infertility

Question 1

what is infertility

Answer 1

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

Question 2

what is primary infertility

Answer 2

when you have not had a live birth previously

Question 3

what is secondary infertility

Answer 3

when you have had a live birth >12 months previously

Question 4

how many couple affected by infertility

Answer 4

1 in 7

Question 5

what is the most common cause of infertility in couples

Answer 5

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

Question 6

why do couples struggling with infertility suffer from psychological distress

Answer 6

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

Question 7

what are some costs of infertility on society?

Answer 7

less births = less tax income

investigation and treatment costs

Question 8

what are the pretesticular causes of infertility in males

Answer 8

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

Question 9

what are the testicular causes of infertility in males

Answer 9

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

Question 10

post testicular causes

Answer 10

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

Question 11

what is cryptorchidism

Answer 11

undescended testes (90% left in inguinal canal)

Question 12

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

Answer 12

40%
anovulation - axis is defective
corpus luteum insufficiency

Question 13

what % of tubule causes account for infertility

and what are they

Answer 13

30%

tubopathy due to infection, endometriosis and trauma

Question 14

what % of uterine causes account for infertility

and what are they

Answer 14

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

Question 15

what % of cervical causes account for infertility

and what are they

Answer 15

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

Question 16

what % of infertility is unexplained

Answer 16

10%

Question 17

what is endometriosis

Answer 17

presence of functioning endometrial tissue outside uterus(5%)

Question 18

what symptoms does endometriosis cause

Answer 18

increased menstrual pain
menstrual irregularities
deep dyspareunia - painful intercourse
infertility

Question 19

what are the treatments for endometriosis

Answer 19

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

Question 20

what are fibroids

Answer 20

benign tumours of myometrium
incidence increases with age
responds to oestrogen

Question 21

where can fibroids form

Answer 21

subserosol
intramural
submucosal
pedunculate subserosol

Question 22

what are some symptoms of fibroid

Answer 22

usually asymptomatic
increased menstrual pain
menstrual irregularities
deep dyspareunia
infertility

Question 23

what are some treatment of fibroids

Answer 23

hormonal - continuous cop,prog, continuous GnRH

hysterectomy

Question 24

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

Answer 24

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

Question 25

what are some pituitary causes of hypogonadotrophic hypogonadism

Answer 25

hypopituitarism | - tumour, infiltration, apoplexy,surgery,radiation

Question 26

what are some causes of hypergonadotrophic hypogonadism

Answer 26

congenital primary hypogonadism - kinefelters (47 xxxy) | crypochidism,trauma,chemo,radiation

Question 27

what is Kallmans syndrome

Answer 27

failure of migration of Gnrh neurones from olfactory placode to hypothalamus

Question 28

what can kallmans syndrome cause

Answer 28

anosmia | reproductive features

Question 29

what reproductive features can kallmans syndrome cause

Answer 29

``` cryptorchidism failure of puberty lack of testicle development micropenis primary amenorrhoea infertility ```

Question 30

what is klinefelters

Answer 30

xxy chromosome high lh,fsh low testosterone

Question 31

what are the signs/symptoms of klinefelters

Answer 31

``` 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 ```

Question 32

how to assess patients for infertility

Answer 32

history -> | examination -> investigation

Question 33

how do you assess history for infertility for males

Answer 33

duration,previous children, milestones, symptoms | medical and surgical, family and social history.

Question 34

how do you carry out examination for infertility for male

Answer 34

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

Question 35

what are the investigations for male infertility

Answer 35

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

Question 36

what are some general lifestyle treatments for male infertility

Answer 36

optimise bmi smoking cessation alcohol reduction

Question 37

specific treatments for male infertility

Answer 37

dopamine agonist for highprl gonadotrophin treatment surgery

Question 38

what is name given to early menopause

Answer 38

premature ovarian insufficiency | prev known as premature ovarian failure

Question 39

how to diagnose premature ovarian insufficiency

Answer 39

high fsh | .25 iU/l

Question 40

causes of poi

Answer 40

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

Question 41

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

Answer 41

high lh:fsh | normal to low oestrodiol

Question 42

what are some causes of hypergonadotrophic hypogonadism

Answer 42

``` acquired primary hypogonadism poi surgery,trauma etc turnenrs congenital primary hypogonadism ```

Question 43

how do we diagnose pcis

Answer 43

exclude other reproductive orders first | rotterdam pc's diagnostic criteria (2/3)

Question 44

what's included in Rotterdam pcos diagnostic criteria

Answer 44

oligo/anovulation | clinical +- biochemical hyperandrogenism and polycystic ovaries

Question 45

how do we know what polycystic ovaries are

Answer 45

>20 follicles | >10 ml

Question 46

treatment for pcos

Answer 46

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

Question 47

what is turners syndrome

Answer 47

45x0

Question 48

signs and symptoms of turners

Answer 48

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

Question 49

how to take history for female infert

Answer 49

breastfeeding? menstruation fam, social history

Question 50

what are some examinations for female infert

Answer 50

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

Question 51

main investigations for female infert

Answer 51

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