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Y2 ENDOCRINOLOGY > Infertility > Flashcards

Infertility Flashcards

1
Q

Infertility affects how many couples?

A

1 in 7

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2
Q

Define infertility?

A

A disease of the reproductive system defined by the failure to achieve a clinical pregnancy after 12+ months of regular unprotected sexual intercourse

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3
Q

What is primary infertility?

A

When have not ever had a live birth previously

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4
Q

What is secondary infertility?

A

When have had a live birth >12 months previously

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5
Q

What are the three types of causes of infertility in males?

A

Pre-testicular, testicular, post-testicular

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6
Q

What are the pre-testicular causes of infertility in males?

A

Congenital and acquired endocrinopathies, Kleinfelters syndrome, Y chromosome deletion

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7
Q

What is Kleinfelters syndrome?

A

47XXY

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8
Q

What are the testicular causes of infertility in males?

A

Congenital. Cryptochordism, infection/STDs, immunological, vascular varicocele, trauma/surgery, toxins

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9
Q

What is cryptochordism?

A

Absence of at least one testicle from the scrotum

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10
Q

How do immunological causes result in infertility in males?

A

Antisperm antibodies

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11
Q

What is vascular varicocele?

A

enlargement of the veins within the scrotum

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12
Q

What toxins cause testicular infertility?

A

Chemotherapy, DXT, drugs, smoking

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13
Q

What are the post-testicular causes of infertility?

A

Congenital absence of vas deferens, obstructive Azoospermia, erectile dysfunction, retrograde ejaculation, Latrogenic vasectomy

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14
Q

What is obstructive Azoospermia?

A

absence of spermatozoa in the ejaculate despite normal spermatogenesis

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15
Q

The normal path of testicular descent is through what structure?

A

Inguinal canal

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16
Q

Cryptochordism increases the risk of what disease?

A

Testicular cancer

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17
Q

What are the impacts of infertility?

A

Psychological distress on the couple and the cost to society

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18
Q

What are the costs to society that infertility causes?

A

Lower birth rates, less tax income, investigation and treatment costs

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19
Q

What are the 5 types of causes of infertility in females?

A

Ovarian, tubal, cervical, pelvic and uterine

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20
Q

What percentage of infertility in females is unexplained?

A

10%

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21
Q

Ovarian causes account for what percentage of female infertility?

A

40%

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22
Q

Tubal causes account for what percentage of female infertility?

A

30%

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23
Q

What are the ovarian causes of infertility?

A

Anovulation, corpus luteum insufficiency

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24
Q

What is corpus luteum insufficiency?

A

an abnormally low progesterone level 3 weeks after the onset of menstruation

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25
Why does corpus luteum insufficiency cause infertility?
loss of necessary endometrial changes, results in an impaired ability of the endometrium to allow for proper implantation of a fertilized egg.
26
What are the Tubal causes of infertility in females?
Tubopathy due to infection, endometriosis or trauma
27
What are the cervical causes of infertility in females?
Ineffective sperm penetration due to: chronic cervicitis or presence of antisperm antibodies
28
What is chronic cervicitis?
inflammation of the cervix
29
What are the pelvic causes of infertility in females?
Endometriosis or adhesions
30
What is endometriosis?
The presence of functioning endometrial tissue outside of the uterus
31
What percentage of women suffer from endometriosis?
5%
32
Endometriosis is responsive to what hormone?
Oestrogen
33
What are the symptoms of endometriosis?
Increased menstrual pain, menstrual irregularities, pain during sex, infertility
34
What are the treatments available for endometriosis?
Hormonal treatment such as progesterone or continuous OCP. Laparoscopic ablation, hysterectomy, bilateral salpingo-oophorectomy
35
What are the uterine causes of infertility?
Unfavourable endometrium due to chronic endometritis, fibroids, adhesions or congenital malformation
36
What are fibroids?
Benign tumours of the endometrium
37
What is the correlation between prevalence of endometrial fibroids and age?
Increase with age
38
Endometrial fibroids respond to which hormone?
Oestrogen
39
What are the symptoms of endometrial fibroids?
Usually asymptomatic but can present with increased menstrual pain, menstrual irregularities, infertility, pain during sex
40
What treatments are used for endometrial fibroids?
Hormonal - continuous OCP, progesterone, continuous GnRH agonists. Hysterectomy
41
How are fibroids detected?
Ultrasound
42
What is congenital hypogonadotrophic hypogonadism?
Disorder of GnRH deficiency resulting in low LH/FSH and testosterone/ oestrogen
43
What are the two types of congenital hypogonadotrophic hypogonadism?
Anosmic and normosmic
44
What is the name of the disease caused by anosmic congenital hypogonadotrophic hypogonadism?
Kallmann syndrome
45
What is anosmia?
Loss of sense of smell
46
What causes Kallmann syndrome?
Congenital failure of migration of GnRH neurones with olfactory fibres
47
What are the reproductive features associated with Kallmann syndrome?
Cryptochordism, failure of puberty, lack of testicular development, micropenis, primary amenorrhoea, infertility
48
What are the acquired causes of hypogonadotrophic hypogonadism?
Low BMI, excess exercise, stress
49
How does hypopituitarism cause male infertility?
Decreased LH and FSH
50
How does hyperprolactinaemia cause infertility?
Prolactin blinds to prolactin receptors on Kisspeptin neurones in the hypothalamus inhibiting kisspeptin release resulting in a decrease in downstream GnRH/LH/FSH/T/Oestrogen
51
What treatment is used for hyperprolactinaemia?
Dopamine agonist. Surgery
52
What are the causes of hyperprolactinaemia?
A prolactinoma, pituitary stalk compression, pregnancy and breastfeeding, medications such as dopamine antagonists, PCOS, hypothyroidism
53
When does Kleinfelters syndrome present?
In puberty
54
What are the signs and symptoms of Kleinfelters?
Tall stature, reduced facial hair, breast development, female-type pubic hair pattern, small penis and testes infertility, narrow shoulders, reduced chest hair, wide hips, low bone density
55
What is Turners syndrome?
Ovarian insufficiency due to 45X0
56
What are the symptoms of Turners syndrome?
Short stature, shield chest, wide spaced nipples, webbed neck, poor breast development, elbow deformity, underdeveloped reproductive tract
57
What is secondary amenorrhoea?
Periods stop for at least 3-6 months but have had them regularly in the past
58
What is primary amenorrhoea?
No periods or up to 3 periods a year
59
What is oligo-menorrhoea?
Irregular or infrequent periods, 4-9 cycles a year
60
What is premature ovarian insufficiency?
When the ovaries stop functioning as they should in a woman less than 40 resulting in the same symptoms as menopause
61
What are the symptoms associated with menopause
Irregular periods, vaginal dryness, hot flushes, chills, night sweats, mood disturbance particularly tearfulness, weight gain and slowed metabolism
62
How is premature ovarian insufficiency diagnosed?
High FSH (>25 iU/L) at least 4 weeks apart
63
What are the chances of conception in a women with premature ovarian insufficiency?
20%
64
What are the causes of premature ovarian insufficiency?
Autoimmune, genetics e.g Fragile X/ Turners, Cancer therapy
65
What three symptoms must a patient have at least 2 of to be diagnosed with PCOS? ROTTERDAM CRITERIA
Oligo/anovulation, hyperandrogenism, polycystic ovaries
66
What symptoms of hyperandrogenism can lead to a diagnosis of PCOS? Clinical and biochemical
Clinical hyperandrogenism: hirsutism, acne, male pattern alopecia Biochemical hyperandrogenism: raised FAI or free testosterone
67
How are polycystic ovaries tested for?
Ultrasound showing a ‘pearl necklace’ with >20 follicles or >10ml either ovary on TVUS
68
How is PCOS treated?
metformin to decrease insulin resistance. OCP to treat amenorrhoea, anti-androgens to treat hirsutism and progesterone courses to decrease endometrial cancer risk. Weight loss of 5%
69
Why can just testosterone not be given to treat the endocrine causes of male infertility?
LH/FSH needed for spermatogenesis and increased testosterone will result in negative feedback, decreasing FSH/LH
70
Why does insulin resistance increase in patients with PCOS?
Due to central weight gain
71
What treatment should be offered to reduce complications associated with premature ovarian insufficiency? (Not fertility treatment)
HRT (combined oestrogen and progesterone) to decrease chances of osteoporosis, endometrial cancer and increase sexual function
72
How can women with POI still have children?
With assisted fertility - IVF with egg donation or surrogacy
73
Why are dopamine agonists effective in treating hyperprolactinaemia?
Inhibit prolactin release
74
30 year old, BMI 24kg/m2. Regular periods. Oestradiol 150pmol/L (50-800) LH 3 U/L (2 – 14) FSH 3 U/L (1.5 – 10) Prolactin 300mU/L (100 – 500) What is the diagnosis?
Non-endocrine infertility

Y2 ENDOCRINOLOGY (13 decks)

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