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Summer 15 - Women's Health > Infertility > Flashcards

Infertility Flashcards

1
Q

Define infertility.

A

no pregnancy after 1 year of frequent unprotected sex

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2
Q

What are possible causes of infertility?

A
  • delayed childbearing (incidence increases w/ age)
  • environmental/occupational exposures
  • increased incidence of STIs, PID
  • genital tract problems like endometriosis
  • lack of successful sexual interactions
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3
Q

When should infertility evaluation be done?

A

after 1 year of failure to conceive OR in the case of:

  • age > 35
  • male factor infertility
  • previous infx, dz, or surgery (PID, endometriosis)
  • DES exposure in utero
  • previous infertility work-up, now wanting 2nd pg
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4
Q

What HPI is important to collect?

A
  • female: duration of time w/o conception, efforts to obtain pregnancy (frequency and timing of sex, correlation w/ ovulation, contraceptives)
  • male: prior fertility
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5
Q

What GYN/OB or sexual hx is important to collect?

A
  • female: previous pg, menstrual cycle patterns, puberty and menarche, prior STIs
  • male: libido and prior STIs
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6
Q

What PMH is important to collect?

A
  • female: Rx, OTC, herbal meds, gyn/abd surgery, h/o endocrine disorders
  • male: genital surgery/trauma/infx, medications
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7
Q

What SH is important to collect?

A
  • female: exercise, diet, sleep, tobacco, EtOH, work, stress

- male: tobacco, EtOH, vitamin C, hot tub, baths, constricting underwear, stress, too frequent ejaculation

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8
Q

What FH is important to collect?

A

-female: DES usage or exposure, hx of multiple abortions

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9
Q

What ROS is important to note?

A
  • female: excessive hair growth, breast d/c, weight change

- male: chronic fatigue

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10
Q

What are possible findings on female physical exam?

A
  • adequacy of body weight (more problems BMI 27)
  • acne, oily skin, hirsutism
  • thyroid enlargement
  • galactorrhea
  • abdominal striae
  • cervix, uterus and adnexa for masses, tenderness
  • presence of pink, moist rugated vaginal mucosa
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11
Q

What are possible findings on male physical exam?

A
  • degree of secondary sexual development
  • gynecomastia
  • GU: hypospadias, cryptorchidism, varicocele, hydrocele
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12
Q

What methods can be used to prove ovulation?

A
  1. history: regular, cyclic, predictable menses
  2. ovulation predictor kits (test in AM)
  3. basal body temp: core body temp taken before rising in AM
  4. serum progesterone: >3 ng/mL evidence of recent ovulation
  5. progesterone challenge: bleeding w/in 1 wk of stopping progesterone
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13
Q

Semen Analysis - What are normal values for the following:

  • volume
  • pH
  • sperm concentration
  • motility
  • morphology
  • WBCs
A
  • volume: > 1.5 mL
  • pH: > 7.2
  • sperm concentration: > 15 million/mL
  • motility: 40%, 32% with rapid forward progress
  • morphology: normal > 4%
  • WBCs:
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14
Q

What lab tests should be done in infertility work-up to R/O other problems?

A

-STI screen
-UPT
-TSH
-prolactin (assess pituitary fx)
+/- LH and FSH to assess ovary and feedback loop

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15
Q

Why would a pelvic US be done in infertility work-up?

A

-rule out anatomic abnormality: fibroids, ovarian cysts, endometrial lining

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16
Q

What is a HSG test?

A
  • tests patency of uterine and fallopian structures

- radiopaque dye injected into uterus under fluoroscopy; normal test will show filling of uterus and tubes with dye

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17
Q

Why would a laparoscopy be used in infertility work-up?

A

-identify adhesions, endometriosis, structural problems

18
Q

How is endometrial biopsy used?

A
  • histological criteria are used to date the endometrium within the cycle
  • endometrium that lags behind cycle indicates luteal insufficiency
  • does not distinguish fertile/infertile
19
Q

What does the postcoital/Huhner’s test do?

A

-test quality and receptiveness of ovulatory cervical mucus and sperm tolerance

20
Q

What is clomid (clomiphene citrate) and how does it work?

A
  • antiestrogenic drug

- increases FH and LSH, which promotes maturation and release of egg (ovulation)

21
Q

Clomid Dosage

A

50 mg PO qd x5 days

22
Q

How does human chorionic gonadotropin work?

A
  • given IM when follicles reach appropriate size for ovulation
  • hCG mimics LH surge and causes egg release
23
Q

How does progesterone work?

A

-indicates to endometrial lining to stop growth and prepare for implantation

24
Q

Psychosocial Needs of Couple for Infertility

A
  • counseling
  • financial
  • adoption
  • miscarriage/stillbirth support
25
Q

What is intrauterine insemination?

A
  • collect semen

- sperm is washed and placed in uterus via catheter

26
Q

What are the indications for intrauterine insemination?

A
  • male factor
  • cervical factor
  • unspecified infertility
27
Q

What is in vitro fertilization?

A

-eggs fertilized in vitro with embryos transferred to the uterine fundus

28
Q

What is GIFT (gamete intra-fallopian transfer)?

A
  • placement of both egg and sperm in uterine tube by laparoscopy
  • more invasive than IVF
29
Q

When is GIFT not indicated?

A
  • women with tubal dz

- male factor infertility

30
Q

What is TET (tubal embryo transfer) or ZIFT (zygote intra-fallopian transfer)?

A

-in vitro fertilization of embryo via laparoscopy

31
Q

What are causes of cervical factor infertility?

A
  • infections
  • cervical mucus
  • hostility toward sperm
32
Q

What are management options for cervical factor infertility?

A
  • treat infection
  • timing of sex
  • IVF
  • anti-sperm antibody
  • conjugated estrogens for inadequate mucus
33
Q

What are causes of uterine or tubal factor infertility?

A
  • congenital: physical malformation, genetic abnormality, DES exposure in utero
  • acquired: endometritis, endometriosis, fibroids/polpys
34
Q

What are the management options for uterine/tubal factor infertility?

A

-surgical correction if possible

35
Q

What are causes of endometrial factor infertility?

A
  • endometritis
  • menstrual cycle irregularities
  • trauma
36
Q

What are the management options for endometrial factor infertility?

A
  • treat infx
  • surgical
  • medication
37
Q

What are causes of peritoneal factor infertility?

A
  • endometriosis
  • adhesions
  • distal tubal occlusions
  • ovarian cysts
38
Q

What are the management options for peritoneal factor infertility?

A

-surgical correction if possible

39
Q

What are the causes of ovarian/ovulatory factor infertility?

A
  • PCOS
  • weight extremes
  • hypothalamic
  • hypo/hyperthyroidism
  • hyperprolactinemia (lactation, tumor, dopamine blocking drugs
40
Q

What are the management options for ovarian/ovulatory factor infertility?

A
  • mainly pharmacologic
  • clomiphene citrate (Clomid)
  • menotrophins (hCG)
  • metformine/thiazolidinediones (can try for pts with PCOS)
41
Q

What are causes of male factor infertility?

A
  • varicocele
  • azoospermia (no sperm detected)
  • oligospermia (decreased sperm count)
  • testicular temp
  • trauma
42
Q

What are the management options for male factor infertility?

A
  • azoospermia is untreatable
  • surgical correction if indicated
  • lifestyle mods (boxer underwear)

Summer 15 - Women's Health (7 decks)

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