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FINALS - OBS, GYNAE, BREAST > infertility > Flashcards

infertility Flashcards

1
Q

what defines infertility

A

cannot conceive after 12 months (primary no kids, secondary have a kid)

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2
Q

causes infertility

A

male factor (most common) // ovulation issue // tubal damage

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3
Q

RF infertility

A

older, extreme BMI, no previous pregnancy

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4
Q

what is primary amenorrhoea

A

no menstruation by 15 (with secondary development eg breasts) or 13 with no breast development

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5
Q

what is secondary amenorrhea

A

no period for 3-6 months with normal menses // no period for 6-12 months with oligomenorrhoea

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6
Q

causes of primary amenorrhea

A

hypogonadism eg turners // congenital malformation // CAH // kallmans

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7
Q

causes of secondary amenorrhea

A

hypothalamic eg stress, excersice // PCOD // raised prolactin // ovarian failure // sheehan // ashermans // pregnancy

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8
Q

what congenital malformations can cause amenorrhea

A

imperforated hymen, mullarian agenesis (no uterus forms)

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9
Q

how does CAH cause infertility

A

underproduction of cortisol and aldosterone and overproduction of androgens

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10
Q

what is ashermanns

A

(secondary) - adhesions in uterus

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11
Q

what is sheehans

A

(secondary) hypopituitary after obstetric bleed

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12
Q

invx amenorrhea

A

bHCG // FBC + TFT // endocrine profile (LH, prolactin, andorgen, oestrogen)

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13
Q

what would LH + FSH + oestradiol indicate in amenorrhea

A

raised LH, FSH + low oestrogen = ovarian problem (eg premature failure) // raised oestrogen = gonadal dysgensis eg turners

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14
Q

endocrine profile in secondary hypothalamic disorder eg exercise, anorexia

A

low FSH, LH, oestradiol

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15
Q

endocrine profile in secondary pituitary disorder eg sheehan, hypopituitarism

A

low FSH, LH, oestradiol

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16
Q

tubal causes infertility

A

PID

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17
Q

what is Premature ovarian insufficiency

A

ovaries stop producing oestrogen before 40

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18
Q

causes Premature ovarian insufficiency

A

idiopathic // bilateral oophorectomy // radio or chemp // mumps // autoimmune

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19
Q

symptoms Premature ovarian insufficiency

A

menopause eg flushes, night sweats // infertile // secondary amenorrhoea

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20
Q

sex hormone profile premature ovarian failure

A

raised FSH (2 readings 4-6 weeks apart!!!) // low oestradiol

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21
Q

mx Premature ovarian insufficiency

A

HRT or COCP until 51

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22
Q

symptoms PCOS

A

subfertility // oligo or amenorrhea // hirsutism, acne androgens) // obesity // acanthosis nigricans + T2DM (insulin resisitance) // obesity

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23
Q

imaging in PCOS

A

USS - cysts on ovaries

24
Q

endocrone hormone profile PCOS

A

raised LH // mildly raised testosterone // ShBH is low to normal // glucose tolerance

25
Q

criteria for diagnosing PCOS

A

rotterdam, 2/3: amenorrhoea // clinical or biochemical signs of hyperandrogenism (hirsutism, acne, raised testosterone) // USS = cysts

26
Q

lifestyle mx PCOS

A

weight loss

27
Q

hirsutism and acne mx PCOS

A

COCP eg or co-cyprindiol // topical eflornithine // spironolactine, finasteride

28
Q

inferitlity mx PCOS

A

clomifene or metformin // (gonadotrophins)

29
Q

(surgical mx PCOS)

A

ovarian drilling

30
Q

function LH in men

A

leydig cells –> testosterone

31
Q

function FSH in males

A

(with testosterone) induce spermatogenesis

32
Q

function sertoli cells males

A

release inhibin –> decrease FSH + LH

33
Q

male fertility causes

A

CF (bilateral absent vas deferens) // cryptochorism // klinefelters (47XXY) // mumps // tumour

34
Q

what is azoospermia

A

no sperm in ejaculate

35
Q

what is oligozoospermia

A

Low sperm count

36
Q

what is Teratozoospermia

A

decreased normal sperm

37
Q

when should semen analysis be performed

A

between 3-5 days no ejaculation // if abnormal repeat 3 months

38
Q

invx for infertility

A

serum analysis + serum progesterone on day 21 (7 days before period)

39
Q

normal progesterone results

A

<16 - low // 16-30 = repeat // >30 = ovulation is occuring

40
Q

lifestyle advice for ovulation

A

folic acid // BMI 20-25 // intercourse every 2-3 days // stop drinking and smoking

41
Q

what causes ovulation

A

luteal phase - LH surge

42
Q

what is a class 1 anovulatory disorder

A

hypogonadotrophic hypogonadism an-ovulation //low LH, FSH, oestrogen // hypothalamic eg exercise, AN

43
Q

is a class 2 anovulatory disorder

A

normogonadotrophic normoestrogenic an-ovulation // PCOS // 80!!!

44
Q

what is class 3 anovulatory disorder

A

hypergonadotrophic hypoestrogen anovulation // high LH and FSH, low oestrogen // problem with ovaries eg premature ovarian failure

45
Q

which class of anovulatory disorders will not benefit from ovulation induction

A

class 3 (premature ovarian failure)

46
Q

lifestyle advice for ovulation indcution

A

weight loss, exercise

47
Q

medications for ovulation induction

A

Clomiphene citrate // letrozole // gonadotrophins

48
Q

what induction is useful in PCOS (class 2)

A

clomiphene citrate and letrozole // gonadotrophins last line

49
Q

what induction is useful in class 1

A

gonadotrophins

50
Q

when is IVF indicated

A

female infertility: tubal disease // last resort if ovulation induction hasnt worked in class 1 and 2 // class 3 (premature ovarian failure)

51
Q

when is artificial insemination used

A

male infertility eg CF

52
Q

what is ovarian hyperstimualtion

A

SE of IVF or gonadotrophin therapy

53
Q

mild ovarian hyperstimualtion

A

abdo pain and bloating

54
Q

moderate ovarian hyperstimualtion + invx

A

mild N+V // USS = ascites

55
Q

severe ovarian hyperstimualtion + invx

A

clinical ascites, oliguria // haemocrit >45 // hypoproteinaemia

56
Q

critical ovarian hyperstimualtion + invx

A

VTE, ARDS, anuria, tense ascites, renal failure, shock

57
Q

mx severe ovarian hyperstimualtion

A

fluid replacement // anticoag // ascites paracentesis

FINALS - OBS, GYNAE, BREAST (27 decks)

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