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OB > Infertility > Flashcards

Infertility Flashcards

1
Q

subfertility

A

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

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2
Q

primary infertility

A

those couples who have never conceived

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3
Q

secondary infertility

A

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

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4
Q

sterility

A

intrinsic inability to achieve pregnancy, few pts are truly sterile

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5
Q

fecundity

A

probability of achieving live birth in 1 menstrual cycle

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6
Q

fecundability

A

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

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7
Q

male eval

A

semen analysis- checks sperm count, motility, morphology

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

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8
Q

spematogenesis takes how many days

A

74

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9
Q

Collecting semen

A

abstain from sex for 2-3 days before

get to lab w/in 1 hr

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10
Q

Further male tests

A

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)

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11
Q

Sims-Huhner test

A

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

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12
Q

female eval & ovulatory factors

A

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

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13
Q

mittelschmerz

A

bleeding into abdominal cavity from ruptured follicle causes irritation

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14
Q

CL secretes

A

estrogen
progesterone
androgens
& requires continued LH secretion to function

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15
Q

progesterone & estrogen peak

A

middle of luteal phase

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16
Q

increased estrogen & progesterone inhibit

A

FSH & LH from pituitary

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17
Q

CL during pregnancy

A

persists supported by hCG

estrogen & pregest levels maintained= no menses

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18
Q

CL & menstruation

A

CL degenerates to fibrous corpus albicans & estrogen & progest fail

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19
Q

menstrual phase

A

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

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20
Q

proliferative phase

A

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

21
Q

secretory phase

A

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

22
Q

Postaglandins found in secretory endometrium produce…

A

vasospasm

23
Q

max potential for oocyte fertilization occurs for how long

A

12-24 hrs

24
Q

max potential for sperm fertilization is

A

3 days

25
Q

most fertile days are_____days prior to ovulation

A

3 days= 20% chance

day of= 15% chance

26
Q

how long after LH surge does ovulation occur

A

24-36 hrs

27
Q

cervical mucous changes during ovulation

A

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

28
Q

Temp change when measuring BBT

A

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

29
Q

hypogonadotropic hypogonadal anovulation (5-10%)

A

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

30
Q

normogonadotropic normoestrogenic anovulation (70-85%)

A

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

31
Q

hypergonadotropic hypoestorgenic anovulation (10-30%)

A

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

32
Q

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

A

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)

33
Q

CCCT

A

100mg clomid on cycle day 5-9, measure FSH levels day 3 & 10

an abnormal result w/ either test virtually confirms tx failure

34
Q

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

A

progesterone challenge test

testosterone level, DHEA-S

35
Q

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

A

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

36
Q

Progesterone challenge test

A

10 mg PO x5 days

bleeding a week after indicates sufficient estrogen & patent outflow tract

37
Q

Pelvic factors that may cause infertility

A

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

38
Q

DES

A

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

39
Q

hystero-salpingogram (HSG)

A

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

40
Q

chlamydia antibodies

A

simple inexpensive test that can predict the presence of tubal dz

41
Q

unexplained infertility

A

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

42
Q

varicocele & infertility

A

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

43
Q

you can use what to tx sperm autoantibodies

A

steroids

44
Q

ICSI

A

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

45
Q

female therapies

A 
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
46
Q

Clomid

A

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

47
Q

Aromatase inhibitors

A

decrease estradiol levels

48
Q

laparoscopic ovarian diathermy

A

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

49
Q

bromocriptine or other DA agonist

A

elevated PRL results in decreased estradiol & anovulation

OB (13 decks)

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