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Women's health > Infertility > Flashcards

Infertility Flashcards

1
Q

What is infertility?

A

Infertility involves the inability to conceive a child after 18 months of regular unprotected intercourse. In the case of woman > 35 the time delay is only 6 months.

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2
Q

What is Fecundability ?

A

Fecundability is defined as the probability of achieving a pregnancy within one menstrual cycle or the ability to achieve a live birth from one cycle’s exposure to the risk of pregnancy

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3
Q

What are the factors that affect fertility ?

A
  • Increasing age
  • Lifestyle factors
  • Chronic and genetic diseases.
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4
Q

What is the single most factor affecting fertility?

A

Age

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5
Q

What is the most fertile period ?

A

22-26 years.

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6
Q

What is the egg reserve relative to age ?

A

At 30: 12% of Ovarian egg reserve remains.
At age 40: 3% of the Ovarian eggs remain.

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7
Q

What are the causes of infertility ?

A

Unknown= 30%
Spermatic issues = 25%
No coitus and Endometriosis= 5%
Anovulation= 20%
tubal obstruction= 15%

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8
Q

Where is fertilization normally occurs ?

A

Ampula of fallopian tube.

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9
Q

What are the Causes of infertility in Women?

A

Ovulatory dysfunction
Tubal damage
Endometriosis
Coital problems
Cervical factors
Unexplained

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10
Q

What are the causes of Anovulation?

A

*PCOS
* Premature ovarian failure
* Pituitary insufficiency
*Hypothalamic insufficiency
*Other causes; Thyroid, Androgen Excess, Obesity

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11
Q

What are the tubal conditions associated to infertility, their dx, and management ?

A

The tubal conditions are Hx of ectopic pregnancy, STIs, adhesions, congenital conditions and hydrosalpinx etc. The dx is through Hysterosalpingogram or laproscopy. The management is tubal canulation and tubal reconstructive surgery.

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12
Q

What is the gold standard for Dx PCOS ?

A

Laparoscopy with histological verification

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13
Q

_______ fragmentation may affect the fertility status, failure of IVF and miscarriages.

A

A high DNA

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14
Q

What is the dosing and MOA of Clomiphene Citrate

A

50 mg daily, days 2-6 of cycle. It inhibits estroge receptors and prevents estrogen mediated reduction in FSH surge leading to ovulation.

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15
Q

What is PGT-A (Preimplantation Genetic Testing for Aneuploidy)?

A

Screens for an abnormal number of chromosomes in the embryo which
Helps to identify embryos with the highest implantation potential and lowest risk of miscarriage.

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16
Q

What is PGT-M (Preimplantation Genetic Testing for Monogenic/Single Gene Defects)?

A

It Screens for specific single-gene disorders that run in the family
Used when there is a known risk of passing on a genetic disease.

17
Q

What is the contraindication for embryo transfer ?

A

If E2 > 13,000 pmol/l no embryo transfer.

18
Q

What is Ovarian hyper stimulation syndrome ?

A

Ovarian enlargement and the presence of multiple ovarian follicles with ascites and or pleural and pericardial effusions.

19
Q

What is the risk of OHSS?

A

Intravascular volume depletion can cause stroke, pulmonary embolism, arterial and venous thrombosis, renal impairment, ARDS and death.

20
Q

What are the risk factors for OHSS?

A

*All women undergoing controlled ovarian stimulation.
*Women with previous medical history of PCO(polycystic-ovaries).
*High AMH level.(Within PCO category).
*Women under the age of 30 years.
*Lean body mass.
*Previous history of OHSS.

21
Q

What is the presentation of mild OHSS?

A

Abdominal bloating
Mild abdominal pain/discomfort
Ovarian size usually <8cm*

22
Q

What is the presentation of moderate OHSS?

A

*Moderate abdominal pain/discomfort
*Nausea +/- Vomiting
*Ultrasound evidence of ascites
Ovarian size 8-12cm

23
Q

What is the presentation of sever OHSS?

A

*Clinical ascites (occasionally hydrothorax)
*Oliguria
* haematocrit >45% (but less than 55%)
*Hypoproteinaemia
Ovarian size usually >12cm

24
Q

What is the criteria for OHSS dx?

A

*Tense ascites or large hydrothorax
*Haematocrit >55%
*White Cell Count > 25.00/ml
*Oligo/anuria
*Thromboembolism

25
Q

What is the Tx of OHSS?

A
  • Drainage
  • Bed rest and protein drinks and fluids.

Women's health (10 decks)

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