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Charis & Ellie VS Reproduction > Infertility > Flashcards

Infertility Flashcards

1
Q

What is infertility?

A

Inability to conceive after 12 months regular intercourse without contraceotion

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2
Q

What is primary infertility?

A

Couple hasn’t conceived before

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3
Q

Secondary infertility?

A

Couple have conceived together in the past (even if it hasn’t resulted in a live birth)

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4
Q

Definition of oligomenorrhoea?

A

Cycles >35 days

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5
Q

Amennorhoea?

A

Absent menstruation

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6
Q

What triggers menstruation?

A

LH surge

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7
Q

What follows ovulation?

A

Progesterone peaks

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8
Q

How do you confirm ovulation?

A

Midluteal serum progesterone (>30nmol/L)
Day 21 (28 cycle)
Adjust for cycle length

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9
Q

Investigations if amenorrhoeic/cycle longer than 42 days?

A
  • Follicular phase bloods- LH, FSH, E2
  • Testosterone, SHBG, FAI
  • Prolactin
  • Diagnostic semen analysis
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10
Q

Semen analysis looks at?

A

Sperm conc- 16 million per ml
Progressive motility - 30%
Sperm morphology - 4% normal

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11
Q

What should sperm conc be (units)?

A

16 million per ml

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12
Q

Initial info to get at infertility consultation?

A
  • Patients seen as couple
  • Establish length of relationship
  • length of time trying to get pregnant
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13
Q

What to ask about female in infertility consultation?

A

History
Exam/USS: pelvic anatomy- uterus & ovaries, transvaginal US
Investigation

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14
Q

What to look into for the male in an infertility consultation?

A

History
Diagnostic semen analysis
Examination
Investigations

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15
Q

Abnormal findings in infertility investigations?

A
  • Congenital uterine abnormalities
  • Fibroids
  • Endometrial polyp
  • Hydrosalpinx
  • PCOS
  • Ovarian cyst
  • Tubal patency
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16
Q

Types of ovarian cysts?

A

Simple
Dermoid
Cancer
Endometrioma

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17
Q

Investigations of tubal patency?

A

Hysterosalpingogram (HSG)

Diagnostic laparoscopy and hydrotubation

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18
Q

When would you do a diagnostic laparoscopy?

A

Possible tubal/pelvic disease
Known previous pathology
History suggestive of pathology
Prev abnormal HSG

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19
Q

When is a hysteroscopy performed?

A

-Cases where sus or known endometrial pathology (uterine septum, adhesions, polyp)

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20
Q

Lifestyle advice for infertility?

A
    1. Stop smoking
      1. BMI: 18.5-30
      2. Reduce/lessen alcohol consumption
      3. Moderate caffeine
      4. Stop recreational drugs
      5. Folic acid
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21
Q

Most common reason for ovulatory problems?

A

Polycystic ovarian syndrome (PCOS)

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22
Q

What criteria do you use for PCOS?

A

Revised Rotterdam diagnostic criteria

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23
Q

Revised Rotterdam diagnostic criteria?

A

2 of:

  • Oligo/menorrhoea
  • Polycystic ovaries
  • Clinical and/or biochem signs of hyperandrogenism (acne/hirsutism)
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24
Q

Scan appearance of polycystic ovaries?

A

12/more 2-9mm follicles
Increased ovarian volume >10ml
Unilateral/bilateral

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25
Q

1st line for ovulation induction?

A

Clomifene citrate

  • 50-100-150 mg tab, days 2-6
  • 70-80% ovulate, 30-40% conceive

Alternatively Letrozole (Tamoxifen)

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26
Q

Other methods of ovarian induction?

A

Gonadotrophin injections

Laparoscopic ovarian diathermy

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27
Q

Details about gonadotrophin injections?

A
  • Recombinant FS
  • 80% ovulate, 60-70% conceive
  • Risks: multiple pregnancy, overstimulation
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28
Q

Details about laparoscopic ovarian diathermy?

A
  • 80% ovulate, risk ovarian destruction

- Mainly singleton pregnancies

29
Q

Whats the downside of clomifene?

A

CLOMIFENE RESISTANCE

30
Q

What’s the craic with clomiphene resistance?

A

15-20% of ptnts don’t ovulate on it

  • Wt loss
  • Letrozole
  • Adjuvant metformin
31
Q

Approach to abnormal semen parameters?

A
  • Examination
  • Check LH, FSH, Testosterine, prolactin
  • Karyotype, CF mutation
  • 50% unexplained causes
32
Q

What does treatment mainly include for abnormal semen parameters?

A

-ART (assisted repro technology)
Intrauterine insemination (iui)
IVF
Intracytoplasmic sperm injection

33
Q

Treatment for blocked fallopian tubes?

A

Generally no treatment
-Could try IVF, hydrosalpinx reduces IVF success by 50%

-Cannulation using guidewire or microcatheter
Proximal tube occlusion

-Reversal of sterilisation- not on NHS

34
Q

Eligibility criteria for assisted reproduction technology?

A
  • Stable relationship (2y + same sex is g)
  • Female age <40y
  • Female BMI (18.5-30)
  • Non smokers (at least 3/12 before treatment)
  • No biological child
  • No illegal substances/abuse substance
  • Neither sterilized
  • Duration unexplained infertility 2y
  • Up to 3 cycles treatment
35
Q

Biggest factor influencing infertility?

A

Female age

36
Q

All terms meaning type 1 ovulation disorder?

A

Hypogonadal hypogonadism

Hypothalamic pituitary failure

37
Q

The problem in type 1 ovulation disorder?

A

Problem with not producing enough GnRH or dysregulation in pulsatility

38
Q

Hormones levels in hypogonadal hypogonadism?

A

Low LH

Low FSH

39
Q

Causes of type 1 ovulation disorder?

A
  • Stress
  • XSive exercise
  • Low BMI
  • Brain tumours
  • Head trauma
  • Kallman syndrome
  • Drugs (steroids, opiates)
40
Q

What will be present in hypothalamic pituitary failure?

A

Amenorrhoea

41
Q

Treatment of hypogonadal hypogonadism?

A
  • Improvement to modifiable factors

- Ultimate treatment: pulsatile GnRH pump or FSH and LH daily injections

42
Q

Another term for type 2 ovulation disorder?

A

Normogonadotrophic anovulation

43
Q

Main cause of T2 ovulation disorder?

A

Polycystic ovarian syndrome

44
Q

Hormone levels in type 2 ovulation disorder?

A

Normal GnRH
Normal FSH
Potential XS LH

45
Q

What charcterizes type 2 ovulation disorder?

A

Multiple small cysts within the ovary and by XS ovarian androgen production

46
Q

What is T2 ovulation disorder assoc with?

A 
Obesity 
Hyperinsulinaemia 
Insulin resistance 
Increased risk of T2DM 
HT 
Hyperlipidaemia 
Increased CVS risk
47
Q

Diagnostic criteria of normogonadotrophic anovulation?

A

2 or more:

-Clinical and/or biochem evidence of hyperandrogenism, oligo/anovulation, Polycystic ovaries on US

48
Q

Treatment of T2 ovulation disorder?

A

Wt loss
Treating acne
Treating hirsutism
Fertility treatment: involves ovulation induction

49
Q

1st line fertility treatment for normogonadotrophic anovulation?

A

Clomifene used on days 2-6 of cycle

50
Q

What may become 1st line ovulation induction?

A

Letrozole (as it requires less monitoring)

51
Q

2nd line fertility treatment?

A

Gonadotrophin injections with recombinant FSH

However this risks multiple pregnancy and overstimulation

52
Q

Risks of gonadotrophin injection?

A

Overstimulation and multiple pregnancy

53
Q

3rd line infertility treatment?

A

Laparoscopic ovarian diathermy

Isn’t risk of multiple pregnancies but procedure risks ovarian destruction

54
Q

Terms for type 3 ovulation disorder?

A

Hypergonadotropic hypogonadism

Premature ovarian failure

55
Q

What is characteristic of Type 3 ovulation disorder?

A

Premature menopause
Ovarian failure before age 40
Amenorrhoea

56
Q

Hormone levels in type 3?

A

LH raised
FSH raised
Oestrogens decreased

57
Q

Causes of type 3 ovulation disorder?

A
  • Turner syndrome
  • Other genetic conditions
  • AI failure
  • Surgery
  • Chemo/radio therapy
58
Q

What can a person with T3 ovulation disorder not do?

A

Be stimulated to produce eggs

59
Q

What should people with premature ovarian failure be on?

A

Combined HRT

60
Q

Infertility treatment if peri-menopausal?

A

-Egg donor and then hormonal treatment to help them maintain a pregnancy

61
Q

Type 4 ovarian disorder other term?

A

Hyperprolactinaemia

62
Q

Whats happening in T4 ovarian disorder?

A

Person has elevated serum prolactin and low/normal FSH and LH
Frequently due to pituitary adenoma

63
Q

Azoospermia?

A

No sperm in ejaculate

64
Q

Asthenozoospermia?

A

% of progressive motile sperm is below reference limit

65
Q

Oligozoospermia?

A

Total number/concentration of sperm below reference limit

66
Q

Teratozoospermia?

A

% of morphologically normal sperm below reference limit

67
Q

Initial GP investigations in women for infertility?

A

Day 21 progesterone to establish ovulation
TSH
Rubella immunity checked
Chlamydia screen
-Ensure smear up to date
-If amenorrhoeic or cycle lasts longer than 42 days they should have follicular phase bloods (LH, FSH, E2), testosterone, SHBG, FAI and prolactin checked

68
Q

Initial GP investigations in men?

A

Diagnostic semen analysis
If there are abormal semen parameters he male should be examined as well as LH, FSH, testosterone and checked for genetic causes

Charis & Ellie VS Reproduction (71 decks)

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