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Spring 2014 - OB TEST 7/8 - ADNEXA/INFERTILITY ✔️ > Infertility > Flashcards

Infertility Flashcards

0
Q

Secondary infertility is…

A

Conceived at least once and not again for at least one year

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1
Q

Primary infertility is…

A

Never conceived

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2
Q

Prime causes of infertility from greatest to least…

A 
Unexplained
Sperm problems
Ovulatory failure
Tubal damage
Endometriosis/cervical mucous 
Coital problems
Other
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3
Q

5 steps of conception…

A 
Ovulation
Insemination
Fertilization
Transportation
Implantation
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4
Q

The cervix needs to provide a __________ environment to harbor sperm.

A

Non hostile

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5
Q

In the cervix, the glands need to secrete __________ and crypts need to hold __________.

A

Mucus

Sperm

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6
Q

How is ultrasound used to evaluate the cervix?

A

Cervical length to assess for cervical incompetence

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7
Q

2 main objectives in evaluating the uterus…

A

Assess structural anatomy

Assess endometrium

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8
Q

In evaluating the uterus, assessing for structural anatomy refers to…

A

Evaluating uterine shape (unicollis, bicornuate, etc.)

DES treatments - T shaped uterus

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9
Q

Evaluate the uterus for…

A

Echogenicity

Masses - fibroids

Assess endometrium - thickness, echogenicity, lesions

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10
Q

Why measure the endometrium?

A

Make sure it changes appropriately throughout the menstrual cycle

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11
Q

In the first half of the menstural cycle, mucosa begins to…

A

Proliferate because of increasing estrogen levels

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12
Q

Proliferative endo =

A

Triphasic endo - 3 stripes

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13
Q

After ovulation, what is secreted and by what?

A

Progesterone by the corpus luteum

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14
Q

Secretion of progesterone begins in what phase?

A

Secretory phase of endometrial cycle

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15
Q

What happens to the endometrium during the secretory phase and why? What is lost?

A

Endo becomes thickened and very echogenic as a result of stromal edema

Loss of the triple line sign

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16
Q

How thick does the endometrium have to be to achieve pregnancy?

A

At least 6 mm thick

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17
Q

What happens to the endometrium if not enough progesterone is produced during the luteal phase?

A

A thin endometrial lining by US

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18
Q

Lack of progesterone production is known as?

A

Luteal phase deficiency

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19
Q

Luteal phase deficiency (lack of progesterone) is associated with?

A

Infertility and early pregnancy loss

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20
Q

Why is endometrial appearance important for planning infertility treatments?

A

For embryo transfer

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21
Q

4 things that can make an endometrium irregular…

A

Submucosal fibroids
Polyps
Adhesions
Synechiae - scar tissue from d&c’s

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22
Q

What can be used in situations to further delineate anatomic structures of irregular endometriums?

A

Saline infusion sonography

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23
Q

When evaluating the fallopian tubes what accounts for 50% reduction in pregnancy rate and doubling spontaneous miscarriage rate?

A

Hydrosalpinx

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24
Q

What improves in vitro fertilization success?

A

Tube removal

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25
Q

How is tubal patency assessed?

A

By injecting saline into the tube and looking for spillage of fluid into the cul de sac or around the ovary or by using contrast to evaluate for spillage

26
Q

If spillage is seen from the fallopian tubes, ________ is inferred.

A

Patency

27
Q

If no spillage from the fallopian tubes is noted and patient complains of pain during injection, tube may be _______.

A

Blocked

28
Q

What can obstruct a fallopian tube?

A

Adhesions

29
Q

During follicular phase several antral follicles on the ovary measure?

A

Less than 5 mm

30
Q

What hormone creates the dominant follicle?

A

FSH

31
Q

What is the dominant follicle growth rate?

A

Approximately 1 to 3 mm/day until it reaches 22 mm

32
Q

At what size do the dominant follicles rupture?

A

22 mm

33
Q

Rupture of a follicle is associated with?

A

Increased or decreased size

34
Q

Sonographic ovulation findings?

A

Eh ones within fluid left behind (corpus luteum)

Free fluid in peritoneal cavity

35
Q

Key drugs in ovarian induction therapy?

A 
Clomiphene citrate (clomid) oral
Human menopausal gonadotropins (pergonal) injected
36
Q

Once therapy is started, US is used to monitor the number and size of follicles in what days?

A

8-14 (follicular phase of menstrual cycle)

37
Q

What size follicles get counted by the sonographer after ovarian induction therapy?

A

Greater than 1 cm in long and trans

38
Q

Measurement of an optimal mature follicle?

A

16-20 mm

39
Q

During ovarian induction therapy, what is US correlated with?

A

Serum estradiol levels

40
Q

Why is correct measurement of the follicle important?

A

HCG may need to be given to trigger ovulation - pergonal

41
Q

Monitor endometrium for what 2 things?

A

Thickness 2-3 mm to 12-14 mm

Echogenicity

42
Q

What is OHSS?

A

Syndrome that presents sonographically as enlarged ovaries with multiple cysts, ABD ascites, pleural effusions

If this is seen patient will be removed from meds immediately

43
Q

What is IVF?

A

Method of fertilizing human oocytes outside the body

44
Q

During IVF, what happens to the mature oocytes?

A

They are collected and mixed in a dish with a sample of sperm

Resulting embryos see placed back in the uterus

45
Q

Treatment plan for IVF is…

A 
Ovarian monitoring
Needle aspiration of oocytes
Incubation of oocytes
Fertilization
Transferring embryos into uterus
46
Q

With IVF, how many follicles are evaluated before triggering ovulation?

A

4

47
Q

Oocytes are retrieved with what kind of US guidance?

A

TV’s

48
Q

What is intrauterine insemination?

A

Technique used to treat male factor infertility

Catheter containing sperm placed into uterine fundus

49
Q

What is TDI?

A

Therapeutic donor insemination or artificial insemination

50
Q

What is GIFT?

A

Gamete intrafallopian transfer - sperm and egg injected into the fimbrated end of tube

51
Q

What is ZIFT?

A

Zygote intrfallopian transfer - trans cervical placement of zygote into fallopian tubes

52
Q

Complications of assitive reproductive technology (ART)?

A

OHSS
Ectopic
Multiple gestation

53
Q

Factors of ART?

A 
Central/ovulatory
Male
Cervical
Uterine
Tubal/peritoneal
54
Q

What is an anovulation?

A

Failure of hypothalamus and pituitary to produce hormones stimulating ovulation

55
Q

What happens when ovulation fails?

A

LUF - luteinized unruptured follicle syndrome - enlarges but fails to rupture and release the oocyte

56
Q

Central/ovulatory factors…

A

BEST predictor of ovulation is basal body temperature - spike of .6-.8°

Regular menses does not guarantee ovulation

57
Q

Male factors…

A

Enough sperm to penetrate and fertilize ovum

Sperm count

Sperm motility - #1 test

58
Q

Cervical/mucus factors…

A

Cervical mucus must allow transportation of sperm into uterus

If mucus is poor (high viscosity), it’ll act as a barrier

59
Q

2 types of mucus changes?

A

Pre ovulatory - clear & copious

Post ovulatory - mucus becomes tacky & sparse

60
Q

What checks mucus consistency?

A

Spin barkeit and ferning

61
Q

What evaluated sperm mucus interaction?

A

Post coital test - PCT

62
Q

Endometrial/uterine factors…

A

Fertilized ovum must be able to implant within endometrial lining

Luteal phase inadequacy

63
Q

Tubal/peritoneal factors…

A

Oviducts must allow transport of sperm to ovum

Passage of fertilized ovum to uterus

Adhesions cause issues

Distal fallopian tube - MOST COMMON BLOCKAGE

Laparoscopy - gold star for evaluating

Spring 2014 - OB TEST 7/8 - ADNEXA/INFERTILITY ✔️ (4 decks)

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