Brainscape's Knowledge GenomeTM

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


See full index

rds > fertility & health > Flashcards

fertility & health Flashcards

1
Q

lifestyle factors affecting male fertility (7)

A
  1. obesity: ROS damage sperm
  2. opioids → dynorphin signalling (co-expressed by Kiss neurones) → switches off HPG axis → hypogonadotrophic hypogonadism
  3. anabolic steroids → negative feedback on LH, FSH + ∴ intratesticular testosterone
    also smoking, cannabis, caffeine, alcohol
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

diagnostic criteria of PCOS (3)

A
  1. oligo/anovulation
  2. androgen excess (biochemical/clinical)
  3. polycystic ovaries on USS#
    - > need 2/3
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

mechanisms causing symptoms in PCOS

A

increased LH and/or insulin resistance -> increased androstendione production
cause of anovulation not well understood: increased follicles and stroma -> oestrogen and progesterone -> negative feedback and decreased FSH -> antral follicle arrest
5alpha-reductase converts testosterone to DHT -> hirsutism, acne, etc.

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

causes of anovulation (3)

A

primary ovarian insufficiency
deficiency/disordered regulation of gonadotrophins
PCOS

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

causes of hypogonadism (2)

A

primary ovarian insufficiency

disorders of gonadotrophin regulation

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

causes of secondary ovarian dysfunction (3 categories, 11)

A 
organic: hyperprolactinaemia, Kallman syndrome, destructive lesions of hypothalamus
functional (most common): weight loss, stress, exercise
gonadotrophin deficiency (rare): pituitary tumours/surgery/irradiation, granulomatous/inflammatory infiltration, iron overload
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

FSH and oestrogen levels in:

  1. primary ovarian insufficiency
  2. hypothalamic/pituitary disorders
  3. PCOS
A
  1. high FSH, low oestrogen
  2. normal/low FSH, low oestrogen (should measure prolactin)
  3. normal FSH, normal oestrogen, high LH
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

treatment of hypothalamic amenorrhoea (3)

A

Hyperprolactinaemia: dopamine agonists
Functional: diet, psychotherapy
Familial: give pulsatile GnRH

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

main cause of hyperprolactinaemia

A

pituitary adenoma (50%)

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

treatment of hyperprolactinaemia (1)

A

dopamine agonists, even in pts w pituitary tumours

normalizes prolactin, restores ovulation and can cause shrinking of prolactinoma

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

how does arrested antral follicle development occur in PCOS

A

more follicles and stroma in PCOS → increased oestrogen + progesterone → negative feedback on FSH → arrest of follicle maturation

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

PCOS investigations (5)

A

Oligo/amenorrhoea: FSH, (LH), prolactin, oestradiol
Hirsutism: testosterone
Obesity (BMI >30): glucose tolerance test

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

definition of infertility

A

inability to conceive after 1 year of regular unprotected intercourse

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

features of Klinefelter syndrome

A

47XXY
loss of sperm production in late teens/early 20s
low IQ, tall stature

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

genetic causes of male infertility

A
  1. Klinefelters
  2. CFTR mutations
  3. Y microdeletions (spontaneous or inherited)
  4. chromosomal rearrangements: SRY translocation -> XX male (cannot produce sperm w/o Y chromosome; infertile)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

CFTR

  1. what is it
  2. mutations lead to?
A
  1. cystic fibrosis transmembrane regulator (cAMP-activated chloride channel)
  2. mild: poor sperm quality
    moderate: congenital bilateral absence of vas deferens (CBAVD)
    severe: CBAVD, clinical cystic fibrosis, pancreatic and liver disease
17
Q

define premature ovarian insufficiency

A

Accelerated loss of ovarian follicles + ∴ ovarian reserve before age of 40 years
Due to rapid depletion of oocytes or complete lack of oocytes
Aetiology unclear; Turner’s, fragile X syndrome

18
Q

long term health consequences of premature ovarian insufficiency (4)

A
  1. increased cardiovascular mortaility
  2. increased risk of Parkinsons disease
  3. increased risk of dementia
  4. increased risk of osteoporosis
19
Q

treatment of premature ovarian insufficiency + principles (4)

A

HRT:

  1. Pre pubertal POI: To induce development of secondary sexual characteristics
  2. To relieve immediate sequelae of menopause i.e. symptom relief and quality of life
  3. To prevent long term sequelae of menopause
  4. To create an environment conducive to successful replacement of donated embryos
20
Q

triad of POI (clinical features)

A
  1. elevated gonadotrophins
  2. oestrogen deficiency
  3. amenorrhoea
21
Q

osteoporosis treatments and MOA (4)

A
  1. bisphosphonates: cause apoptosis of osteoclasts (bone resorption)
  2. statins:
    a. inhibit RANKL receptor activation → ↓differentiation of osteoclasts → ↓resorption
    b. ↓apoptosis of osteoblasts
  3. pulsatile teriparatide (recombinant human parathyroid hormone): ↓resorption and ↑synthesis → ↓fragility fractures
  4. Denosumab: monoclonal antibody against RANKL (osteoclast receptor) -> inhibition of osteoclast activation
    Led to fatal cases of severe hypocalcaemia
22
Q

investigations for fertility

A

tests for ovarian reserve
1. antral follicle count (USS)
2. FSH (responds to number of oocytes available for recruitment)
3. AMH: produced by granulosa cells around pre-antral follicles (best test)
assessment of tubal patency
4. hysterosalpingogram: X-ray test w injection of dye
5. Sono-hysterosonography: slow infusion of sterile saline solution into uterus during USS
6. Laparoscopy and dye-test-in presence of co-morbidities (e.g. endometriosis)
other
7. semen analysis

23
Q

menstrual cycle

A
  1. Menstruation
  2. Recruitment of antral follicles → ↑FSH
    a. Dominant follicle produces inhibin
    b. Granulosa cells produce oestradiol → proliferation of endometrium and ↓FSH
  3. high levels of oestrogen → +ve feedback → LH surge → ovulation
  4. Corpus luteum → ↑progesterone → remodelling of endometrium in prep for pregnancy:
    a. ↑blood flow and uterine secretions
    b. ↓contractility of smooth muscle in uterus
    c. ↑basal body temperature
  5. Absence of implantation + hCG → ↓progesterone → menstruation
24
Q

basic structure of endometrium (2)

A
  1. Stratum functionalis shed each month in menstruation

2. Basal layer contains stem cells for regeneration

25
Q

common causes of female infertility (7)

A
  1. Polycystic ovarian syndrome
  2. Smoking
  3. Tubal blockage
  4. Obesity
  5. Pelvic inflammatory disease
  6. Advanced maternal age
  7. Endometriosis
26
Q

MOA of clomiphene citrate

A

SERM: inhibits -ve feedback to hypothalamus → ↑FSH

rds (13 decks)

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