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Aneesha Flashcards BRS 2 > Infertility > Flashcards

Infertility Flashcards

1
Q

what is infertility?

A

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

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2
Q

what is primary infertility?

A

infertility with no previous live birth

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3
Q

Does male factor, female factor or a combination account for most cases of infertility?

A
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4
Q

what is secondary infertility?

A

infertility with a live birth 12+ months previously

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5
Q

what is the prevalence of infertility?

A

affects 1 in 7 couples
But ~ half of these will then conceive in the next 12 months (ie at 24months ~ 7% of couples)

55% seek help - positive association with socioeconomic status

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6
Q

what are the psychological impacts of infertility?

A

no biological child, impact on wellbeing of couple, larger family, investigations and treatments (often failing)

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7
Q

what are the societal costs of infertility?

A

less births, less tax income, investigation and treatment costs.

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8
Q

what are the male pre-testicular causes of infertility?

A

congenital and acquired endocrinopathies e.g Klinefelters, HPG, T, PRL issues

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9
Q

what are the testicular causes of male infertility?

A

congenital
cryptorchidism
infection - STDs
immunological - antisperm ABs
vascular - varicocoele
trauma/surgery
toxins - chemo, dxt, drugs, smoking

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10
Q

what are the post testicular causes of male infertility?

A

congenital - abscence of vas deferens in CF
obstructive azoospermia
erectile dysfunction - retrograde ejaculation, mechanical impairment, psychological
latrogenic - vasectomy

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11
Q

what is cryptorchidism?

A

undescended testes - 90% in inguinal canal, as normal pathway of descent is through inguinal canal

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12
Q

what are the types of causes of female infertility?

A

pelvic (5%)- endomteriosis, adhesions,
ovarian (40%)- anovulation, Corpus luteum insufficiency
tubal (30%)-Tubopathy due:
-Infection
-Endometriosis
-Trauma

uterine (10%)-Unfavourable endometrium due:
-Congenital malformations
-Infection/Inflammation/Scarring (adhesions)
-Fibroids

cervical (5%) Ineffective sperm penetration due:
-Infection/Inflammation
-Immunological (antisperm Ab)

and unexplained (10%)

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13
Q

what is endometriosis?

A

presence of functioning endometrial tissue outside the uterus

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14
Q

what is the prevalence of endometriosis in women?

A

5%

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15
Q

what are the symptoms of endometriosis?

A

menstrual pain and irregularity, deep dyspareunia, infertility

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16
Q

what are fibroids?

A

benign tumours of the myometrium

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17
Q

what is the prevalence of fibroids in women?

A

1-20% pre-menopausal women

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18
Q

are fibroids or endometriosis responsive to oestrogen?

A

both

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19
Q

what are the symptoms of fibroids?

A

usually asymptomatic
menstrual pain, irregularities
deep dyspareunia
infertility

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20
Q

what are the blood results for a hypothalamic cause of endocrine male infertility?

A

low LH/FSH
low testosterone

low GnRH (not measurable)

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21
Q

what are the blood results for pituitary causes of endocrine male infertility?

A

low LH/FSH
low testosterone

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22
Q

what are the blood results for gonad causes for endocrine male infertility?

A

high LH/FSH
low testosterone

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23
Q

Endocrine Male Infertility at different levels of HPG axis

A
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24
Q

what is Kallman’s syndrome?

A

failure of migration of GnRH neurons along with olfactory neurons to hypothalamus from olfactory placode (during first 10wks of development)
This leads to anosmia and reproductive features

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25
Q

what are the reproductive features of Kallmann’s?

A

Failure of puberty
Infertility

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26
Q

what are the blood test results for someone with Kallmann’s?

A

low LH/FSH
low testosterone

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27
Q

how is hyperprolactinemia treated?

A

cabergoline

or pit surgery/radiotherapy

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28
Q

what is the karyotype for Klinefelter syndrome?

A

47XXY

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29
Q

what is the karyotype for Turner syndrome?

A

45X0

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30
Q

what are the features of Klinefelters syndrome?

A

tall stature
decreased facial/chest hair
mildly impaired IQ
narrow shoulders
Slight breast deveolpment
female pattern pubic hair
wide hips
small penis/testes
low bone density
INFERTILITY

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31
Q

how would you approach a male history for infertility?

A

duration
previous children
pubertal milestones,
associated symptoms (eg. T deficiency, PRL symptoms, CHH features)
medications/drugs

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32
Q

how would you approach examining a male presenting with infertility?

A

BMI, sexual characteristics, testicular volume, anosmia

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33
Q

what are the 3 main investigations for males presenting with infertility?

A

semen analysis
blood tests
imaging

34
Q

what is semen analysis?

A

measures volume (1.5ml normal), sperm concentration-15 million/ml (Azospermia = No sperm, Oligospermia = Reduced sperm)
and total mobility of a sperm sample (40%)

35
Q

what are the main blood tests for a male presenting with infertility?

A

LH, FSH, PRL
Morning Fasting Testosterone
Karyotyping

36
Q

what are the imaging methods used for males presenting with infertility?

A

Scrotal US/Doppler
(for varicocoele/obstruction, testicular volume)

MRI Pituitary
(if low LH/FSH or high PRL)

37
Q

what are the typical lifestyle treatments for general male inferility?

A

optimise BMI
smoking cessation
alcohol cessation/ reduction

38
Q

what are specific treatments for male hyperPRL?

A

dopamine agonist - cabergoline

39
Q

What type of surgery can be used to treat male infertiliy?

A

Micro TESE (microtesticular sperm extraction)

40
Q

how is testosterone prescribed to males not desiring fertility?

A

daily gel
3 weekly IM injections
3 monthly IM injections
implants/oral preparations less common

41
Q

what to prescribe to males desiring fertility?

A 
hCG injections (act on LH receptors)
if no response after 6mnth, add FSH injections
42
Q

what treatments are used for males wanting fertility?

A

gonadotrophin treatment

NO TESTOSTERONE - -ve feedback on LH/FSH

43
Q

when is testosterone prescribed to males presenting with infertility?

A

if fertility is not desired, only for symptomatic relief

44
Q

What blood results would you see in premature ovarian insufficiency?
How is POI diagnosed?

A

High FSH/ LH, low oestradiol
Diagnosis High FSH >25 iU/L (x2 at least 4wks apart)

45
Q

Can conception occur in premature ovarian insufficieny?

A

Yes, in 20%

46
Q

what is primary amenorrhoea?

A

menses not started after 16 years old

47
Q

what is secondary amenorrhoea?

A

periods start at puberty but stop for at least 3-6mnths

48
Q

what is amenorrhoea?

A

no periods for at least 3-6mnths

or up to 3 periods/yr

49
Q

what is oligomenorrhoea?

A

irregular/infrequent periods, >35day cycles

or 4/9 cycles/yr

50
Q

what is early menopause?

A

menopause occurring in a female under 45

51
Q

how is early menopause diagnosed?

A

high FSH (>25iU/L) twice at least 4wk apart

52
Q

what are the odds for conception in a female with early menopause?

A

20%

53
Q

Causes of premture ovarian insufficiency?

A

Autoimmune
Genetic eg Turner’s Syndrome
Cancer therapy Radio- / Chemo-therapy in the past

54
Q

What blood results would you see in Anorexia Nervosa-Induced Amenorrhoea?

A

Low FSH/LH/ oestradiol

55
Q

how does hypothalamic causes of infertility in women show in a blood test?

A

low LH/FSH
low E2
hypogonadotrophic hypogonadism

56
Q

what are the female congenital causes of hypogonadotropic hypogonadism?

A

anosmic (kallmann’s syndrome) or normosmic

57
Q

what are the acquired female causes of hypogonadotrophic hypogonadism?

A

low BMI
stress
excessive exercise
hyperprolactinemia

58
Q

what are the blood results for pituitary causes of female infertility?

A

low LH/FSH
low E2

59
Q

what are the causes of female hypogonadotropic infertility? (pituitary causes)

A

hypopituitarism-
tumour
infiltration
apoplexy
surgery
radiation

60
Q

what are the acquired gonadal causes of female primary hypogonadism?

A 
early menopause/primary ovarian insufficiency
surgery
trauma
chemo
radiation
polycystic ovarian syndrome (PCOS)
61
Q

what are the congenital causes of female primary hypogonadism?

A

turners syndrome

early menopause/premature ovarian insufficiency

62
Q

what are the blood results for PCOS?

A

high LH/FSH

low or normal E2

63
Q

what are the blood results for female primary hypogonadism?

A

high LH/FSH

low E2

64
Q

what is PCOS’ burden of disease?

A

affects 5-15% women of reproductive age

most common endocrine disorder in women, most common cause of infertility

65
Q

how is PCOS diagnosed?

A

exclude other reproductive disorders

Rotterdam criteria - 2/3

66
Q

what is the Rotterdam PCOS diagnostic criteria?

A

oligo or anovulation
clinical+/- biochemical hyperandrogenism
polycystic ovaries on utrasound

67
Q

how is oligo/anovulation assessed for the rotterdam criteria of PCOS?

A

by menstrual frequency - oligomenorrhoea (<8-9 cycles a year)

68
Q

how is clinical hyperandrogenism for the rotterdam PCOS criteria assessed?

A

clinical - acne, hirsutism, alopecia

69
Q

how is biochemical hyperandrogenism for the rotterdam PCOS criteria assessed?

A

raised androgens on blood test (e.g testosterone)

70
Q

why are polycystic ovaries on ultrasound not diagnostic for PCOS?

A

30% of women have polycystic ovaries so isn’t confirmational

71
Q

how does Clomiphene act for female fertility?

A

oestradiol receptor antagonist
reduces negative feedback of oestrogen on hypothalamus/pituitary gland
therefore increases LH/FSH
FSH stimulates follicle growth

72
Q

what treatments for PCOS aim to restore ovulation?

A

weight loss
letrozole (aromatase inhibitor)
clomiphene (oestradiol receptor modulator)
FSH stimulation

73
Q

how does letrozole act for female infertility?

A

inhibits aromatase (test-oest)
therefore reduces negative feedback of oestrogen on LH/FSH
therefore increases serum LH/FSH leading to stimulation of follicle growth

74
Q

what are the treatments for PCOS?

A
75
Q

what are the physical features of Turner’s syndrome?

A

short stature
low hairline
shield chest
webbed neck
poor breast development, wide spaced nipples
elbow deformity
brown nevi
short 4th metacarpal
small fingernails

76
Q

what are the internal features of Turner’s syndrome?

A

coarctation of aorta
underdeveloped reproductive tract
amenorrhoea

77
Q

what are the main history points for a female presenting with infertility?

A

duration, previous children, pubertal milestones,
menstrual History, medications/drugs

78
Q

what are the examinations to consider for females presenting with infertility?

A

BMI, sexual characteristics, hyperandrogenism signs, anosmia

79
Q

what are the main types of investigations for females presenting with infertility?

A

blood tests
pregnancy test
imaging

80
Q

what are the blood tests for a female presenting with infertility?

A 
LH/FSH/PRL
oestradiol, androgens
follicular phase 17-OHP, mid-luteal progesterone
sex hormone binding globulin
albumin, iron studies
pit/thyroid study
karyotyping
81
Q

what are the imaging methods used for a female presenting with infertility?

A

Ultrasound (transvaginal)
hysterosalpingogram
MRI pit

Aneesha Flashcards BRS 2 (47 decks)

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