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REI Stuff > Infertility > Flashcards

Infertility Flashcards

1
Q

Tests for ovarian reserve and N values (7)

A

D3 FSH (N: <10IU/L) if >10 IU/L meaning poor responder

Estradiol (N: <50 pg/ml), must be taken with FSH, if >60-80 tapos N FSH = poor responder

Clomiphene Citrate Test

AMH (N: >1.2 ng/ml, if DOR bologna: 0.5-1.1; if Poseidon, <1.2, speroff 0.2-0.7)

AFC (bologna <5-7, poseidon <5 speroff <3-4)

ovarian volume (DOR: <3ml)

inhibin (DOR: <40-45pg/ml)

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2
Q

Clomiphene Citrate Test

A

Administer 100mg CC on D5-9 x 5 days

D3 and D10 FSH

if 10-22 IU/L = DOR

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3
Q

When to test females for ovarian reserve

A

35 and above
previous ovarian sx
smoking
previously poor responder
fam hx early menopause
unexplained infertility

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4
Q

substance abuse MOA infertility

A

marijuana - inhibits GnRH and messes with ovulatory function
cocaine - dec spermatogenesis in males and inc tubal disease women
alcohol - decreased semen parameters and impotence
caffeine - limit to 200mg or 1 12oz coffee or else delay time to conception, miscarriage

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4
Q

smoking MOA infertility

A

accelerated follicular depletion
menstrual abnormalities
gamete mutagenesis

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5
Q

cycle fecundity

A

20-30%

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5
Q

cycle fecundability

A

20%

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6
Q

time to conception in married couples who are fertile

A

3mo 57%
6mo 72%
1y 85%
2y 93%

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7
Q

causes of infertility

A

ovulatory 20-40
male 30-40
tubal 30-40

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8
Q

largest # spontaneous pregnancy

A

within 3 years

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8
Q

chances of winning in life

A

pregnancy without treatment declines:

by about 5% for each additional year of female partner age

by 15–25% for
each added year of infertility

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9
Q

tests for ovulation

A

BBT +0.4-0.8F from basal 97-98deg – fertile period 1 week before BBT rise

serum progesterone - <3ng/ml anovulatory, taken 1 week before menses

LH kit must do 2-3 days before expected ovulation, at 4-6pm (ovulation is 14-26 hours after surge and almost all within 48hrs)

EM biopsy - EM date +/- 2

TV-UTZ direct observation of ovary

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9
Q

MOA infertility myoma

A

1) inc myometrial contractions
2) distortion of endometrial cavity, interfering with sperm transport
3) chronic endometritis, dec endometrial receptivity
4) displacement of cervix - poor sperm exposure
5) tubal blockage if isthmic
6) distortion of adnexal anatomy interfering with ovum capture

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10
Q

The most important prognostic factor for achie ving a live birth afte r microsurgical sterilization reversal is

A

age

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11
Q

unexplained infertility

A

10% before age 35
80% at age 40

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12
Q

untreated unexplained infertility fecundability

A

2-4%

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13
Q

unexplained infertility fecundability with CC + IUI

A

5-10%

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14
Q

unexplained infertility fecundability with Gonadotropins + IUI

A

7-10%

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15
Q

unexplained infertility fecundability with IVF

A

25-45%

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16
Q

Feedback mechanism of FSH in males

LH: testosterone, FSH: ___

A

inhibin B (produced by sertoli cells)

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17
Q

ADAM

A

dec libido
DM
metab syndrome
gynecomastia
testicular atrophy
dec muscle mass
inc visceral adipose tissue
sleep disturbances
depressed mood
lethargy
erectile dyfunction
irritability
osteoporosis

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17
Q

increased paternal age

A

inc numerical and structural chromosomal abnormalities
inc dna fragmentation
inc frequency of point mutations

inc birth defects
inc congenital diseases
inc autosomal dominant mutations
inc chuldren with schizophrenia
inc xlinked disease (hemophilia)
inc autistic children

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17
Q

semen parameters that decrease in aging

A

volume, motility, morphology

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18
Q

free testosterone index (FTI)

A

T/SHBG = bioavailable T

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18
Q

hypo T value needs treatment

A

<200ng/dl
<300ng/dl repeat pero hypo na din

18
Q

might benefit from tx T level

A

200-400ng/dl

18
Q

algorithm if u have low T

A

repeat T
check LH
if low LH, check prolactin and do MRI

check E2, LH, FSH, T prolactin

19
Q

contraindications to androgen therapy

A

prostate/breast CA
prostate nodule
hct >50% erythrocytosis
OSA untreated
severe lower urinary tract symtpoms (IPSS>19)
PSA >3 ng/ml without uro eval
class III or IV HF

20
Q

T goals therapy

A

300-400ng/dl

check q3 months

21
Q

monitoring T tx

A

q3 months
PSA
serum T
prostate exam
CBC
weight gain/edema

dexa (1-2 yrs after tx starts)

22
Q

T options for ADAM

A

parenteral ester IM 75mg/week 150mg q2 weeks

scrotal patch 40cm2 OD

skin patch 5mg OD

testosterone gel 5g/day

23
Q

side effects of T therapy

A

edema
prostate disease
fluid retention
gynecomastia
RBC mass/ erythrocytosis
worsening OSA
CVD

24
Q

hypo-hypo

A

kallman
single gene deletions
tumors
infiltrative disease
hyperPRL
drugs
illness/injury
chronic illness/malnutrition
infection (meningitis)
obesity

24
Q

MOA mumps orchitis

A

destruction of germinal epithelium
immune dysfunction
ischemia

25
Q

causes of male infertility

A

hypothalamic-pituitary disorders (1-2%)
primary gonadal disorders (30-40%)
disorders of sperm transport (10-20%)
idiopathic (40-50%)

25
Q

hyper-hypo

A

kleinfelter 47xxy
y chromosome deletions
single-gene mutations and polymorphisms
cryptochordism
varicocele
orchitis
chemo drugs
radiation
environmental gonadotoxins
chronic illness

26
Q

Disorders of sperm transport (7)

A

epididymal obstruction
vasectomy
CABVD
young syndrome
ejaculatory dyfunction (spinal cord or autonomic)
STD
karatgener’s disease

26
Q

moa varicocele

A

delayed removal of local toxins, hypoxia and stasis

more common L>R

27
Q

abstinence for semen analysis

A

2-3 days

28
Q

WHO 2021

A

1.4ml
39M total sperm count
16M concentration
42% total motility
30% progressive motility
4% normal forms

29
Q

odds of male infertility

A

1 -2-3x
2 - 5-7x
3 - 16x

30
Q

seminal vesicles

A

alkalaine and with fructose

so if CBAVD = acidic and low volume

acidic = prostate

31
Q

semen of hypogonadal men

A

whether 1 or 2 have acidic and onti secretions because no testosterone = no secretions by seminal vesicles

32
Q

causes of oligo

A

varicocele
hypogonadism
y chromosome microdeletions (azfa, azfb)

32
Q

severe oligospermia

A

<5M

oligo = <20M

33
Q

forward progression grade of sperm (0-4)

A

3-4 rapid
2 slow
0-1 nonprogressive

34
Q

total progressive motility

A

% of sperm who have purposeful forward motion (2-4)

35
Q

sperm vitality test

A

differentiate dead from nonmotile sperm

hypoosmotic sperm swelling test = if mag swell buhay

36
Q

quality of spermtogenesis is reflected in

A

sperm morphology

37
Q

strict criteria of morphology success rate

A

highest when morphology 14% and above
worst when morphology <4%

38
Q

true leukocytospermia

A

> 1M leukocytes/ml

39
Q

treatment of aromatase inhibitors in males with severe oligo, low T, N gonadotropins

A

calculate T ng/dl : estradio pg/ml

if <10 = needs AI

40
Q

MI: goal T if hypo-hypo

A

400-900ng/dl
check q 1-2 months x 3-4 months

41
Q

MI: hypo-hypo tx

A

pre-pubertal na walang pake sa spermatogenesis: give T or HCG alone to induce secondary sex characteristics

if post puberty/adult: give 2500-5000IU HCG

if not working: give HCG + 75-150 IU HMG/FSH

42
Q

MOA infertility endomet according to CPG (6)

A

abnormal folliculogenesis
elevated oxidative stress
altered immune action
altered hormonal milieu in follicular and peritoneal fluid
reduced EM receptivitiy

all these lead to:

poor oocyte quality
impaired fertilization and implantation

43
Q

MOA infertility adeno according to CPG (4)

A

aberrant uterine contractility, hindering immediate and continuous sperm transport &
embryonic implantation

dec endometrial activity

inc expression of endometrial cytokines and growth factirs

increased expression of CYP450+ aromatase –> local conversion of androgen to estrogen

44
Q

MOA infertility polyp from CPG (5)

A

mechanical interference with sperm transport

anatomical interference with implantation

inc production of inhibitor factors (glycodelin)

reduced secretion of implantation factors (IGFBP-1, TNF-a, osteopontin)

unresponsiveness to cyclical hormonal changes

45
Q

septum outcomes in pregnancy

A

malpresentation
IUGR
abruptio
perinatal mortality

46
Q

MOA alcoholism in MI

A

inc intake > dec FSH and LH > inc testicular damage > dec testosterone/sex hormones > dec secondary sexual characteristics + erectile dysfunction + infertility

47
Q

lower pregnancy rate and implantation rate seen with women who have

A

hydrosalpinges

48
Q

when to do endocrine evaluation in male (3)

A

oligo <10M/ml

sexual dysfunction

clinical findings of endocrinopathy

49
Q

what to do if severe oligo <5M/ml

A

1) karyotyping
2) screen for y chromosome microdeletions
3) check estrogen (elevated), T (decreased), and gonadotropins (N) = may benefit from aromatase inhibitors

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