Brainscape's Knowledge GenomeTM

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


See full index

Endo > Infertility > Flashcards

Infertility Flashcards

1
Q

What is infertility?

A

Failure to achieve clinical pregnancy after 12 months of regular (every 2-3 days) unprotected sex

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

What is the difference between primary and secondary infertility?

A

Primary - not had birth previously,
Secondary - previous pregnancy >12 months ago

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

What is the percentage of couples that have infertility?

A

14%

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

What percentage of causes are male, female, both, unknown?

A

30% - male/female/both
10% - unknown

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

What is the impact on couples that infertility?

A

Psychological distress - not having baby, investigations & treatment stress

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

Impact on society

A

Less births,
Less tax for govt
Expensive treatment to fund

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

What are the three groups of causes of infertility in men?

A

Pre-testicular, testicular, post-testicular

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

What are examples of pre-testicular causes?

A

Congenital (Klinefelters, extra X chromosome),
Acquired (HPG, testosterone, PRL issues)

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

What are examples of testicular causes?

A

Cryptorchidism,
Infection (STDs),
Immunological (antisperm antibodies),
Vascular (varicocoele),
Trauma/Surgery,
Toxins (radiotherapy)

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

What are examples of post-testicular causes?

A

Congenital (absence
of van deferens in cystic fibrosis)
u
Obstructive (no sperm in semen),
Erectile Dysfunction, Latrogenic (vasectomy)

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

What is cryptorchidism?

A

Testis does not pass through inguinal canal into scrotum

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

What are the six groups of causes of gonadal infertility in women (and relative percentages)?

A

Ovarian (40%),
Tubal (30%),
Uterine (10%),
Cervical (5%),
Pelvic (5%),
Unknown (10%)
(start from ovaries and work your way down)

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

What are examples of ovarian causes?

A

Anovulation, Corpus Luteum Insufficiency

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

What are examples of tubal causes?

A

Tubulopathy - endometriosis, trauma

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

What are examples of uterine causes?

A

Congenital malformations, Fibroids, Infection/Scarring/Inflammation

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

What are examples of cervical causes?

A

Ineffective sperm penetration - infection/inflammation, immunological (antisperm antibodies)

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

What is endometriosis?

A

Presence of functioning endometrial tissue outside uterus

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

What are the symptoms of endometriosis?

A

Menstrual pain, menstrual irregularities, deep dyspareunia (pain during sex), infertility

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

What are fibroids?

A

Benign tumours of myometrium

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

What hormone affects fibroids and endometriosis?

A

Oestrogen - growth fibroids

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

What are the symptoms of fibroids?

A

Usually asymptomatic but can be same as endometriosis (increased menstrual pain, irregularities, deep dyspareunia, infertility)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

HPG Axis

A

Kisspeptin neurones stimulate
Gnrh neurones
Gnrh released in a pulsatile manner, to the hypophyseal portal circulation
Anterior pituitary gonadotrophs secrete LH/FSH pulsatile
Enter systemic circulation and go to the gonads
Diurnal release of testosterone and oestrogen

23
Q

What are four examples of hypogonadotrophic hypogonadism?

A

Anosmic Kallman Syndrome (congenital),
Acquired (low BMI, stress, exercise), Hyperprolactinaemia, Hypopituitarism

24
Q

Effect of hyperprolactinanemia

A

Prolactin inhibits HPG axis
Low LH/FSH/T

25
Q

How do you treat acquired hypogonadotrophic hypogonadism?

A

Lifestyle changes (not medication)

26
Q

What are two examples of primary hypogonadism?

A

Klinefelter’s Syndrome 47XXY (Congenital),
Acquired (testicular causes)

27
Q

How does Kallmann’s Syndrome work?

A

Migration of GnRH neurons from embryological olfactory placode (primitive nose) to hypothalamus is blocked - GnRH system does not form

28
Q

Why does Kallmann syndrome cause anosmia?

A

Olfactory nerve cells also have to migrate from the olfactory placode but cannot, therefore the sense of smell cannot be developed

29
Q

Hypothalamic causes of male infertility
Low Gnrh, LH, FSH, T

A

Congenital hypogonadotrophic hypogonadism (Kallmann’s)
Acquired hypo hypogonadism (low BMI, XS exercise, stress)
Hyperprolactinaemia

30
Q

What are 4 presentations of Klinefelters syndrome?

A

Tall stature,
low facial hair,
small penis/testes,
low bone density

31
Q

Pituitary causes of male infertility
Low LH/FSH/T

A

Hypopituitarism, (tumour, apoplexy, infiltration, surgery, radiation)

32
Q

What questions from history do you need to ask infertile men?

A

Duration of symptoms, previous children, puberty milestones, medications/drugs

33
Q

Why do you need morning fasting testosterone?

A

Morning - diurnal rhythm highest in morning // Fasting - carbohydrates can suppress testosterone

34
Q

What do you need to examine for male infertility?

A

BMI, sexual characteristics, testicular volume, anosmia

35
Q
A
36
Q

What investigations do you need to do for male infertility?

A

Semen analysis (volume, sperm concentration), blood tests (FSH/LH/PRL, morning fasting testosterone), karyotyping, Scrotal Ultrasound // MRI Pituitary

37
Q

What are the general lifestyle measures that should be taken for treating infertility?

A

Optimise BMI, Smoking Cessation, Alcohol Cessation

38
Q

What are the medical treatments for male infertility?

A

Dopamine agonists for hyperprolactinaemia, gonadotrophin treatment, surgery (sperm extraction)

39
Q

Why would you not give a testosterone injection here?

A

Testosterone lowers FSH and LH levels, FSH and LH needed for spermatogenesis, therefore fertility is reduced if testosterone is given

40
Q

What are three causes of POI?

A

Autoimmune,
Genetic (Turner’s Syndrome), Cancer therapy

41
Q

What is POI?

A

Premature ovarian insufficiency - ovaries are unable to produce oestrogen, but FSH/LH very high
Cessation of menstruation before 40 years of age

42
Q

Gonadal causes of male infertility

A

Congenital primary hypogonadism (Klinfelters 47XXY)
Acquired primary hypogonadism (Cryptorchidism, trauma, chemo, radiation)

43
Q

What are the causes of primary hypogonadism in women?

A

PCOS //
POI (Acquired)
// Turners Syndrome (Congenital) XO

44
Q

How common is PCOS?

A

5-15% of reproductive age, most common endocrine disorder and cause of infertility in women

45
Q

What is the criteria system for PCOS diagnosis called and what are the components?

A

Rotterdam Diagnostic Criteria: Oligo or Anovulation, Hyperandrogenism,
Polycystic Ovaries - check with blood test

46
Q

What are the five consequences of PCOS?

A

Amenorrhea, Infertility, Insulin Resistance, Hirsutism, Endometrial Cancer (tissue is not shed)

47
Q

What are the treatments for PCOS?

A

Oral contraceptive pill (amenorrhea),
IVF (fertility),
metformin (improve insulin resistance, fertility), anti-androgens (hirsutism - spironolactone),
progesterone courses (endometrial cancer -shed endometrium less often)

48
Q

What are oestrogen levels like in PCOS?

A

Depends on patient, but usually normal as some testosterone is converted to oestrogen (using aromatase), however in obese patients oestrogen is low

49
Q

What is Turners Syndrome?

A

45X0 (born without one X chromosome)

50
Q

What are the 6 presentations of Turners Syndrome?

A

Short stature,
brown nevi (spots),
amenorrhea,
underdeveloped reproductive tract,
poor breast development, coarctation of aorta (narrow aorta)

51
Q

What are the history questions needed for female infertility?

A

Duration, previous children, puberty milestones, menstrual history, medication

52
Q

What are the examinations needed for female infertility?

A

BMI, sexual characteristics, hirsutism, anosmia

53
Q

What are the investigations needed for female infertility?

A

Blood tests (LH, FSH, PRL, Oestradiol, Mid-Luteal Progesterone - shows presence of corpus luteum and hence ovulation would have worked) // Pregnancy Test // Ultrasound or Pituitary MRI

Endo (13 decks)

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