Infertility

Question 1

subfertility

Answer 1

inability of a couple to conceive, usually w/in 1 yr of unprotected intercourse

Question 2

primary infertility

Answer 2

those couples who have never conceived

Question 3

secondary infertility

Answer 3

couples who conceived at some time in their past- individually or together

Question 4

sterility

Answer 4

intrinsic inability to achieve pregnancy, few pts are truly sterile

Question 5

fecundity

Answer 5

probability of achieving live birth in 1 menstrual cycle

Question 6

fecundability

Answer 6

likelihood of conception per month of exposure;
best perception of fertility of a given woman or couple
20% chance of conception/ month

Question 7

male eval

Answer 7

semen analysis- checks sperm count, motility, morphology

if initial tests of both partners fail to reveal cause, further male tests needed

Question 8

spematogenesis takes how many days

Answer 8

74

Question 9

Collecting semen

Answer 9

abstain from sex for 2-3 days before

get to lab w/in 1 hr

Question 10

Further male tests

Answer 10

male autoantibodies
sperm penetration assay
more sophisticated semen analysis
men with less than 5 million sperm need an endocrine eval (FSH, LH, testosterone, genetic karyotype)

Question 11

Sims-Huhner test

Answer 11

postcoital exam/ mucous study
determines # of active sperm in cervical mucous & length of survival in hrs
value of test never proven; some say no effect on pregnancy rate
analyzes for spinnbarkheit & sperm motility
not really used much anymore

Question 12

female eval & ovulatory factors

Answer 12

women who menstruate every 25-35 days & experience moliminal sx’s (breast tenderness, etc) do not req. lab confirmation of ovulation
if h/o abnormal cycles/ reg. cycles w/o menstrual sx’s then check for ovulation

Question 13

mittelschmerz

Answer 13

bleeding into abdominal cavity from ruptured follicle causes irritation

Question 14

CL secretes

Answer 14

estrogen
progesterone
androgens
& requires continued LH secretion to function

Question 15

progesterone & estrogen peak

Answer 15

middle of luteal phase

Question 16

increased estrogen & progesterone inhibit

Answer 16

FSH & LH from pituitary

Question 17

CL during pregnancy

Answer 17

persists supported by hCG

estrogen & pregest levels maintained= no menses

Question 18

CL & menstruation

Answer 18

CL degenerates to fibrous corpus albicans & estrogen & progest fail

Question 19

menstrual phase

Answer 19

lining sloughs days 1-5 secondary to decreased estrogen & progest as CL degenerates

Question 20

proliferative phase

Answer 20

stimulated by follicular phase estrogen secretion, lining renews & begins glycogen storage days 6-13

Question 21

secretory phase

Answer 21

days 14-28, stimulated by luteal phase progest & continued estrogen secretion
glycogen storage increases
vascular & glandular changes support implantation

Question 22

Postaglandins found in secretory endometrium produce…

Answer 22

vasospasm

Question 23

max potential for oocyte fertilization occurs for how long

Answer 23

12-24 hrs

Question 24

max potential for sperm fertilization is

Answer 24

3 days

Question 25

most fertile days are_____days prior to ovulation

Answer 25

3 days= 20% chance | day of= 15% chance

Question 26

how long after LH surge does ovulation occur

Answer 26

24-36 hrs

Question 27

cervical mucous changes during ovulation

Answer 27

slippery, stretchy (spinbarkheit), clear w/ ferning changes w/in 48 hrs of ovulation to thick, tacky, cellular w/ loss of ferning

Question 28

Temp change when measuring BBT

Answer 28

.5 F rise about 1 day after ovulation that lasts about 10 days 2/2 thermogenic effects ofprogesterone

Question 29

hypogonadotropic hypogonadal anovulation (5-10%)

Answer 29

includes secondary amenorrhea from wt loss/anorexia, stress, severe exercise regimens, pituitary & hypothalmic d/o's

Question 30

normogonadotropic normoestrogenic anovulation (70-85%)

Answer 30

includes women w/ PCOS & those w/ oligomenorrhea who might ovulate occasionally secrete normal amounts of gonadotropins & estrogen but subnormal FSH during follicular phase; all women experience occasional anovulatory cycles

Question 31

hypergonadotropic hypoestorgenic anovulation (10-30%)

Answer 31

premature ovarian failure, ovarian resistance, gonadal dysgenesis, Turner's syndrome, Swyer's syndrome, hyperprolactinemia may have regular anovulatory cycles, usually have oligomenorrhea or amenorrhea; serum gonadotropin levels usually normal

Question 32

ovarian function eval in women over 35 yo & those at risk of premature ovarian failure

Answer 32

Day 3 FSH & estradiol (high FSH mean decreased ovarian function) Clomiphene citrate challenge test (CCCT) ULS by day 10 day 3 inhibin B (falls in women with decreased ovarian reserve prior to increasing FSH)

Question 33

CCCT

Answer 33

100mg clomid on cycle day 5-9, measure FSH levels day 3 & 10 | an abnormal result w/ either test virtually confirms tx failure

Question 34

ovarian function eval in women w/ amenorrhea &/or androgen excess signs

Answer 34

progesterone challenge test | testosterone level, DHEA-S

Question 35

ovarian function eval in women w/ irregular menses & anovulation or h/o SABs

Answer 35

LH predictor kit midluteal progest level (3rd wk of cycle) PRL, TSH

Question 36

Progesterone challenge test

Answer 36

10 mg PO x5 days | bleeding a week after indicates sufficient estrogen & patent outflow tract

Question 37

Pelvic factors that may cause infertility

Answer 37

abnormal uterus, fallopian tubes or ovaries 2/2 PID, appendicitis, IUD, endometriosis, septic AB, ectopic, fibroids, Asherman's syndrome DES exposure

Question 38

DES

Answer 38

diethylstilbestrol- given to pregnant women from 1948-1971 to tx certain high risk conditions

Question 39

hystero-salpingogram (HSG)

Answer 39

radioactive dye ejected into uterus to observe contours, tubal patency often curative invasive- risk of peritonitis, can give prphylactic doxycycline

Question 40

chlamydia antibodies

Answer 40

simple inexpensive test that can predict the presence of tubal dz

Question 41

unexplained infertility

Answer 41

often d/t combined factors often worst case dx 30-80% will achieve preg in 3 yrs

Question 42

varicocele & infertility

Answer 42

can cause decreased semen quality b/c of elevated scrotal temp "wear boxers"

Question 43

you can use what to tx sperm autoantibodies

Answer 43

steroids

Question 44

ICSI

Answer 44

intracytoplasmic sperm injection insert single sperm into oocyte cytoplasm possible risk of chromosomal abnormalities

Question 45

female therapies

Answer 45

``` wt modulation/ lifestyle modification pulsatile GnRH x 3-6 cycles if all else fails correct endocrine d/o's, iatrogenic causes clomid or other SERM (tamoxifen) gonadotropin therapy aromatase inhibitors laparoscopic ovarian diathermy bromocriptine or other DA agonist ART ```

Question 46

Clomid

Answer 46

clomiphene citrate PO med that competes w/ estrogen receptors as agonist/antagonist in hypothalamus to block estrogenic neg FB effects, thus promoting increased follicular development/ hyperovulation

Question 47

Aromatase inhibitors

Answer 47

decrease estradiol levels

Question 48

laparoscopic ovarian diathermy

Answer 48

induce ovulation by wedge resection & drilling by laser or diathermy reserved for special cases

Question 49

bromocriptine or other DA agonist

Answer 49

elevated PRL results in decreased estradiol & anovulation