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HD2 > Fertility, Subfertility And Infertility > Flashcards

Fertility, Subfertility And Infertility Flashcards

1
Q

Subfertility

A

Delayed/reduced capacity to conceive

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2
Q

Infertility

A

reproductive system disease defined by failure to achieve clinical pregnancy after 12 months of regular unprotected sex with no other reason

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3
Q

Primary infertility

A

Couple have never been able to conceive

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4
Q

Secondary infertility

A

Person has had first baby with no difficulty then cannot get pregnant again, or has conceived and has miscarriage or ectopic

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5
Q

What is a main cause of rising infertility rates

A

Having children later in life

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6
Q

How does age affect fertility

A

Decrease, women more than men

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7
Q

When does female fertility start decreasing dramatically

A

30

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8
Q

How long after ovulation is an egg viable

A

~2 days

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9
Q

Female causes of infertility

A

Erratic ovulation
Blocked uterine tubes
Endometriosis
Pituitary or ovarian tumour
Pelvic inflammatory disease
Antisperm antibodies
Age

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10
Q

4 classes of ovulatory causes of infertility

A

Hypothalamic
Pituitary
Ovarian
PCOS

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11
Q

Hypothalamic ovulatory causes of infertility

A

Hypothalamic amenorrhea
Anorexia
Genetic
Autoimmune GAIN
Iatrogenic
Neoplasm

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12
Q

Pituitary ovulatory causes of infertility

A

Hyperprolactaemia - decreased LH and FSH
Functional
Infectious. FIT
Inflammatory
Trauma+Vascular

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13
Q

Ovarian ovulatory causes of infertility

A

Premature ovarian failure
Physiological
Idiopathic. PIE
Endocrine

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14
Q

What are the 3 components of the Rotterdam criteria and how many are needed for a PCOS diagnosis

A

Clinical hyperandrogenaemia
Oligomenorrhea
Polycystic ovaries on ultrasound - 12+ follicles
2/3 needed

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15
Q

Oligomenorrhea

A

Less than 6-9 periods per year

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16
Q

PCOS symptoms

A

Menstrual disturbance
Infertility
Hirsutism
Acne
Male pattern hair loss
Central obesity
Acanthosis nigricans

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17
Q

Hormone abnormalities in PCOS

A

Raised LH with normal FSH
Raised free testosterone >5ng/L
AMH >3.5ng/mL

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18
Q

Why are metabolic abnormalities associated with PCOS

A

Abnormal serum lipid concentrations
Insulin resistance

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19
Q

Tubal and uterine causes of infertility

A

Pelvic inflammatory disease
Previous tubal surgery
Endometriosis
Fibroids
Cervical mucus defect

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20
Q

Endometriosis

A

Presence of tissue similar to endometrium outside uterus, often on uterus, Fallopian tubes, or GI system

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21
Q

Why does endometrial tissue outside uterus grow and bleed in endometriosis

A

Tissue responds to oestrogen and progesterone

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22
Q

What causes pelvic inflammatory disease

A

Bacterial infection spreading from vagina or cervix

23
Q

Fibroid/leiomyoma

A

Non cancerous smooth muscle growth

24
Q

Fibroid/leiomyoma symptoms

A

Heavy periods
Pain on intercourse
Abdominal swelling

25
Q

Fibroid types

A

Redunculated subserosal - abdominal
Subserosal
Submucosal
Intramural
Redunculated submucosal - vaginal

26
Q

Repeated miscarriage causes and treatments

A

Anatomical abnormalities - no treatment
Cervical incompetence - close cervix
Endocrine/hormonal abnormalities - hormone blockers
Genetic/chromosomal abnormalities - no treatment
Blood coagulation protein/platelet defects - low dose aspirin
B CAGE

27
Q

Most common cause of repeated miscarriage

A

Blood coagulation protein abnormalities

28
Q

Blood coagulant protein/platelet defects that can cause repeated miscarriage

A

Factor XIII defects
Factor XII defects
Anticardiolipin antibodies
Lupus anticoagulant
Antophospholipid syndrome

29
Q

Endocrine abnormalities that can cause repeated miscarriage

A

Luteal phase defect
LH hypersecretion on day 8

30
Q

Is infertility easier to detect and treat in men or women

A

Easier to detect in men
Easier to treat in women

31
Q

Male causes of infertility

A

<120 million sperm
Hormone imbalance
Anti sperm antibodies
Varicocele
Sperm quality and movement
Undescended testis
Obstruction - vasectomy, cystic fibrosis
Ejaculatory problems - premature, retrograde
Erectile dysfunction

32
Q

Combined infertility

A

Both man and woman infertile or subfertile

33
Q

Genetic causes of infertility

A

NR5A1 gene mutations
46XY

34
Q

Male idiopathic infertility

A

Semen analysis abnormal but unclear why

35
Q

Female idiopathic infertility

A

Ovulation abnormal but unclear why

36
Q

Why can a MTHFR gene mutation cause infertility

A

Folate deficiency as Cannot convert folic acid to folate

37
Q

General advice to improve conception

A

Intercourse throughout cycle
Stop smoking
Stop/decr alcohol
Take folic acid
Lose weight
Decr stress
Decr caffeine

38
Q

GP investigations before referral

A

Sexual/ contraception/family history
PCOS screen
Thyroid function
Vitamin D
HbA1C
Viral screen
STI screen
Semen analysis

39
Q

When are women referred by a GP to infertility services

A

Aged 36+ and known clinical cause

40
Q

What is assessed in a semen analysisf

A

Volume - lower limit 1.5ml
Progressive motility - lower limit 32%
Morphology - lower limit 4%
DNA integrity

41
Q

Ovulatory function investigations

A

Blood test
Response to gonadotropin stimulation in IVF, ultrasound, hormones - ovarian reserve
Hysterosalpingogram - tubal function
Laparoscopy - uterine function

42
Q

Assisted reproductive options

A

Intrauterine insemination
In vitro fertilisation
Intra cytoplasmic sperm injection

43
Q

Intrauterine insemination

A

Sperm collected and slow sperm removed then inseminated into parter/donor

44
Q

IVF

A

Sperm and eggs collected, Eggs fertilised outside body then inseminated

45
Q

How many cycles of IVF are offered and when

A

3 if woman under 40
1 if woman 40-42 and never previously had IVF and no evidence of low ovarian reserve
Offered after 2yrs unprotected intercourse or 12 cycles IUI

46
Q

intracytoplasmic sperm injection

A

Single spermatic injected directly into egg

47
Q

Who is IUI offered to

A

Unable to have vaginal intercourse
Sperm wash needed

48
Q

Who is ICSI offered to

A

Severe sperm deficiency
Obstructive azoospermia
Non obstructive azoospermia
Previous Failed IVF

49
Q

What causes ovarian hyperstimulation syndrome

A

Drugs used to stimulate ovarian function in IVF or PCOS, esp hCG

50
Q

Ovarian hyper stimulation syndrome

A

Multiple luteinised cysts in ovaries due to drugs used to stimulate ovaries

51
Q

What risks are slightly increased in children born by IVF to mothers over 35

A

Birth defects
Cancer

52
Q

Types of 3rd party reproduction

A

Egg donation
Sperm donation
Embryo adoption
Surrogacy

53
Q

What precautions can be taken for cancer patients who wish to have children in the future

A

Cryopreservation of sperm, embryos, or oocytes

HD2 (23 decks)

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