Infertility Flashcards

1
Q

Definition

A

Failure to conceive within 12 months given adequate opportunity

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2
Q

Rates of conception at 12 months and 24 month

A

90% at 12 months

95% at 2 years

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3
Q

Female causes

A
1. Amenorrhea/ovulatory dysfunction
Hypothalamus/pituitary
PCOS
Premature ovarian failure
Uterine outflow disorders
2. Tubal defect
3. Endometriosis
4. Other
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4
Q

Male causes

A
  1. Hypogonadism->primary and secondary
  2. Cryptocrchidism
  3. XXY
  4. Disordered sperm transport
  5. GU surgery
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5
Q

History

A
  1. Duration of trying
  2. Frequency of intercourse and technique->coitus every other day mid cycle
  3. Contraceptive history
  4. PID, endometriosis
  5. Age of partners
  6. Menstrual history: premenstrual symptoms, regularity, ovulation pain, vaginal secretions (thin=E, thick=P)
  7. FHx->PCOS, fragile X
  8. PMHx: surgery, infections, pain, liver/renal/heart/thyroid
  9. Pap smears, LLETZ (cervical incompetence)
  10. Medication, alcohol, smoking, drugs
  11. Previous pregnancies->miscarriages
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6
Q

Examination

A
1. General
\++Male pattern hair, acne, obesity, acanthosis nigricanc
Adipose->+adrenal, PCOS, diabetes
Galactorrhea (+prolactin)
Thyroid examination
2. Genital
Pelvic organs->fibroids, cysts, endometriosis, PID
Vagina->structural, muscle spasm
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7
Q

Investigations in women

A
1. Ovulatory
TSH->both hyper/hypothyroid can disrupt ovulation
Prolactin->elevates interferes
Androgens (androgen secreting tumors), sex hormone binding globulin
Day 21 serum Progesterone
LH, FSH->if elevated menopause/resistant ovarian
2. Tubal damage->done by specialist infertility gynaecologist
Sonohysteroscopy
Hysterosalpingogram
Laparoscopy
3. Other
Lipids
Glucose
FBC
VZ, rubella screen
Pelvic USS
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8
Q

PCOS: LH, FSH, SHBG

A
LH day 2-5 cycle
If +LH, normal FSH,
\+testosterone, low SHBG=
PCOS
Early follicular FSH/estradiol
- may respond to IVF
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9
Q

Investigations in men

A
Semen analysis->must not ejaculate for 2 days, semen produced by masturbation, all require (if abnormal) repetition at 3 months (duration of spermatogenesis)
TSH
Prolactin
Karyotype
Lipids
Glucose
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10
Q

Treatment in men

A

Treat hormonal deficiency
Donor insemination
IVF
Intracytoplasmic sperm injection

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11
Q

Management in women

A
  1. Referral to fertility specialists
  2. Clomiphene cutrate->5 days in early proliferative
    Anti-estrogen at pituitary= ++FSH->+follicle growth and ovulation
    70-80% fertility in 12 cycles
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12
Q

Side effects of clomiphene citrate

A
Hot flushes
Nausea
HeadA
\+Menstrual pain
\+Chance of multiple pregnancies
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13
Q

Complication of IVF

A
  1. Perinatal morb/mortality
  2. Multiples
  3. Ovarian hyperstimulation
    Mild= bloating, pain, ascites
    Moderate= distension, NV, ascites, hematology and blood chemistry altered
    Severe= ++Ascites, requiring hospitalisation, pleural effusion, prekidney failure, anuria
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14
Q

Mechanisms of ascites, in ovarian hyperstimulation

A
  1. Ascites
    extravasation and increased leakage of
    protein-rich fluid from the intravascular space into the
    abdominal cavity, owing to an osmolar differential.
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15
Q

Pain and renal impairment in ovarian hyperstimulation

A
1. Pain
Torsion
Hemorrhage
Rupture
2. Renal
Extravasation of fluid
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16
Q

Hypercoagulable in ovarian hyperstimulation

A

Hemoconcentration and hypovolemia from third spacing and fluid shift
Also +estrogen