Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

BRS2 Endocrinology > Infertility > Flashcards

Infertility Flashcards

1
Q

What is infertility?

A

A disease of the reproductive system defined by the failure to achieve a clinical pregnancy after ≥12 months of regular unprotected sexual intercourse.

Defined by WHO

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

What is the difference between primary and secondary infertility?

A

Primary - when you have not had a live birth previously.

Secondary - when you have had a live birth >12 months previously

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

How many couples does infertility affect?

A

1 in 7 couples (=14% of couples)

But~ half of these will then conceive in the next 12 months (i.e. at 24 months ~7% of couples)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q 
The following are causes of infertility:
male factor 
female factor 
combined male and female factor 
unknown factor

List them in order from most to least common cause.

A

Male factor = female factor = combined male and female factor

Unknown only 10%

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

What impacts may infertility have on the couple?

A

Psychological distress to couple:

  • No biological child
  • Impact on couples wellbeing
  • Impact on larger family
  • Investigations
  • Treatments (often fail)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How might infertility affect society?

A

Less births
Less tax income
Investigation costs
Treatment costs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Outline the causes of infertility in males. Split your answer up into 3 sections: pre-testicular, testicular and post-testicular.

A 
Pre-testicular:
Congenital and acquired endocrinopathies 
- Klinefelters 47XXY
- Y chromosome deletion 
- HPG, T, PRL 
Testicular:
(Congenital) 
Cryptochordism 
Infection - STDs 
Immunological - antisperm Abs 
Vascular - Varicocoele 
Trauma/surgery 
Toxins - Chemo/DXT (deep X-ray therapy) /Drugs/Smoking

Post-testicular:
Congenital - absence of vas deferens in CF
Obstructive azoospermia
Erectile dysfunction - retrograde ejaculation, mechanical impairment, psychological
Iatrogenic - vasectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is cryptorchidism?

A 
A condition in which one or both of the testes fail to descend from the abdomen into the scrotum.
Undescended testis (90% in inguinal canal)
Normal path for testis descent through inguinal canal.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Outline the causes of fertility in females. Split the causes up into pelvic, tubal, ovarian, uterine and cervical causes.

A 
Pelvic Causes (5%):
Endometriosis and adhesions

Tubal Causes (30%): Tubopathy due to infection, endometriosis, trauma

Ovarian Causes (40%): Anovulation (Endo), corpus luteum insufficiency

Uterine Causes (10%): Unfavourable endometrium due to: Chronic endometriosis (TB), fibroid, adhesions (synechiae), congenital malformation

Cervical Causes (5%): ineffective sperm penetrations due to chronic cervicitis, immunological (antisperm Ab)

Unexplained (10%)

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

What is endometriosis?

A

A condition resulting from the appearance of endometrial tissue outside the uterus > Pelvic pain (associated with menstruation).

(Happens to 5% of women; functioning tissue responds to
oestrogen.)

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

What are the symptoms of endometriosis?

A

Increased menstrual pain
Menstrual irregularities
Deep dyspareunia (pain during sexual intercourse)
Infertility

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

What are the treatment options for endometriosis?

A

Hormonal (Continuous OCP, progesterone)
Laparoscopic ablation
Hysterectomy
Bilateral salpingo-oophorectomy - moves ovaries and tubes

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

What are fibroids?

A

Benign tumours of the myometrium (1- 20% of pre-menopausal women, the frequency of fibroids increases with age).
Responds to oestrogen (Functioning endometrium tissue)

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

What are the symptoms of fibroids?

A

Can be asymptomatic.

Increased menstrual pain
Deep dyspareunia
Infertility

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

What are the treatment options for fibroids?

A

Hormonal (e.g. continuous OCP, progesterone, continuous GnRH agonists)
Hysterectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Which neurones regulate the pulsatility of the hypothalamic-pituitary gonadal axis?

A

Kisspeptin neurones

• Inhibited by prolactin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Which hypothalamic regulatory hormone controls FSH & LH secretion?

A

Gonadotrophin releasing hormone (GnRH) released from parvocellular GnRH hypothalamic neurones secreted into the primary capillary plexus within the median eminence.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Which endocrine cells release FSH and LH?

A

Gonadotrophs located in the anterior pituitary gland secreted into the secondary capillary plexus.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What cells do LH bind on to initiate testosterone release?

A

Leydig Cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What type of cell does FSH bind to support spermatogenesis?

A

Sertoli cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Explain what happens in a patient with hyperprolactinaemia and what happens to the their testosterone, oestrogen, FSH and LH levels.

A

Prolactin released from lactotrophs exerts an inhibitory effect on kisspeptin neurones and thus downregulating the pulsatile action of GnRH secretion from hypothalamic neurones.

  • Low testosterone/oestrogen
  • Low FSH
  • Low LH
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are the symptoms of hyperprolactinaemia?

A

Oligomenorrhoea (>35d menses) or amenorrhoea (3-6 months with no menses)/low libido (and other hypogonadal symptoms)/ infertility/osteoporosis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

List the causes of hyperprolactinaemia.

A

Prolactinoma is a common cause (Secondary hypogonadism)

Pituitary stalk compression

Pregnancy & breastfeeding (Increased physiological release of prolactin)

Medications (Dopamine antagonists (anti-emetics and antipsychotics, oestrogens e.g. OCP).

Rare causes: PCOS and hypothyroiditis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is the treatment for a hyperprolactinaemia?

A

Dopamine (D2) agonists – cabergoline > Dopamine inhibits prolactin secretion from lactotrophs within the anterior pituitary gland.

If D2 agonist ineffective > Surgery (Transsphenoidal)/DXT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What is Klinefelter's syndrome?
A pre-testicular congenital defect concerned with a chromosomal disorder of 47XXY, interfering with the development of the testes. The pituitary gland retains normal gonadotropic function, however the deficiency in testosterone leads to hypergonadotropic hypogonadism.
26
What happens to a patients FSH, LH and testosterone levels in Klinefelter's syndrome?
High FSH High LH Low testosterone.
27
List the symptoms of a male patient with Klinefelter's syndrome.
``` Micropenis and small testes Female-type pubic hair pattern Infertility (accounts for up to 3% of cases) Gynecomastia Decreased facial hair Tall stature Mildly impaired IQ Wide hips, narrow shoulders, reduced chest hair and low bone density. ```
28
What is Kallman Syndrome?
Refers to the failure of GnRH hypothalamic neurone migration with olfactory bundles, therefore a typical clinical feature also includes anosmia. Reduced GnRH releases causes a downstream reduction in gonadotropin secretion. Hypogonadotropic hypogonadism (Low FSH, LH & Testosterone).
29
List the reproductive symptoms a patient with Kallmans syndrome would present with.
Lack of testicle development Micropenis Primary amenorrhoea Infertility
30
List the causes of congenital hypogonadotrophic hypogonadism (secondary hypogonadism).
Kallmans Syndrome (Anosmia) or normosmic
31
List the acquired causes of hypogonadotrophic hypogonadism.
Low BMI, excess exercise, stress
32
List the causes of hypopituitarism (potentially lead to hypogonadism).
``` Pituitary tumour Infiltration Pituitary apoplexy Pituitary surgery Radiation ```
33
What is the name of the condition that gives rise to congenital primary hypogonadism?
Klinefelters (47XXY)
34
List the causes of acquired primary hypogonadism.
Cryptochirdism, trauma, chemo, radiation
35
Does hyperprolactinaemia cause hypogonadotrophic hypogonadism or hypergonadotrophic hypogonadism?
Hypogonadotrophic hypogonadism
36
What would the initial history for a male being considered for infertility involve?
Duration, previous children, pubertal milestones, associated symptoms (Testosterone deficiency, PRL symptoms, CHH symptoms), medical & surgical history, family and social history, medications/drugs.
37
What should an examination of a patient being considered for infertility include?
``` BMI Epididymal hardness Sexual characteristics Testicular volume Presence of vas deferens Other endocrine signs, Syndromic features Anosmia ```
38
List the investigations involved in determining whether or not a male patient is infertile.
Semen analysis Blood tests: LH, FSH, PRL; morning fasting testosterone; sex-hormone binging globulin (SHBG); albumin, iron studies; also pituitary/thyroid profile; karyotyping > for sex chromosome abnormalities Microbiology: Urine test, chlamydia swab Imaging: Scrotal US/doppler (for varicocele/ obstruction, testicular volume), MRI pituitary (If low LH/FSH or high PRL)
39
What general lifestyle changes would you suggest to a infertile male?
Optimise BMI Smoking cessation Alcohol reduction/ cessation
40
What specific treatment would there be for male infertility?
Dopamine agonist (Cabergoline) for hyperprolactinaemia Gonadotrophin treatment for fertility (Will also increase testosterone) Testosterone (If no fertility is required) Surgery (Micro testicular sperm extraction)
41
How long does the menstrual cycle last?
28 day cycle (24-35 days) | ± 2 days each month
42
What is primary amenorrhoea?
Later than 16 years is regarded as abnormal.
43
What is secondary amenorrhoea?
Common for periods to be irregular/ anovulatory for first 18 months. Periods start but then stop for at least 3-6 months.
44
Define amenorrhoea.
No periods for at least 3-6 months OR up to 3 periods per year.
45
Define oligo-menorrhoea (few periods).
Irregular or infrequent periods >35 day cycles OR 4-9 cycles per year
46
Does the Premature Ovarian Insufficiency have the same symptoms as menopause?
Yes
47
What is POI?
Premature ovarian failure is the cessation of menses for more than a year in an individual less than the age of 40 secondary to loss of ovarian function.
48
In how many cases of POI can conception still occur?
20%
49
How can you diagnose if a patient has POI?
Diagnosis High FSH >25iU/L (x2 at least 4 weeks apart). Serum oestradiol is low, thus there is a loss of negative feedback.
50
List the causes of POI
Autoimmune Genetic (Fragile X syndrome/ Turner’s Syndrome (Monosomy X) Cancer therapy (Radio-/chemotherapy)
51
What is PCOS?
In PCOS, there are polycystic ovaries where the follicles are undeveloped sacs, in which the eggs develop. These eggs cannot release the egg hence no ovulation or maturation – leading to infertility if untreated.
52
What % of women of reproductive age does PCOS affect?
5-15%
53
Outline the diagnosis of PCOS using the Rotterdam PCOS Diagnostic Criteria (2 out of 3)
Oligomenorrhoea or anovulation (amenorrhoea): - Normally assessed by menstrual frequency. - <21 days or >35 days - <8-9 cycles/year - >90 days for any cycle If necessary anovulation can be proven by: lack of progesterone rise OR US (ultrasonogram) Clinical +/- Biochemical hyperandrogenism: Clinical - Acne, hirsutism (Ferriman-Gallwey score), alopecia (Ludwig score) Biochemical - Raised androgens (e.g. testosterone) ``` Polycystic ovaries (US): greater than or equal to 20 follicles OR greater than or equal to 10ml either ovary on TVUS (8MHz) Don't use US until 8 year post-menarche due to high incidence of multi-follicular ovaries at this stage. ```
54
List and explain the treatments for PCOS.
Taking metformin and the OCP will lead to irregular menses/amenorrhoea >infertility. Can treat using clomiphene, letrozole and/or IVF. For hirsutism > creams, waxing, laser and/or anti-androgens e.g. spironolactone. (Progesterone can be taken to decrease the risk of endometrial cancer.
55
How does letrozole?
Works via inhibiting the aromatase-mediated conversion of testosterone to oestradiol. This means levels of oestradiol drop, hence there is less negative feedback exerted on GnRH secretion. Greater GnRH pulsatile release > Increases FSH and LH levels. FSH is required to stimulate ovaries to grow a follicle.
56
Outline the mechanism of clomiphene.
An oestradiol receptor antagonist prevents negative feedback being exerted on hypothalamic-pituitary axis leading to a marked response with increased GnRH and FSH/LH.
57
What is Turner's syndrome?
Turner’s syndrome is a chromosomal abnormality with the karyotype 45X0.
58
What are the symptoms/characteristic features of Turner's syndrome?
``` Short stature Shield crest with widely spaced nipples High arched palate Webbed feet Gonadal dysgenesis Aortic coarctation Short fourth metacarpal and elbow deformity. There is primary amenorrhoea and delayed puberty due to hypergonadotropic hypogonadism ```
59
Describe the LH, FSH and androgen levels in a patient with Turner's syndrome.
LH and FSH are elevated | Androgens reduced
60
What aspects may the history of a patient with female infertility include?
Duration, previous children, pubertal milestones, breastfeeding Menstrual history: oligomenorrhoea or 1/20 amenorrhoea, associated symptoms (e.g. Oestrogen deficiency, PRL symptoms, CHH features), medical & surgical history, family history, social history, medications/drugs
61
What may the examination of a female patient who could potentially have infertility involve?
Including BMI, sexual characteristics, hyperandrogenism signs, pelvic examination, other endocrine signs, syndromic features, anosmia.
62
List the investigations that would be involved to determine whether or not a patient has infertility.
``` Blood tests: LH, FSH, PRL Oestradiol, androgens Follicular phase 17-OHP, Mid-Luteal Prog Sex hormone binding globulin (SHBG) Albumin, Iron studies Pituitary/thyroid profile Karyotyping ``` Always conduct pregnancy test (urine or serum beta-HCG) Microbiology: Urine test Chlamydia swab Imaging: US (Transvaginal) Hysterosalpingogram MRI pituitary (If low FSH/LH or high PRL)

BRS2 Endocrinology (15 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions