Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Gynae > Infertility > Flashcards

Infertility Flashcards

1
Q

How to interpret mid luteal progesterone

A

Under 16- repeat and refer if chronically low
16-30- repeat
Over 30- normal indicating ovulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What must be done when giving in a sperm sample

A

Must be after of abstinence of between 2-7 days
Delivered within 1 hour to lab

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

First line infertility treatment for PCOS

A

Lose weight especillay when overweight
Losing even just 5% can cause infertility to spontaneously resolve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Why is gonadotrophin treatment only used later down line in PCOS

A

Risk of multiple pregnancy
OHSS risk higher

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is chance of getting pregnant after 1 and 2 years

A

After 1 year of regular UPSI
- 85%
After 2 years of regular UPSI
- 93%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the causes of infertility for couples

A

Men 30% of time the problem lies with them
Women
1. Ovulation problem
2. Tubal problem
3. Uterine or peritoneal problem

25% of time it is unknown

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How are ovulatory disorders classified

A

Class 1- hypothalamic failure
Class 2- failure of HPO axis
Class 3- ovarian failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are causes of class 1 ovulation disorders

A

Hypothalamic dysfunction
- kallmans
- stress
- excess exercise

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is most common class 2 ovulation disorder

A

PCOS
Other causes include hyperprolactinaemia, cushings

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are causes of class 3 ovulation disorders

A

Ovarian failure
- dysgenesis in turners
- chemo and radiation
- premature ovarian insufficiency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What can cause tubal, uterine and cervical causes of infertility

A

Previous PID
Endometriosis
Salpingectomies for ectopics
Submucosal fibroids
Any procedure or operation on reproductive organs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Which drugs can cause subfertility in a woman

A

NSAIDa
Chemo (ovarian failure)
Spironolactone
Marijuana and cocaine
Post contraception
- injectables
- dermal patch
- vaginal ring

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Which contraceptives cause infertility after removal

A

Injectable- a year
Dermal and vaginal ring a few months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are terms for reduced sperm count, poor sperm motility and abnormal sperm morphology

A

Count- oligospermia
Motility- asthenozoospermia
Morphology- teratozoospermia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Causes of infertility in males

A

Primary spermatogenesis failure
- post mumps
- torsion
- trauma
- klinefelters
- varicocele
- cryptochordism

Obstructive
- cysts
- post epidimytis
- post surgical procedure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the generic causes of infertility in both women and men

A

Alcohol
Smoking
BMI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Initial management of someone in primary care with infertility

A

Advice about smoking, alcohol, weight and drugs known to cause infertility- check necessity
If has been going on for 1 year with regular UPSI then refer
Consider early referral if meets criteria
Investigations
- for men a semen sample and screen for chlamydia
- for every woman do chlamydia screen and mid luteal progesterone
If menstruation problem do hormone screen
- gonadotrophins
- TFTs
- prolactin
- weekly progesterone until ovulation if irregular periods
Discuss psychological support- will be a focus from infertility team

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How is infertility investigated in a man in primary care

A

Semen analysis
Chlamydia screen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What to do with an abnormal sperm analysis

A

If abnormal repeat in 3 months then refer if second one abnormal
EXCEPT REPEAT IN 2-4 weeks IF
- sperm count under 5 million or
- very anxious about results

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

How is infertility investigated in a woman in primary care

A

Every woman
- Chlamydia screen
- mid luteal progesterone
If menstrual problems then
- gonadotrophins
- TFTs
- prolactin
- weekly progesterone until ovulation occurs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What investigations are done in secondary care for woman with infertility

A

If suspected PID/endometriosis or tubal disease then offer laparascopic tubal investigation
If no suspicion of anatomical disease causing infertility then offer hysterosalpingogrpahy or hysterosalpingo- contrast USS

22
Q

How does hysterosalpingography work

A

Catheter passed into uterus and dye injection- imaged on X-ray to detect blockage

23
Q

What are management options for infertility

A

Medical
- clomiphene
- Gonadotrophins
- pulsatile GNRH
- dopamine agonists
Surgical
- tubal catheter
- endometrial or fibroid removal treatment
Assisted conception
- IVF
- intrauterine insemination
- intracytoplasmic sperm injection
- oocyte donor
- sperm donor

24
Q

What is treatment for infertility caused by hyperprolactinaemia

A

Dopamine agonists

25
Q

How can tubal blockage infertility be treated

A

1st line- if mild can attempt tubal catheterisation
2nd line- IVF

26
Q

How does IVF work

A

Remove eggs, inseminate them, incubate for 2 days and place in uterus

27
Q

When consider IVF

A

Tubal blockage
Men with subfertility
Idiopathic infertility
Annovulatory treatment failure

28
Q

How does intrauterine insemination work

A

Sperm inserted into uterus while inducing ovary with anti-oestrogens or gonadotrophins

29
Q

Who is intracytoplasmic sperm injection indicated in

A

Erection or ejaculation issues
Spinal injuries or DM
Oligospermia

30
Q

How does oocyte donation work

A

Oocytes taken from a donor after stimulation and then fertilised by partners sperm

31
Q

Who is oocyte donation possible in

A

Woman at risk of transmitting infection or genetic disorder to child
Ovarian failure from chemo/radiation
Ovarian dysgenesis

32
Q

Who is donor insemination indicated in

A

Female only couples
Males with very low sperm
Men at risk of transmitting genetic disease or infection

33
Q

What is best option for infertility treatment in people with turners

A

Oocyte donation

34
Q

Annovulatory infertility treatment

A

1st line Clomiphene
2nd line Gonadotrophins or pulsatile GNRH or dopamine agonists
3rd line IVF

35
Q

Criteria for earlier infertility referral in women

A

36 or older and been trying for 6 months
History of PID and STI
Endometriosis
Previous abdo or pelvic surgery
Abnormal pelvic examination
Known reason for infertility like chemo

36
Q

Criteria for earlier infertility referral in men

A

History of genital pathology
History of gential surgery
Varicocele
Abnormal genital examination
Known reason for infertility like chemo

37
Q

What are the problems of assisted conception

A

Increased risk of mutliple pregnancy
OHSS risk
Ectopic pregnancy
Infection from invasive procedures

38
Q

What is pathophysiology of OHSS

A

Ovaries are overstimulated and so too many follicles develop causing fluid to leak out

39
Q

How is OHSS classified

A

Mild
- abdo pain and bloating

Moderate
- mild with N&V and US evidence of ascites

Severe
- moderate with visible ascites
- oligouria
- HCT over 45
- hypoproteinaemia

Critical
- severe with anuria
- VTE
- tense ascites

40
Q

How to monitor OHSS extravascular fluid loss

A

HCT

41
Q

Management of mild and moderate OHSS

A

As an outpatient
- paracetamol
- oral fluids
- monitor every 2-3 days
- can do paracentesis if need to in outpt setting with USS

42
Q

When admit with OHSS

A
  • are unable to achieve satisfactory pain control
  • are unable to maintain adequate fluid intake due to nausea
  • show signs of worsening OHSS despite outpatient intervention
  • are unable to attend for regular outpatient follow-up
  • have critical OHSS
43
Q

Who is given VTE prophylaxis with OHSS

A

Severe and critical
Give LMWH

44
Q

When do paracentesis in OHSS

A

Pleural effusions
Severe abdo distension causing pain
Oligouria unresponsive to fluids

45
Q

What treatments are particulalry associated with OHSS

A

IVF
Gonadotrophins

46
Q

Normal ranges for male sperm factors

A

Motility- at least 50% should have normal motility
Morphology- over 4% good morphology
Sperm count- over 15 million is good sperm count
Volume- over 1.5 ml

47
Q

What is gold standard for assessing tubal patency

A

Laparoscopy and dye

48
Q

How does clomiphene regime work

A

In oligomenorrheic women give a progestogen for 10 days and anticipate a withdrawal bleed. Once this happens give clomiphene on day 2 of the period and continue for 5 days
It is most effective when patient on period

49
Q

How long can clomiphene be given for

A

6 cycles as extreme ovarian cancer risk

50
Q

When investigating subfertility what do to when oligomenorrhoea to investigate ovulation

A

Weekly progesterone

51
Q

How manage infertility in PCOS in GP

A

If BMI over 25 recommend weight loss
Ask to have regular sex for 2 years then can refer to fertility clinic for clomiphene etc

Gynae (11 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions