infertility Flashcards
what defines infertility
cannot conceive after 12 months (primary no kids, secondary have a kid)
causes infertility
male factor (most common) // ovulation issue // tubal damage
RF infertility
older, extreme BMI, no previous pregnancy
what is primary amenorrhoea
no menstruation by 15 (with secondary development eg breasts) or 13 with no breast development
what is secondary amenorrhea
no period for 3-6 months with normal menses // no period for 6-12 months with oligomenorrhoea
causes of primary amenorrhea
hypogonadism eg turners // congenital malformation // CAH // kallmans
causes of secondary amenorrhea
hypothalamic eg stress, excersice // PCOD // raised prolactin // ovarian failure // sheehan // ashermans // pregnancy
what congenital malformations can cause amenorrhea
imperforated hymen, mullarian agenesis (no uterus forms)
how does CAH cause infertility
underproduction of cortisol and aldosterone and overproduction of androgens
what is ashermanns
(secondary) - adhesions in uterus
what is sheehans
(secondary) hypopituitary after obstetric bleed
invx amenorrhea
bHCG // FBC + TFT // endocrine profile (LH, prolactin, andorgen, oestrogen)
what would LH + FSH + oestradiol indicate in amenorrhea
raised LH, FSH + low oestrogen = ovarian problem (eg premature failure) // raised oestrogen = gonadal dysgensis eg turners
endocrine profile in secondary hypothalamic disorder eg exercise, anorexia
low FSH, LH, oestradiol
endocrine profile in secondary pituitary disorder eg sheehan, hypopituitarism
low FSH, LH, oestradiol
tubal causes infertility
PID
what is Premature ovarian insufficiency
ovaries stop producing oestrogen before 40
causes Premature ovarian insufficiency
idiopathic // bilateral oophorectomy // radio or chemp // mumps // autoimmune
symptoms Premature ovarian insufficiency
menopause eg flushes, night sweats // infertile // secondary amenorrhoea
sex hormone profile premature ovarian failure
raised FSH (2 readings 4-6 weeks apart!!!) // low oestradiol
mx Premature ovarian insufficiency
HRT or COCP until 51
symptoms PCOS
subfertility // oligo or amenorrhea // hirsutism, acne androgens) // obesity // acanthosis nigricans + T2DM (insulin resisitance) // obesity