/nutrition/protection
53
What is the function of the Leydig cells?
Produce testosterone
54
What is the function of the blood-testicular barrier?
Protection against antisperm antibodies
55
Which cells do LH and FSH act on in males?
LH acts on leydig cells
| FSH acts on seminiferous tubules to produce inhibit and ABP (androgen binding protein)
56
What kind of feedback is there in the HPA axis in females and males?
Females - positive and negative
| Males - just negative
57
What affect does prolactin have on spermatogenesis?
Increases
58
What happens when sperm are hyper activated?
Lose cholesterol, gain calcium
| Swim faster towards egg
59
How does the oocyte prevent polyspermic penetration?
Releases cortical granules - hardens outer egg
60
How can infection affect sperm production?
STIs/epididydmitis can damage seminiferous tubules and lower sperm count (lowers fertility)
61
Why has sperm count generally been decreasing over time?
```
Heat exposure
Radiation
Air pollution
Food chain pollution with excess oestrogen
Stress
Reduced sexual activity
```
62
What is Kallman syndrome?
Lack of formation of anterior pituitary leading to infertility (type of hypog hypog)
Pt looks young ,no smell sense
Treatment is LH and FSH
63
What is androgen insensitivity syndrome?
46 XY but appear female
| testes insensitive to testosterone
64
What are the three groups of male infertility disorders?
1. Genetic (sex disorders)
2. Hypothalamic-pituitary (hormonal)
3. Target tissue (testes problems e.g. infection)
65
Which processes are needed for successful conception?
```
Ovulation
Spermatogenesis
Intercourse
Ejaculation
Fertilisation
Implantation
```
66
How is infertility defined?
Woman not conceived after a year of unprotected sex
67
How does a couple's chance of conceiving change over time?
Decreases
68
What factors positively affect a woman's fertility?
1. Less time trying
2. Previous pregnancy
3. AGE (under 30)
69
What is the most common cause of infertility in second time pregnancies?
Tubal factor (previous pregnancy is risk factor for tubal disease)
70
What are common causes of tubal damage?
Infection
Surgery
Ectopic pregnancy
Endometriosis
71
How can women with tubal damage be helped to conceive?
IVF
72
What 3 lifestyle factors reduce fertility?
Obesity
Smoking
Excessive alcohol
73
What fertility investigations can we do for women?
Ovulation test
Pelvic anatomy and tubal latency (laparoscopy/HSG)
Ovarian reserve (AFC and AMH)
74
What fertility investigations can we do for men?
Semen fluid analysis (concentration, motility, morphology)
75
What can cause male sub fertility?
Azoospermia (no sperm in semen)
| Blocked/absent genital tracts due to infection, trauma, drugs, radiotherapy, varicocele, congenital causes
76
What is obstructive azoospermia?
Spermatogenesis normal
| Obstructive problem
77
What is the most common fertility treatment for male infertility?
ICSI (intracytoplasmic sperm injection)
| some men may need surgical retrieval of their sperm
78
At what point does a foetus gain legal status?
24 weeks (no abortion after this unless medical reasons)
79
What is section 1a of abortion act?
'Social ground' (mental health of mother etc)
80
What is section 1b of abortion act?
Prevent injury to mother
81
What is section 1c of abortion act?
Risk to life of mother
82
What is section 1d of abortion act?
Risk that child will be seriously handicapped
83
What is conscientious objection?
Nobody has to actively participate in controversial procedure like abortion
84
What is reproductive autonomy?
Father cannot prevent woman from obtaining an abortion
85
What is pre-implantation genetic diagnosis?
Select embryo free of gene (e.g. breast cancer gene) through testing one cell from 8 cell embryo
But discarding embryos - unethical
