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infertility Flashcards

1
Q

what is infertility

A

disease of the reproductive system defined by failure to achieve a clinical pregnancy after> 12 months regular (2-3days) unprotected sex

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2
Q

what is primary infertility

A

when you have not had a live birth previously

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3
Q

what is secondary infertility

A

when you have had a live birth >12 months previously

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4
Q

how many couple affected by infertility

A

1 in 7

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5
Q

what is the most common cause of infertility in couples

A

male defect - 30%
female defect - 30%
combined factor - 30%
unknown - 10%

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6
Q

why do couples struggling with infertility suffer from psychological distress

A 
no biological child
impact on couples wellbeing 
impact on larger families
investigations
treatment can fail
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7
Q

what are some costs of infertility on society?

A

less births = less tax income

investigation and treatment costs

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8
Q

what are the pretesticular causes of infertility in males

A

congenital and acquired endocrinopathies
klinefelters - 47xxxy
Y chromosome deletion
problems with hpg axis - prl,gonadotrophs

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9
Q

what are the testicular causes of infertility in males

A 
congenital
cryptorchidism
infection e.g std
immunological - antisperm abs
vascular - variococoele
trauma/surgery
toxins - chemo,dxt,drugs,smoking
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10
Q

post testicular causes

A

congenital - absebse of vans deferens
obstructive azoospermia
erectile dysfunction - retrograde ejaculation,mechanical impairment or psychological
iactogenic e.g vasectomy

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11
Q

what is cryptorchidism

A

undescended testes (90% left in inguinal canal)

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12
Q

what % of infertility cause in female do ovarian causes account for and what are they?

A

40%
anovulation - axis is defective
corpus luteum insufficiency

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13
Q

what % of tubule causes account for infertility

and what are they

A

30%

tubopathy due to infection, endometriosis and trauma

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14
Q

what % of uterine causes account for infertility

and what are they

A 
10%\unfavourable endometrium due to
chronic endometritis(tb)
fibroid
adhesions (synechiae)
congenital malformation
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15
Q

what % of cervical causes account for infertility

and what are they

A

5%
ineffective sperm penetration due to
chronic cervicitis
immunological - antisperm ab

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16
Q

what % of infertility is unexplained

A

10%

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17
Q

what is endometriosis

A

presence of functioning endometrial tissue outside uterus(5%)

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18
Q

what symptoms does endometriosis cause

A

increased menstrual pain
menstrual irregularities
deep dyspareunia - painful intercourse
infertility

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19
Q

what are the treatments for endometriosis

A

hormonal - continuous cop,prog
laparoscopic ablation
hysterectomy
bilateral sapling oophorectomy

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20
Q

what are fibroids

A

benign tumours of myometrium
incidence increases with age
responds to oestrogen

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21
Q

where can fibroids form

A

subserosol
intramural
submucosal
pedunculate subserosol

22
Q

what are some symptoms of fibroid

A 
usually asymptomatic
increased menstrual pain
menstrual irregularities
deep dyspareunia
infertility
23
Q

what are some treatment of fibroids

A

hormonal - continuous cop,prog, continuous GnRH

hysterectomy

24
Q

what are causes of hypothalamic hypogonadotrophic hypogonadism in males an d females

A
  • congenital hypogonadotrophic hypogonadism
  • anosmic (kallman syndrome) or normosmic
  • acquired - low bmi, stress, exercise
    hyperprolactinaemia
25
Q

what are some pituitary causes of hypogonadotrophic hypogonadism

A

hypopituitarism

- tumour, infiltration, apoplexy,surgery,radiation

26
Q

what are some causes of hypergonadotrophic hypogonadism

A

congenital primary hypogonadism - kinefelters (47 xxxy)

crypochidism,trauma,chemo,radiation

27
Q

what is Kallmans syndrome

A

failure of migration of Gnrh neurones from olfactory placode to hypothalamus

28
Q

what can kallmans syndrome cause

A

anosmia

reproductive features

29
Q

what reproductive features can kallmans syndrome cause

A 
cryptorchidism
failure of puberty
lack of testicle development 
micropenis
primary amenorrhoea
infertility
30
Q

what is klinefelters

A

xxy chromosome
high lh,fsh
low testosterone

31
Q

what are the signs/symptoms of klinefelters

A 
tall stature
reduced facial hair
breast development 
mildly impaired iq
narrow shoulders
wide hips
low bone density
small penis and testes
infertilty
female type pubic hair pattern
32
Q

how to assess patients for infertility

A

history ->

examination -> investigation

33
Q

how do you assess history for infertility for males

A

duration,previous children, milestones, symptoms

medical and surgical, family and social history.

34
Q

how do you carry out examination for infertility for male

A

bmi, sexual characteristics, testicular vol, epididymal hardness, presence of vas deferens,endocrine signs,anosmia, syndromic features

35
Q

what are the investigations for male infertility

A 
semen analysis
blood tests - lh,fsh,prl
morning fasting testosterone
shbg
albumin
karyotyping
urine and chlamydia test
imaging
36
Q

what are some general lifestyle treatments for male infertility

A

optimise bmi
smoking cessation
alcohol reduction

37
Q

specific treatments for male infertility

A

dopamine agonist for highprl
gonadotrophin treatment
surgery

38
Q

what is name given to early menopause

A

premature ovarian insufficiency

prev known as premature ovarian failure

39
Q

how to diagnose premature ovarian insufficiency

A

high fsh

.25 iU/l

40
Q

causes of poi

A

autoimmune
genetic e.g fragile x syndrome/turners
cancer therapy

41
Q

what do you expect to see in levels of hormone for pcos

A

high lh:fsh

normal to low oestrodiol

42
Q

what are some causes of hypergonadotrophic hypogonadism

A 
acquired primary hypogonadism
poi
surgery,trauma etc
turnenrs
congenital primary hypogonadism
43
Q

how do we diagnose pcis

A

exclude other reproductive orders first

rotterdam pc’s diagnostic criteria (2/3)

44
Q

what’s included in Rotterdam pcos diagnostic criteria

A

oligo/anovulation

clinical +- biochemical hyperandrogenism and polycystic ovaries

45
Q

how do we know what polycystic ovaries are

A

> 20 follicles

>10 ml

46
Q

treatment for pcos

A

OCP for irregular menses
and insulin resistance - metformin
hirsutism - creams, wax,laser and anti androgens
progesterone course for endometrial cancer risk

47
Q

what is turners syndrome

A

45x0

48
Q

signs and symptoms of turners

A 
short stature
low hairline
shield chest and widest spaced nipples
amenorrheoa
poor great dev
coarctation of aorta
small fingernails 
elbow deformity
webbed neck
49
Q

how to take history for female infert

A

breastfeeding?
menstruation
fam, social history

50
Q

what are some examinations for female infert

A

bmi,sexual characteristics, hyperangrogenism signs, pelvic examination
oendocrine signs,syndromic features,anosmia

51
Q

main investigations for female infert

A 
ash,fh,prl
oestrodiol,androgens
lookout follicular stage, mid luteal for congenital...
alumni and ironshbg
pregnancy test
microbiology
imaging - transvagibal us

brs2 (65 decks)

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