Infertility Flashcards
a disease characterized by failure to achieve successful pregnancy after 12 months of attempting or due to an impaired capacity to reproduce with one’s partner
infertility
in absence of known etiology, and presence of regular, unprotected intercourse, evaluation should be initiated at ____ months when the female is under 35 years old
12
in absence of known etiology, and presence of regular, unprotected intercourse, evaluation should be initiated at ____ months when the female is 35 years or older
6
what are the 2 most common causes of infertility in couples?
tubal/pelvic pathology
male
what is the greatest non-modifiable factor for fertility?
female age
maternal age over _____ is associated with placental abruption, pre-term delivery, low birth weight, intrauterine growth restriction, stillbirth, and perinatal mortality
40
what are the 3 tests used to evaluate ovulatory function?
ovulation predictor kits
basal body temp
mid-luteal serum progesterone level
tests for LH rise in urine to evaluate ovulatory function
ovulation predictor kits
what causes the change in body temperature during ovulation?
progesterone rise
what is the most common etiology of infertilify?
PCOS
what is the criteria for PCOS?
2/3:
< 9 menses/year
OR
> 35 day cycle intervals
+
Polycystic appearing ovaries on US
Hyperandrogenism
assesses reproductive potential as a function of the number of oocytes
ovarian reserve
what is the most predictive of live birth rates?
female age
what are the 3 tests used for ovarian reserve?
AMG
FSH/estradiol levels on day 3
antral follicle count
what are 3 tests to assess fallopian tube patency?
hysterosalpingogram (HSG)
hysterosallpingo-contrast sonogram
laparoscopy with chromopertubation
at what point in the cycle should a hysterosalpingogram be done?
follicular phase (days 5-12)
when should prophylactic antibiotics be considered for a hysterosalpingogram? (2)
history of STI/PID
known tubal abnormality
what are 2 contraindications for a hysterosalpingogram?
pregnancy
purulent cervical discharge
allergy to iodine contrast
large fibroids > 4-5cm and those that are close to or inside the endometrial cavity are most concerning
uterine leiomyoma
patient presents with abnormal bleeding, menorrhagia, and pelvic pressure/pain. Dx?
uterine leiomyoma
intrauterine adhesions that present with light/absent menses
asherman’s syndrome
used to evaluate myometrial defects, intracavity defects like polyps, ovarian cysts, antral follicle count, follicular development, and pathology.
pelvic sonogram
what are the 2 peritoneal factors that cause infertility?
endometriosis
pelvic/adnexal adhesions
what should be considered to diagnose and treat peritoneal factors leading to infertility?
laparoscopy
absence of spermatozoa in semen
azoospermia
deficiency of spermatozoa in semen
oligospermia
poor semen motility (weak)
asthenospermia
morphologic abnormality of sperm
teratospermia
what should be encouraged during pre-conception counseling? (2)
prenatal vitamins
folic acid 1mg
what is the optimal timing of intercourse? (2)
1-5 days prior to ovulation
intercourse every day to every 3rd day
what are 3 vaginal lubricants that are not spermicidal?
canola oil
mineral oil
hydroxyethyl-cellulose-based lube
what is the 1st line treatment for infertility?
lifestyle modifications
what are 2 second line treatment options for infertility? (2)
letrozole
clomiphene citrate
what is the ovulation induction protocol?
letrozole 2.5mg on cycle day 3
what is the ovulation induction protocol if a patient is amenorrheic? (2)
induce menses with Provera 10mg x 10 days
random start of letrozole 2.5 mg
what is the ovulation induction protocol if a patient is nonresponsive?
increase dose to letrozole 5mg x 5 days
used in patients with PCOS for anovulation
metformin
what is the optimal treatment for unexplained infertility?
clomiphene citrate + intrauterine insemination for 3-6 attempts
most aggressive treatment for infertility but has the highest success rate
in vitro fertilization
what are 4 benefits of IVF?
decrease # of necessary sperm
fallopian tubes not needed
control # of embryos transferred
preimplantation genetic testing
