Brainscape's Knowledge GenomeTM

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


See full index

Repro > Infertility > Flashcards

Infertility Flashcards

1
Q

Define infertility

A

Inability to conceive after regular sex for 12 months without contraception

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

What is the difference between primary & secondary infertility?

A

Primary have never conceived secondary have conceived but it didn’t result in a child (e.g. miscarriage/ectopic)

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

What is the length of a regular cycle?

A

28-35 days

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

Define oligomenorrhoea

A

cycles >35days

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

Define primary and secondary amenorrhoea

A

Primary never have had periods and secondary have had them and then they stopped

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

What do ovulatory predictor kits detect and why are they not 100% reliable?

A

Detects LH surge (24-36hr before ovulation), not 100% reliable only 97% because of how people might excrete their LH

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

How is ovulation assessed and how is this adjusted for cycle length?

A

Midluteal serum progesterone, adjust by doing it about a week before end of cycle

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

What are initial investigations in primary care for infertility for females? (5)

A 
Day 21 progesterone to establish ovulation (or adjusted to cycle day) 
TSH 
Rubella immunity
Chlamydia screen 
Ensure cervical smear up to date
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What affect does rubella have in foetus if mother is infected during pregnancy?

A

Affects neurological development

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

If cycle lasts longer than 42 days or if amenorrhoeic, what investigations are carried out?

A

Follicular phase bloods: LH,FSH, E2
Testosterone, Sex Hormone Binding Globulin (SHBG), FAI (free antigen index) - tells you how much available testosterone in system
Prolactin

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

What are the 3 important parameters in diagnostic semen analysis?

A

Need to be:
16million sperm per ml
30% progressive motility
At least 4% to be normal morphologically

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

What is azoospermia

A

No sperm in ejaculate

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

Asthenozoospermia

A

poor sperm swimming - low progressive motility

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

oligozoospermia

A

concentration of sperm low

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

teratozoospermia

A

morphologically normal sperm below reference limit

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

List 6 possible abnormal findings from ultrasound of female

A 
congenital uterine abnormality 
fibroids
endometrial polyp
hydrosaplinx 
PCOS
Ovarian cyst (simple, dermoid, cancer, endometrioma)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is hydrosaplinx?

A

fluid in fallopian tube usually due to blockage

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

How is tubal patency test done & when is it used?

A

Hysterosaplingogram (HSG) - xray on uterus with dye
Used if no known risk factors/pelvic pathology and laparoscopy contraindicated e.g. obesity, previous pelvic surgery, Crohn’s disease

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

What is surgical option for tubal patency testing?

A

laparoscopy and hydrotubation (HTB )

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

When would you do HTB?

A

possible tubal/pelvic disease e.g. PID
Known previous pathology e.g. ectopic pregnancy, ruptured appendix, endometriosis
History suggestive of pathology e.g. dysmenorrhoea, dyspareunia
Previously abnormal HSG

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

When is hysteroscopy preformed?

A

When suspected or known endometrial pathology e.g. uterine septum, adhesions, polyp

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are some lifestyle advice changes for management of infertility?

A 
stop smoking!! 
BMI 18.5-30 
Reduce/stop alcohol 
moderate caffeine
stop recreation drugs/methadone
folic acid
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Why is it recommended to take folic acid up to 3 months preconception and for first 3 months of pregnancy?

A

Reduce chance of neural tube defects in foetus

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

What is the most common cause of ovulation problems?

A

Polycystic ovarian syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Outline Rotterdam diagnostic criteria for PCOS.

A

Need 2/3 of:

  1. oligo/amenorrhoea
  2. polycystic ovaries (12/more 2-9mm follicles, increased ovarian volume >10ml and unilateral/bilateral)
  3. Clinical and/or biochemical signs of hyperandrogenism (acne, hirsutism)
26
Q

What is first, second and third line for ovulation induction?

A

Clomifene citrate/letrozole
Gonadotrophin injections
Laparoscopic ovarian diathermy

27
Q

What is clomifene/letrozole?

A

anti-oestrogen property so boosts FSH signal from pituitary

28
Q

What are risks of gonadotrophin injections?

A

multiple pregnancy, overstimulation

29
Q

What is 3rd line for ovulation induction?

A

Laparoscopic ovarian diathermy

30
Q

All 3 ovulation induction treatment options have approx. 80% ovulation rate. What is best one for getting single child pregnancy?

A

ovarian diathermy

31
Q

15-20% of patients do not ovulate on clomifene. What are some options for clomifene resitant?

A

weight loss,
letrozole or
adjuvant metformin because it improves insulin resistance, reduction in androgen production and increase in SHBG (restoration of menstruation and ovulation, may increase pregnancy rate, improves sensitivity to clomifene)

31
Q

If male abnormal semen analysis, what investigations should you do?

A 
Male exam (volume of testicle exam) 
Check LH, FSH, testosterone, prolactin 
Karyotype (e.g. Klinefelters), Cystic Fibrosis mutation, Y microdeletions (spermatogenesis coding gene)
32
Q

List 3 types of treatment assisted reproduction technology (ART)

A

IUI: intrauterine insemination +/- superovulation
IVF: in vitro fertisialtion
ICSI: intracytoplasmic sperm injection

33
Q

There is limited/no treatment for tubal disease. What are options?

A

If small proximal tube occlusion cannulation using guidewire or microcatheter but otherwise IVF (Hydrosalpinx reduces IVF success by 50%)

34
Q

What are the criteria for art eligibility? (8)

A 
stable relationship 2y (incl. same sex) 
female age <40yrs (<42yrs) 
Female BMI 18.5-30 
non-smokers (at least 3/12 pre-treatment) 
no biological child 
no illegal/abusive substances
neither partner to havebeen sterilised
duration unexplained infertility 2years
35
Q

If they meet ART criteria how many goes of IVF do they get? Is eligibility checked each time?

A

3 times, yes eligibility checked each time

36
Q

What is treatment schedule for IVF

A

Day 21: buserelin for 2-3 weeks
baseline scan
FSH/hMG injections for 8-9 days
Action scan
stop everything if ready (can see follicles)
hCG single injection (acts like LH to simulate LH surge)
egg recovery 36hrs later
crinone gel daily to mimic progesterone surge
Embryos cultured & then transfer

37
Q

What percent of couples are affected by infertility?

A

15%

38
Q

What is chance couple with conceive in second year of trying?

A

50%

39
Q

How frequent should sexual intercourse be when trying to conceive?

A

2-3 times per week

40
Q

What is most common reason for requiring IVF/ICSI treatment?

A

abnormal sperm - male factor infertility

41
Q

List 3 common complications of IVF treatment.

A

multiple pregnancies
hyperstimulation
Procedure side effects: bleeding & infection

42
Q

According to UK law, how many embryos can be transferred following IVF?

A

3

43
Q

By 24 months approximately what percentage of couples will have conceived?

A

94%

44
Q

If patient has had a child in a previous relationship but in current relationship they have not had a child. Is that still primary infertility?

A

Yes

45
Q

Infertility causes are approximately __ male, __ female and __ unexplained.

A

1/3, 1/3, 25%

46
Q

What is most important factor in fertility?

A

Woman’s age - sharp decline from 35 onwards and miscarriage risk goes up

47
Q

What are 3 basic concepts when approaching infertility?

A

Ovulating? Tubal blockage? Sperm?

48
Q

Luteal phase is constant whereas follicular phase is variable. This means people with longer period have longer ___ phase.

A

Follicular phase

49
Q

Transvaginal ultrasound scans are routine part of infertility consultation, true/false?

A

True

50
Q

One faulty cystic fibrosis gene can result in absence of one or both vas deferns. True/false?

A

True

51
Q

Abnormal semen analysis results are usually treatable. True/false?

A

False - >50% unexplained causes and usually few treatment options except ART

52
Q

Reversal of sterilisation is available on the NHS. True/false?

A

False - it is not available

53
Q

When is intrauterine insemination (IUI) a good option? (2)

A

Same sex couple,

issues with sexual function e.g. dyspareunia, erectile dysfunction

54
Q

When is ICSI a good option? (1)

A

Male factor infertility

55
Q

When can woman be considered for ART when between age 40-42?

A

If they’ve never had treatment and have a reasonable prognosis

56
Q

How many cycles of treatment can you get if you are eligible for ART?

A

3 cycles

57
Q

What is buserelin?

A

Downregulation nasal spray, is a GnRH agonist so pituitary function is suppressed

58
Q

What is current live take home baby rate per cycle IVF treatment?

A

Approx. 30%

59
Q

1 in __ have fertility assessment in UK?

A

1 in 6

60
Q

When a man has had a vasectomy, what is the best fertility treatment?

A

Surgical sperm retrieval and ICSI

Repro (49 decks)

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