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Obstetrics and Gynaecology > Fertility > Flashcards

Fertility Flashcards

1
Q

What are the main causes of male infertility

A 
Unexplained (40-50%)
Testicular disease (30-40%)
Obstruction/transport (10-20%)
Hypothalamic pituitary (1-2%)
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2
Q

What are the hormonal causes of male infertility

A

Hypogonadotropic hypogonadism (kallmann syndrome, anorexia)
Testicular failure: kleinfelter’s syndrome, chemo/radio, undescended
Hyperprolactinaemia
Acromegaly, Cushing’s Disease, hyper or hypothyroidism

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3
Q

What are the obstructive causes of male infertility

A

Vasectomy, infection, congenital absence of vas deferens (CF)

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4
Q

What are the non-obstructive causes of male infertility

A

Undescended testis, orchitis, torsion/trauma, chromosomal (klinefelters), kartangers syndrome

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5
Q

What investigations would be appropriate for male infertility

A

Semen analysis
twice over 6wk apart
volume, density, motility, progression, morphology

If abnormal semen analysis
LH and FSH
Testosterone
PRL
Thyroid function
If severely abnormal semen analysis/ azoospermic
Endocrine profile
Chromosome analysis
Screen for CF
Testicular biopsy

If abnormality on genital examination
Scrotal US scan

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6
Q

What lifestyle changes could you recommend for male infertility

A

Frequency sexual intercourse: 2-3x/week and avoid lubricants that are sperm toxic
Alcohol: < 4 units per day
Smoking
Caffeine: nil evidence
BMI: < 30 improve fertility
Avoid tight fitting underwear + prolonged hot situations
Certain occupations: overheating/exposure to chemicals
Complementary therapies
Benefits of anti-oxidants (vitamin C or zinc)

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7
Q

What would indicate an obstructed cause of male infertility

A

Normal testicular volume
Normal 2o sexual characteristics
Vas deferens may be absent
Normal LH, FSH and testosterone

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8
Q

What would indicate a non-obstructed cause of male infertility

A 
Low testicular volume
Reduced 2o sexual characteristics
Vas deferens present
High LH, FSH
Low testosterone
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9
Q

How do the treatment options differ in mildly reduced sperm count, very low sperm count and Azoospermia

A

Mildly reduced sperm count = interuterine insemination

Very low sperm count = intracytoplasmic sperm injection

Azoospermia = surgical sperm aspiration or donor sperm insemination

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10
Q

What are the risk factors for female infertility

A 
>30
no previous pregnancy
>3 years trying to conceive 
caffeine intake
BMI >30
recreational drugs
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11
Q

What is the difference between primary and secondary infertility

A

Primary= couple have never conceived

Secondary = previously conceived but the pregnancies were unsuccessful

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12
Q

What are the possible causes for female infertility

A

tubal disease
unexplained
anovulation
PCOS

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13
Q

What tests would be suitable for female infertility

A

BMI
General examination
Assessing body hair distribution, galactorrhoes
Pelvic examination
Assessing for uterine and ovarian abnormalities/ tenderness/ mobility

Endocervical Swab- For chlamydia
Cervical Smear if due
Bloods - For Rubella immunity

Mid-luteal serum progesterone
Day 21, >30mmol/l is suggestive of ovulation

Serum gonadotrophin 
antimullerian hormone
prolactin
TFT
testosterone

Hysteroscopy
Suspected/known endometrial pathology (uterine septum, adhesions, polyp)

Pelvic US scan:
When abnormal pelvic examination (enlarged uterus/ adnexal mass, or when possible polyp seen at HSG)

Endocrine profile + chromosomes:
If anovulatory cycle or infrequent periods
(urine hCG, PRL, TSH, Test and SHBG, LH, FSH and oestradiol)
If hirsutism (testosterone and SHBG)
If Amenorrhoea
(endocrine profile, chromosome analysis)

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14
Q

What are the causes of primary amenorrhoea

A

genitourinary malformations e.g. vaginal septum
congenital causes ie turners syndrome and kallman’s syndrome
hypothalamic-pituitary dysfunction

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15
Q

What are the main causes of secondary amenorrhea

A 
methods of contraception
radiotherapy
drug use
asherman syndrome
hypothalamic dysfunction
premature ovarian failure
thyroid disease
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16
Q

What is the definition of primary amenorrhea

A

failure to menstruate by the age of 16 in the presence of normal secondary sexual characteristics, or 14 in the absence of secondary sexual characteristics

17
Q

Name some conditions that can cause ovulatory dysfunction leading to subfertility

A 
chronic system illness
eating disorders
PCOS
hyperprolactinaemia
Hypo/hyperthyroidism
cannabis
nonsteroidal antiinflammatory diseases
18
Q

Name a tubal factor that might lead to subfertility

A

PID
previous tubal surgery
previous ectopic pregnancy
endometriosis

19
Q

Name a uterine problem that could lead to subfertility

A

fibroid
uterine septa
congenital anomaly
asherman syndrome

20
Q

Name a psychosexual issue leading to subfertility

A

vaginismus

dyspareunia

21
Q

What blood tests are useful in female subfertility

A

Mid-luteal serum progesterone
Day 21, >30mmol/l is suggestive of ovulation

Serum gonadotrophin 
antimullerian hormone
prolactin
TFT
testosterone
22
Q

What scan is indicated in female sub fertility

A

transvaginal USS

23
Q

What invasive procedure can used to assess subfertility

A

hysteroscopy

24
Q

What is the most common cause of anovulation

A

PCOS

25
Q

What are the treatment options for anovulation

A

initial management - optimize chronic medical conditions, ensure appropriate BMI (19-30), decrease high exercise levels, stop smoking, decrease alcohol and caffeine

first line - metformin or clomifene citrate

Second line - combined metformin and clomifene citrate OR laparoscopic ovarian drilling

26
Q

What is the management plan in those with hyperprolactinaemia

A

dopamine antagonists

27
Q

What are the symptoms of ovarian hyperstimulation syndrome

A

caused by high levels of oestrogen during IVF
causing accumulation of fluid in the abdomen or chest and intravascular fluid depletion

abdominal pain
ascites 
pleural effusions
hepatorenal failure
respiratory distress syndrome
28
Q

How is OHSS treated

A

chest and ascitic drains
fluid balance
thromboprophylaxis
consider abandoning IVF cycle due to risk of OHSS and ovarian torsion

29
Q

What are the criteria to apply for NHS funding in IVF

A

<40
no previous children from either couple
BMI <30

Obstetrics and Gynaecology (4 decks)

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