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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
Q

Why does corpus luteum insufficiency cause infertility?

A

loss of necessary endometrial changes, results in an impaired ability of the endometrium to allow for proper implantation of a fertilized egg.

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26
Q

What are the Tubal causes of infertility in females?

A

Tubopathy due to infection, endometriosis or trauma

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27
Q

What are the cervical causes of infertility in females?

A

Ineffective sperm penetration due to: chronic cervicitis or presence of antisperm antibodies

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28
Q

What is chronic cervicitis?

A

inflammation of the cervix

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29
Q

What are the pelvic causes of infertility in females?

A

Endometriosis or adhesions

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30
Q

What is endometriosis?

A

The presence of functioning endometrial tissue outside of the uterus

31
Q

What percentage of women suffer from endometriosis?

A

5%

32
Q

Endometriosis is responsive to what hormone?

A

Oestrogen

33
Q

What are the symptoms of endometriosis?

A

Increased menstrual pain, menstrual irregularities, pain during sex, infertility

34
Q

What are the treatments available for endometriosis?

A

Hormonal treatment such as progesterone or continuous OCP. Laparoscopic ablation, hysterectomy, bilateral salpingo-oophorectomy

35
Q

What are the uterine causes of infertility?

A

Unfavourable endometrium due to chronic endometritis, fibroids, adhesions or congenital malformation

36
Q

What are fibroids?

A

Benign tumours of the endometrium

37
Q

What is the correlation between prevalence of endometrial fibroids and age?

A

Increase with age

38
Q

Endometrial fibroids respond to which hormone?

A

Oestrogen

39
Q

What are the symptoms of endometrial fibroids?

A

Usually asymptomatic but can present with increased menstrual pain, menstrual irregularities, infertility, pain during sex

40
Q

What treatments are used for endometrial fibroids?

A

Hormonal - continuous OCP, progesterone, continuous GnRH agonists. Hysterectomy

41
Q

How are fibroids detected?

A

Ultrasound

42
Q

What is congenital hypogonadotrophic hypogonadism?

A

Disorder of GnRH deficiency resulting in low LH/FSH and testosterone/ oestrogen

43
Q

What are the two types of congenital hypogonadotrophic hypogonadism?

A

Anosmic and normosmic

44
Q

What is the name of the disease caused by anosmic congenital hypogonadotrophic hypogonadism?

A

Kallmann syndrome

45
Q

What is anosmia?

A

Loss of sense of smell

46
Q

What causes Kallmann syndrome?

A

Congenital failure of migration of GnRH neurones with olfactory fibres

47
Q

What are the reproductive features associated with Kallmann syndrome?

A

Cryptochordism, failure of puberty, lack of testicular development, micropenis, primary amenorrhoea, infertility

48
Q

What are the acquired causes of hypogonadotrophic hypogonadism?

A

Low BMI, excess exercise, stress

49
Q

How does hypopituitarism cause male infertility?

A

Decreased LH and FSH

50
Q

How does hyperprolactinaemia cause infertility?

A

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
Q

What treatment is used for hyperprolactinaemia?

A

Dopamine agonist. Surgery

52
Q

What are the causes of hyperprolactinaemia?

A

A prolactinoma, pituitary stalk compression, pregnancy and breastfeeding, medications such as dopamine antagonists, PCOS, hypothyroidism

53
Q

When does Kleinfelters syndrome present?

A

In puberty

54
Q

What are the signs and symptoms of Kleinfelters?

A

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
Q

What is Turners syndrome?

A

Ovarian insufficiency due to 45X0

56
Q

What are the symptoms of Turners syndrome?

A

Short stature, shield chest, wide spaced nipples, webbed neck, poor breast development, elbow deformity, underdeveloped reproductive tract

57
Q

What is secondary amenorrhoea?

A

Periods stop for at least 3-6 months but have had them regularly in the past

58
Q

What is primary amenorrhoea?

A

No periods or up to 3 periods a year

59
Q

What is oligo-menorrhoea?

A

Irregular or infrequent periods, 4-9 cycles a year

60
Q

What is premature ovarian insufficiency?

A

When the ovaries stop functioning as they should in a woman less than 40 resulting in the same symptoms as menopause

61
Q

What are the symptoms associated with menopause

A

Irregular periods, vaginal dryness, hot flushes, chills, night sweats, mood disturbance particularly tearfulness, weight gain and slowed metabolism

62
Q

How is premature ovarian insufficiency diagnosed?

A

High FSH (>25 iU/L) at least 4 weeks apart

63
Q

What are the chances of conception in a women with premature ovarian insufficiency?

A

20%

64
Q

What are the causes of premature ovarian insufficiency?

A

Autoimmune, genetics e.g Fragile X/ Turners, Cancer therapy

65
Q

What three symptoms must a patient have at least 2 of to be diagnosed with PCOS? ROTTERDAM CRITERIA

A

Oligo/anovulation, hyperandrogenism, polycystic ovaries

66
Q

What symptoms of hyperandrogenism can lead to a diagnosis of PCOS? Clinical and biochemical

A

Clinical hyperandrogenism: hirsutism, acne, male pattern alopecia
Biochemical hyperandrogenism: raised FAI or free testosterone

67
Q

How are polycystic ovaries tested for?

A

Ultrasound showing a ‘pearl necklace’ with >20 follicles or >10ml either ovary on TVUS

68
Q

How is PCOS treated?

A

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
Q

Why can just testosterone not be given to treat the endocrine causes of male infertility?

A

LH/FSH needed for spermatogenesis and increased testosterone will result in negative feedback, decreasing FSH/LH

70
Q

Why does insulin resistance increase in patients with PCOS?

A

Due to central weight gain

71
Q

What treatment should be offered to reduce complications associated with premature ovarian insufficiency? (Not fertility treatment)

A

HRT (combined oestrogen and progesterone) to decrease chances of osteoporosis, endometrial cancer and increase sexual function

72
Q

How can women with POI still have children?

A

With assisted fertility - IVF with egg donation or surrogacy

73
Q

Why are dopamine agonists effective in treating hyperprolactinaemia?

A

Inhibit prolactin release

74
Q

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?

A

Non-endocrine infertility

Y2 ENDOCRINOLOGY (13 decks)

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