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ENDOCRINOLOGY 2 > INFERTILITY > Flashcards

INFERTILITY Flashcards

1
Q

What is the definition of infertility?

A

A disease of the reproductive system defined by the failure to achieve a clinical pregnancy after >= 12 months of regular unprotected sex

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2
Q

What is the difference between primary and secondary infertility?

A

Primary - no live births previously

Secondary - have had a live birth > 12 months previously

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3
Q

What is the proportion of couples who have infertility?

A

1 in 7 but then half of these will conceive in the next 12 months

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4
Q

What are the costs of infertility to society?

A

Less births
Less tax income
Investigation costs
Treatment costs

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5
Q

What is a pre-testicular cause of infertility in men?

A

Congenital and acquired endocrinopathies

e.g. Kilinefelters

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6
Q

What are the testicular causes of infertility in men?

A 
Congenital
Cryptorchidism
Infection (STDs)
Immunological (antisperm antibodies)
Vascular (varicocoele)
Trauma/surgery
Toxins (chemo/drugs/smoking)
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7
Q

What are some post-testicular causes of infertility in men?

A

Congenital
Obstructive azoospermia
Erectile dysfunction (retrograde ejaculation, mechanical impairment)
Latrogenic (vasectomy)

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8
Q

What is cryptorchidism?

A

Undescended testes through inguinal canal

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9
Q

List the 5 causes of infertility in women

A
  • Ovarian causes
  • Tubal causes
  • Uterine causes
  • Cervical causes
  • Pelvic causes
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10
Q

What is endometriosis?

A

Presence of functioning endometrial tissue outside the uterus which responds to oestrogen

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11
Q

What are the symptoms of endometriosis?

A

Increased menstrual pain
Menstrual irregularities
Deep dyspareunia (painful intercourse)
Infertility

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12
Q

What are the treatments for endometriosis?

A

Hormonal (e.g. OCP, progesterone)
Laparascopic ablation
Hysterectomy
Bilateral salpingo-oophorectomy (take out affected area)

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13
Q

What are fibroids?

A

Benign tumours of the myometrium which respond to oestrogen

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14
Q

What are symptoms of fibroids?

A 
Usually asymptomatic
Increased menstrual pain
Menstrual irregularities
Deep dyspareunia (painful intercourse)
Infertility
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15
Q

What are the treatments for fibroids?

A

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

Hysterectomy

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16
Q

What causes hypogonadotrophism, hypogonadism and low GnRH in male infertility?

A

Congenital hypogonadotrophic hypogonadism
e.g. Kallmann syndrome (anosmic)

Acquired hypogonadotrophic hypogonadism
e.g. low BMI, XS exercise, stress

Hyperprolactinaemia

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17
Q

What causes hypogonadotrophism and hypogonadism in male infertility?

A

Hypopituitarism e.g. tumour, infiltration, apoplexy, surgery, radiation

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18
Q

What causes hypergonadotrophism and hypogonadism in male infertility?

A

Congenital primary hypogonadism
e.g. Klinefelters

Acquired primary hypogonadism
e.g. cryptorchidism, trauma, chemo, radiation

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19
Q

What is Kallmann syndrome and what does it present as?

A

Failure of migration of GnRH neurones with the olfactory fibres (from olfactory placode to hypothalamus)

Anosmia
Cryptorchidism
Failure of puberty e.g. micropenis, primary amenorrhoea
Infertility

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20
Q

What does hyperprolactinaemia inhibit and cause?

A

Kisspeptin neurones causing low GnRH/LH/FSH/T/Oest

Oligo/amenorrhoea
Low libido
Infertility
Osteoporosis

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21
Q

What is the chromosomal abnormality in Klinefelter syndrome?

A

XXY sex chromosome in men

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22
Q

What are the symptoms of Klinefelter syndrome?

A 
Tall stature
Little facial hair
Breast development
Female-type pubic hair development
Mildly impaired IQ
Narrow shoulders
Wide hips
Small penis and testes
Low bone density
Infertility
23
Q

What investigations can you undertake with infertile men?

A 
Semen analysis (volume, sperm conc., motility)
LH/FSH/PRL blood test
Morning fasting testosterone
Sex hormone binding globulin test
Karyotyping
Pituitary/thyroid profile
Urine test
MRI for pituitary
Scrotal ultrasound
24
Q

What are 3 lifestyle treatments for male infertility?

A

optimise BMI
Smoking cessation
Alcohol reduction

25
Q

What are specific treatments for male infertility?

A

Dopamine agonist for hyperprolactinaemia
Gonadotrophin treatment for fertility
Testosterone if no fertility is required
Surgery

26
Q

List all the categories causes of female infertility

A 
Tubal causes
Uterine causes
Cervical causes
Ovarian causes
Pelvic causes
Idiopathic
27
Q

What are some tubal causes of female infertility?

A

Infection
Endometriosis
Trauma

28
Q

What are some uterine causes of female infertility?

A

Chronic endometritis (Tb)
Fibroid
Adhesions
Congenital malformation

29
Q

What are some cervical causes of female infertility?

A

Ineffective sperm penetration:

  • Chronic cervicitis
  • Immunological (antisperm Ab)
30
Q

What are some ovarian causes of female infertility?

A

Anovulation

Corpus luteum insufficiency

31
Q

What are some pelvic causes of female infertility?

A

Endometriosis

Adhesions

32
Q

What is amenorrhoea?

A

No periods for at least 3-6 months
Or
Up to 3 periods a year

33
Q

What is primary amenorrhoea?

A

Later than 16 years old regarded as abnormal

34
Q

What is secondary amenorrhoea?

A

Periods start but then stop for 3-6 months

35
Q

What is oligomenorrhoea?

A

Irregular or infrequent periods > 35 day cycles
Or
Up to 4-9 cycles per year max

36
Q

What is premature ovarian insufficiency (POI)?

A

Early menopause previously called premature ovarian failure (POF). Conception can still occur in 20%

37
Q

What is the diagnosis of premature ovarian insufficiency (POI)?

A

High FSH > 25 iU/L (x2 at least 4 weeks apart)

38
Q

What are the causes of premature ovarian insufficiency (POI)?

A

Autoimmune
Genetic e.g. fragile X syndrome, Turner’s syndrome
Cancer therapy (radio/chemo in past)

39
Q

What causes low GnRH, hypogonadotrophism and hypogonadism in women?

A

Congenital hypogonadotrophic hypogonadism
- Anosmic (Kallmann syndrome) or normosmic

Acquired hypogonadotrophic hypogonadism
- Low BMI, XS exercise, stress

Hyperprolactinaemia

40
Q

What causes hypogonadotrophism and hypogonadism in women?

A

Hypopituitarism e.g. tumour, apoplexy, surgery, radiation

41
Q

What causes hypergonadotrophism and hypogonadism in women?

A

Polycystic ovarian syndrome (PCOS)

Acquired primary hypogonadism:

  • POI
  • surgery, trauma, radiation, chemo

Congenital primary hypogonadism:

  • Turner’s syndrome
  • POI
42
Q

What is the epidemiology of PCOS?

A

Affects 5-15% of women of reproductive age
Frequent family history
Most common endocrine disorder in women and cause of infertility of women

43
Q

How do you diagnose PCOS and explain it

A

Exclude other reproductive disorders then…

Rotterdam PCOS diagnostic criteria (2/3)
- Oligomenorrhoea/anovulation
- Clinical signs of (with/out biochemical) 
  hyperandrogenism
- Polycystic ovaries
44
Q

Which combination of diagnostic criteria gives the worst metabolic risk?

A

Oligomenorrhoea/anovulation

Clinical signs of (with/out biochemical) hyperandrogenism

45
Q

How is PCOS treated?

A

Patient is asked which symptoms they want to get rid of and tailored treatment plan is drawn up

46
Q

If a PCOS patient wishes to remove oligo/amenorrhoea and thus infertility as a symptom what can they take?

A

Oligo/amenorrhoea:

  • Oral contraceptive pill
  • Metformin

Infertility:

  • Clomiohene
  • Letrozole
  • IVF
47
Q

If a PCOS patient wishes to remove impaired glucose homeostasis (T2DM) as a symptom what can they do?

A

Metformin

Diet + lifestyle

48
Q

If a PCOS patient wishes to remove hirsutism as a symptom what can they take?

A

Anti-androgens e.g. spironolactone

Creams, waxing, laser

49
Q

If a PCOS patient wishes to remove an increased endometrial cancer risk as a symptom what can they take?

A

Oral contraceptive pill

Progesterone courses

50
Q

What are the symptoms of Turner’s syndrome?

A 
Short stature
Low hairline
Shield chest
Wide spaced nipples
Small fingernails
Brown nevi
Webbed neck
Coarctation of aorta
Poor breast development
Elbow deformity
Underdeveloped reproductive tract
Amenorrhoea
51
Q

What are the blood tests that can be done to investigate female infertility?

A 
LH, FSH, PRL
Oestradiol, androgens
Mid-luteal progesterone
Sex hormone binding globulin (SHBG)
Albumin, iron studies
Pituitary/thyroid profile
Karyotyping
52
Q

What are some microbiological tests that can be done to investigate female infertility?

A

Urine test

Chlamydia swab

53
Q

What are some imaging techniques that can be done to investigate female infertility?

A

Transvaginal ultrasound
Hysterosalpingogram
MRI pituitary if hypogonadotrophism or hyperprolactinaemia

ENDOCRINOLOGY 2 (12 decks)

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