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endocrine > infertility > Flashcards

infertility Flashcards

1
Q

definition of infertility

A

failure to achieve a clinical pregnancy after 12 months of more of regular unprotected sexual intercourse (in absence of known reason) in a couple who have never had a child (WHO definition)

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2
Q

what factors increase chances of conception

A
  • Woman aged under 30 years
  • Previous pregnancy
  • Less than three years trying to conceive
  • Intercourse occurring around ovulation
  • Woman’s body mass index (BMI) 18.5 – 30m/kg2
  • Both partners non-smokers
  • Caffeine intake less than two cups of coffee daily
  • No use of recreational drugs
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3
Q

what are some common causes of secondary infertility

A
  • tubal disease
  • fibroids
  • endometriosis/adenomyosis
  • weight related
  • age related
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4
Q

gynaelogical conditions that cause anovulatory infertility

A
  • anorexia, bulimia, excessive exercise
  • hyperprolactinaemia, tumours, Sheehan syndrome
  • PCOS, premature ovarian failure
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5
Q

other conditions that cause anovulatory infertility

A
  • Systematic disorder: e.g. chronic renal failure.
  • Endocrine disorder: e.g. testosterone secreting tumours, congenital adrenal hyperplasia, thyroid
  • Drugs: e.g. depo-provera, explanon, OCP
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6
Q

clinical features of PCOS

A

obesity, hirsutism or acne, menstrual cycle abnormalities and infertility

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7
Q

endocrine features of PCOS

A

high free androgens, high LH, impaired glucose tolerance

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8
Q

diagnosis of PCOS

A

score 2 out of three:

  • chronic anovulation
  • polycystic ovaries
  • hyperandrogenism (clinical or biochemical)
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9
Q

clinical features of premature ovarian failure

A

hot flushes, night sweats, atrophic vaginitis, amenorrhoea, infertility

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10
Q

endocrine features of premature ovarian failure

A

high FSH, high LH, low oestradiol

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11
Q

infective causes of tubal disease

A
  • Pelvic inflammatory disease (chlamydia, gonorrhoea, other: anaerobes, syphilis, TB)
  • transperitoneal spread: appendicitis, intra-abdominal abscess
  • following procedure: IUCD insertion, hysteroscopy, HSG
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12
Q

non-infective causes of tubal disease

A
  • endometriosis
  • surgical (sterilisation, ectopic pregnancies)
  • fibroids
  • polyps
  • congenital
  • salpingitis isthmica nodosa
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13
Q

clinical features of hydrosalpinx

A
  • abdominal/pelvic pain febrile
  • vaginal discharge dyspareunia
  • cervical excitation menorrhagia
  • dysmenorrhoea
  • infertility
  • ectopic pregnancy
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14
Q

what is endometriosis

A

presence of endometrial glands outside uterine cavity

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15
Q

causes of endometriosis

A

Retrograde menstruation is most likely cause, altered immune function, abnormal cellular adhesion molecules, genetic

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16
Q

clinical features of endometriosis

A

dysmenorrhoea (classically before menstruation), dysparenuia, menorrhagia, painful defaecation, chronic pelvic pain, uterus may be fixed and retroverted, scan may show characteristic ‘chocolate’ cysts on ovary, infertility, asymptomatic

17
Q

drugs that cause male infertility

A
  • alcohol
  • SSRI anti-depressants
  • tobacco
  • cocaine
  • marijuana
  • testosterone supplements
18
Q

clinical features of non-obstructive male infertility

A

low testicular volume
reduced secondary sexual characteristics
vas deferens present

19
Q

endocrine features of non-obstructive male infertility

A

High LH, FSH and low testosterone

20
Q

clinical features of obstructive male infertility

A

normal testicular volume
normal secondary sexual characteristics
vas deferens may be absent

21
Q

endocrine features of obstructive male infertility

A

Normal LH, FSH and testosterone

22
Q

investigation of infertility

A

infertility history, gynaecology, andrology, sexual history, social history, PMH, PSH, POH

23
Q

examination of female infertility

A
  • BMI
  • General examination, assessing body hair distribution, galactorrhoea
  • Pelvic examination, assessing for uterine and ovarian abnormalities/tenderness/mobility
24
Q

examination of male infertility

A
  • BMI
  • General examination
  • Genital examination, assessing size/position testes, penile abnormalities, presence vas deferens, presence varicoceles
25
Q

investigations for female infertility

A
  • endocervical swab for chlamydia
  • cervical smear if due
  • blood for rubella immunity
  • midluteal progesterone level (day 21 of 28 day cycle or 7 days prior to expected period in prolonged cycles), -progesterone > 30nmol/l suggestive ovulation
  • Test of tubal patency: hysterosalpingiogram (HSG) /hycosy or laparoscopy
26
Q

investigations for male infertility

A
  • History (PMH, occupation, drugs, social, andrology)
  • Examination (general and genitalia)
  • Semen analysis: twice over 6 weeks apart
27
Q

what are some vitamin supplements for infertility

A
  • folic acid

- vitamin D

28
Q

management of hypothalamic anovulation

A
  • stabilise weight
  • pulsatile GnRH
  • gonadotrophin daily injections
  • USS of ovarian response
29
Q

how is ovulation inducted in PCOS

A
  • clomifene citrate
  • gonadotrophin daily injections
  • laparoscopic ovarian diathermy
30
Q

what can reproductive surgery be used for

A
  • pelvic adhesions
  • grade 2 endometriosis
  • chocolate cysts in ovary
  • tubal block
31
Q

treatment for women with proximal tubal obstruction

A
  • selective salpingography plus tubal catheterisation

- hysteroscopic tubal cannulation

32
Q

how should submucosal fibroids be treated

A

hysteroscopically to improve conception rates

33
Q

treatment of male infertility

A

Surgery to obstructed vas deferens (50% success following vasectomy)

Intrauterine insemination in mild disease

Intracytoplasmic sperm injection (ICSI)

Surgical sperm aspiration from epididymis or testicle combined with ICSI

Donor sperm insemination.

endocrine (40 decks)

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