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BRS YEAR 2 > Infertility > Flashcards

Infertility Flashcards

1
Q

What is inferility? - dc

A

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

(every 2-3 days = regular intercourse)

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2
Q

What is primary infertility?

A

When have no had a live birth previously

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3
Q

What is secondary infertility?

A

When have had a live birth more than 12 months previously

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4
Q

How common is infertility in couples?

A

1 in 7 - 14% of couples are infertile

Half of these will conceive in the next 12 months
in 24 months - 7% of couples are infertile

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5
Q

What are the psychological distresses of infertility?

A 
No biological child
Impact on couples wellbeing
Impact on larger family
Investigations
treatments (often fail)
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6
Q

What is the cost to society due to infertility?

A

Fewer births
Less tax income
Investigation costs
Treatment costs

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7
Q

What are the main pre-testicular causes of infertility?

A

Congenital and acquired endocrinopathies (Kleinfelters - 47XXY), Y chromosome deletion, HPG, PRL (prolactinoma)

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8
Q

What are the main testicular causes of infertility?

A 
Cryptorchidism 
Infection (STDs)
Immunological (Antisperm antibodies) 
Vascular (varicoele)
Trauma/surgery
Toxins
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9
Q

What are the main post-testicular causes of male infertility?

A

Absence of vas deferens in patients with cystic fibrosis

Obstructive azoospermia

Erectile dysfunction

Latrogenic- vasectomy

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10
Q

What is the function of the vas deferens?

A

Transports mature sperm from the epididymis to the urethra in preparation for ejaculation

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11
Q

What are the three main types of erectile dysfunction?

A

Retrograde ejaculation
Mechanical impairment
Psychological

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12
Q

What is retrograde ejaculation?

A

The semen within the urethra travels back into the bladder.

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13
Q

What is cryptorchidism?

A

There is undescended testis in the inguinal canal. into the scrotum.

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14
Q

What is the main cause of infertility in females?

A

Ovarian causes (anovulation, and a corpus luteum insufficiency)

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15
Q

Which hormone is mainly secreted by the corpus lutuem?

A

Progesterone

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16
Q

Shat are the five main types of female infertility causes?

A

1) Ovarian causes
2) Tubal causes
3) Uterine causes
4) Cervical causes (ineffective sperm penetration due to chronic cervicitis) and antisperm ABs
5) Pelvic causes (endometriosis and adhesions)

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17
Q

What is endometriosis?

A

a condition resulting from the appearance of functioning endometrial tissue outside the uterus and causing pelvic pain,

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18
Q

What are the symptoms of endometriosis?

A

Menstrual pain
Menstrual irregularities
Deep dyspareunia (Pain during sexual intercourse)
infertility

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19
Q

Why do individuals with endometriosis experience menstrual pain?

A

Endometrial tissue responds to oestrogen in a cyclic manner.

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20
Q

What are the treatments for endometriosis?

A 
Hormonal (continuous OCP, progesterone)
Laparscopic ablation (removal of endometrial tissue)
Hysterectomy 
Bilateral salpingo-oophorectomy
Moves ovaries and tubes
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21
Q

What are fibroids?

A

Benign tumours of the myometrium that respond to oestrogen

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22
Q

What are the symptoms of fibroids?

A 
Asymptomatic usually 
Increased menstrual pain 
Menstrual irregularities 
Deep dyspareunia
Infertility
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23
Q

What are the treatments available for fibroids?

A

Hormonal (Continuous OCP, progesterone, continuous GnRH agonist)
Hysterectomy

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24
Q

Which neurones control the pulsatile secretion of gonaodtropins?

A

Kisspeptin neurones

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25
Which endocrine cells secrete LH and FSH?
Gonadotrophs within the anterior pituitary gland
26
Which hormones are released from the gonads
Inhibin, activin, oestrogen, testosterone, progesterone
27
Which enzyme converts testosterone to oestrogen?
Aromatase
28
What type of feedback is exerted by oestrogen on the hypothalamic pituitary gonadal axis?
Negative feedback on anterior pituitary secretion of gonaodtropins and hypothalamic neurones
29
What effect does prolactin have on kisspeptin neurones?
Inhibits kisspeptin neurones and thus decreases pulsatile action of GnRH secretion from hypothalamic neurones, This causes a downstream inhibition on LH and FSH release from the anterior pituitary gonaodtrophs, as well as testosterone release from the testes.
30
Which hormones are insufficient in a patient with hyperprolactinaemia?
LH, FSH and testosterone
31
What type of hypogonadism is Klinefelters syndrome?
Primary hypogonadism, there is an insufficient secretion of testosterone from the testes.
32
What impact does Klinefelters syndrome have on LH and FSH levels?
Dysregulation of negative feedback system, stimulating increased secretion of LH and FSH due to low testosterone.
33
What is Kallman's syndrome?
Hypogonadotrophic hypogonadism, in addition to anosmia
34
What are the three forms of acquired hypogonadotrophic hypogonadism?
Low BMI (Anorexia can cause hypothalamic suppression) Excess exercise Stress
35
What are the common causes of hypopituitarism?
Tumour, infiltration, apoplexy, surgery and radiation
36
Which hormones are deficient in congenital and acquired hypogonadotrophic hypogonadism, and hyperprolactinaemia?
GnRH (Not measurable) LH FSH Testosterone
37
What type of hypogonadism is Klinefelters syndrome?
Hypergonadotrophic hypogonadism
38
How does Kallmann syndrome cause male infertility?
There is failure of migration of GnRH neurones with olfactory fibres to the hypothalamus, therfore leading to a hypogonaodtrophic hypogonadism as there is a failure to secrete GnRH
39
What are the clinical features of Kallman syndrome?
``` Anosmia Cryptorchidism Failure of puberty Lack of testicle development Micropenis Primary amenorrhoea Infertility ```
40
What agonists can be prescribed to treat hyperprolactinaemia?
Dopamine agonists (cabergoline) Dopamine inhibits prolactin release from lacotrophs.
41
What is the available treatment for individuals with hyperprolactinaemia?
Dopamine agonists (cabergoline) Transsphenoidal surgery Sellar radiotherapy
42
What are the causes of hyperprolactinaemia?
``` Prolactinoma (micro/macro) Pituitary stalk compression Pregnancy & breast feeding Medication (dopamine antagonists, including anti-emetics and antipsychotics) Oestrogens (OCP) ``` PCOS and hypothyroidism
43
What are the clinical features of Klinefelters syndrome?
``` Tall stature Decreased facial hair Breast development Female-type pubic hair pattern Small penis and testes Infertility Mildly impaired IQ Narrow shoulders Reduced chest hair wide hips low bone density ```
44
What is examined during a medical examination of a patient with suspected Klinefelters syndrome?
``` BMI Sexual characteristics Testicular volume Epididymal hardness Presence of vas deferens ```
45
What is the normal testicular volume for a male?
50ml
46
What happens to testicular volume in a patient with Klinefelter's syndrome?
Low testicular volume (1.5ml)
47
What should be measured in a blood test of a patient with suspected Klinefelter's syndrome?
LH FSH and PRL Morning fasting testosterone Sex hormone binding globulin (SHBG) Albumin, iron studies (Iron deposition can affect pituitary function) Pituitary/thyroid profile (Thyroid hormone can affect bioavailable testosterone) Karyotyping
48
What is varicocoele?
A varicocele is an enlargement of the veins within the scrotum. Varicoceles are a common cause of low sperm production and decreased sperm quality, which can cause infertility.
49
When should a pituitary MRI be conducted in a patient with hypogonadism?
If there is low LH/FSH or high prolactin
50
What general lifestyle changes can be done to improve male fertility?
1) Optimise BMI 2) Smoking cessation 3) Alcohol reduction/cessation
51
What treatment is available for male infertility?
1) Dopamine agonists for hyperprolactinaemia 2) Gonadotrophin treatmnt for fertility (will also increase testosterone). 3) Testosteorne (for symptoms if no fertility is required) 4) Surgery (micro testicular sperm extraction)
52
What is the initial test that should be conducted for a patient presenting with female inferility?
Pregnancy test (beta-hcg)
53
What is primary amenorrhoea?
The absence of menarche by age 16
54
What is secondary ammenorrhoa?
Irregular periods, anovulatory for first 18 months. | Periods START but cease for 3-6 month minimum.
55
What is ammenorrhoea?
No periods for at least 3-6 months | Or up to 3 periods a year
56
What is oligo-menorrhoea?
Irregular or infrequent periods >35 day cycle | 4-9 cycles per year
57
What is the hormone profile in a patient with premature ovarian insufficiency?
LH and FSH are elevated Oestradiol decreased The ovaries fail to release oestrogen
58
What are the clinical symptoms presented in patients with a premature ovarian insufficiency?
``` Menopause before the age of 40 hot flushes sleep disturbances infertility Vaginal dryness and atrophy High FSH > 25iU/L (x2 at least 4wks apart) ```
59
What is the hormone pattern in a female patient with anorexia nervosa-induced amenorrhoea?
There is hypogonadotrophic hypogonadism Low FSH/LH and low oestradiol There is low leptin which feedback on kisspeptin neurones to reduce pulsatility.
60
What are two main examples of congenital primary hypogonadism?
Turner's syndrome | Premature ovarian insufficiency
61
What criteria is used to diagnose a patient with PCOS?
Rotterdam PCOS diagnostic criteria (2 of 3)
62
What are the three criterions for PCOS?
Oligo or anovulation Clinical/biochemical hyperandrogenism Clinical (Acne, hirsutism, alopecia) Polycystic ovaries (>20 follicles)
63
What are the associated risks with PCOS?
Increased insulin resistance (impaired glucose homeostasis, T2DM, gestational DM) Hirsutism Increased endometrial cancer risk Infertility (irregular menses)
64
What treatment can be prescribed to treat female infertility?
Clomiphene Letrozole IVF
65
What drug can be prescribed to PCOS patients with increased insulin resistance?
Metformin
66
What drug can be prescribed as an anti-androgen?
Spironolactone
67
What are the clinical features in a patient with Turner's syndrome (45X0)?
``` Short stature Low hairline Shield chest Wide spaced nipples Short 4th metacarpal small fingernails Brown nevi Characteristic facies Webbed neck Coarctication of aorta Poor breast development Elbow deformity Underdeveloped reproductive tract AmenORRHOEA. ```

BRS YEAR 2 (12 decks)

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