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3. Y5 Zero to finals: O&G > Infertility > Flashcards

Infertility Flashcards

1
Q

What proportion of couples fail to conceive naturally?

A

1/7

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2
Q

After trying to conceive for how long should investigations and referrals for infertility be started? (2 options)

A
  1. 12 months
  2. 6 months if: woman 35+ yrs
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3
Q

What are the causes of infertility? (5 things)

A
  1. Sperm (30%)
  2. Ovulation (20%)
  3. Tubal (15%)
  4. Uterine (10%)
  5. Unexplained (20%)
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4
Q

What is some general advice for infertility? (5 things)

A
  1. Woman takes 400mcg folic acid daily
  2. Have healthy BMI
  3. X Smoking / Alcohol
  4. Reduce stress (fx libido + relationship)
  5. Intercourse every 2-3 days
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5
Q

What initial investigations should you do in primary care for infertility? (5 things)

A
  1. BMI
  2. Chlamydia screening
  3. Semen analysis
  4. Female hormone testing
  5. Rubella immunity in mother
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6
Q

What does a LOW BMI suggest the cause of infertility is?

A

Anovulation

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7
Q

What does a HIGH BMI suggest the cause of infertility is?

A

PCOS

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8
Q

What does Female hormone testing involve? (5 things)

A
  1. Serum LH + FSH
  2. Serum progesterone
  3. Anti-Mullerian hormone
  4. TFTs (if symptoms suggest dis)
  5. Prolactin (when symptoms of galactorrhoea / amenorrhoea)
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9
Q

Why should you check Prolactin in infertility?

A

Hyperprolactinaemia causes anovulation

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10
Q

Which day range is Serum LH + FSH checked?

A

Day 2-5

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11
Q

Which day is Serum progesterone checked?

A

Day 21

(or 7 days b4 end of cycle if not 28 day cycle)

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12
Q

What does High FSH suggest?

A

Poor ovarian reserve (aka number of follicles left in ovaries)

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13
Q

What explains the High FSH in poor ovarian reserve?

A

Pit gland prod extra FSH in attempt to stimulate follicular dev

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14
Q

What does Low LH suggest?

A

PCOS

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15
Q

What does a rise in Progesterone @ day 21 indicate? (2 things)

A
  1. Ovulation has occurred
  2. Corpus luteum formed + started secreting progesterone
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16
Q

When in the cycle can Anti-Mullerian hormone be tested for?

A

Anytime

17
Q

What is Anti-Mullerian hormone a marker for?

A

Most accurate marker of ovarian reserve

18
Q

What is Anti-Mullerian hormone released by?

A

Granulosa cells in follicles

19
Q

What does Low Anti-Mullerian hormone suggest?

A

Eggs are depleted

20
Q

What further investigations should you for infertility in Secondary care? (3 things)

A
  1. US Pelvis
  2. Hysterosalpingogram
  3. Laparoscopy + Dye test
21
Q

What are you looking for in a US Pelvis of infertility? (2 things)

A
  1. PCOS
  2. Structural abn in uterus
22
Q

What are you looking for in a Hysterosalpingogram of infertility?

A

Fallopian tube patency

23
Q

What are you looking for in a Laparoscopy + Dye test of infertility? (3 things)

A
  1. Fallopian tube patency
  2. Adhesions
  3. Endometriosis
24
Q

What is a benefit of a Hysterosalpingogram?

A

Can do Tubal cannulation during it –> opens up tube –> restores fertility

25
Q

What is a risk of having a Hysterosalpingogram?

A

Infection

26
Q

What precautions are taken with Hysterosalpingogram to reduce risk of infection? (2 things)

A
  1. Prophylactic abx
  2. Chlamydia + Gonorrhoea screening b4 hand
27
Q

What is a benefit of a Laparoscopy?

A

Can treat adhesions / endometriosis on the job

28
Q

What are the management options for infertility caused by ANOVULATION? (6 things)

A
  1. Weight loss (if overweight +/- PCOS)
  2. Clomifene
  3. Letrozole (instead of clomifene)
  4. Gonadotropins (if resistant to clomifene)
  5. Ovarian drilling (if PCOS)
  6. Metformin (for insulin sensitivity / obesity related to PCOS)
29
Q

What drug class in Clomifene?

A

Anti-oestrogen (selective oestrogen receptor modulator)

30
Q

What day range is Clomifene given?

A

Days 2-6 of menstrual cycle

31
Q

What are the physiological steps of Clomifene in restoring fertility? (4 steps)

A
  1. Stops negative feedback of oestrogen on hypothalamus
  2. Increased GnRH release
  3. Increased FSH + LH
  4. Ovulation
32
Q

What are the physiological steps of Ovarian drilling in restoring fertility? (3 steps)

A
  1. Multiple holes drilled in ovaries using diathermy / laser (@ laparoscopy)
  2. Womans hormone profile improved
  3. Regular ovulation
33
Q

What are the management options for infertility caused by TUBAL DEFECTS? (3 things)

A
  1. Tubal cannulation @ hysterosalpingogram
  2. Laparoscopy to remove adhesions / endometriosis
  3. IVF
34
Q

What is the management option for infertility caused by Uterine DEFECTS?

A

Surgery to correct polyps / adhesions / structural abn

35
Q

What are the management options for infertility caused by Sperm defects? (5 things)

A
  1. Surgical sperm retrieval
  2. Surgical correction of vas deferens obst
  3. Intra-uterine insemination
  4. Intracytoplasmic sperm infection (ICSI)
  5. Donor insemination
36
Q

What does Intra-uterine insemination involve? (2 steps)

A
  1. Collecting + separating high quality sperm
  2. Injecting them directly into uterus
37
Q

What does Intracytoplasmic sperm injection (ICSI) involve? (2 steps)

A
  1. Injecting sperm directly into cytoplasm of egg (which then becomes embyro)
  2. Embryo injected into uterus
38
Q

When is Intracytoplasmic sperm injection (ICSI) useful? (2 things)

A
  1. Sperm motility issues
  2. Low sperm count

3. Y5 Zero to finals: O&G (27 decks)

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